In principle, only patients with an ASA (American Society of Anaesthesiologists)-score I or II qualify for an elective surgical procedure, such as an implantation treatment. Surgical risks are weighed against the potential benefits offered by oral implants. Counter-indications to implant rehabilitation include recent myocardial infarction and cerebrovascular accident, immunosuppression, active treatment of malignancy, drug abuse, as well as long-standing intravenous bisphosphonate use. In the case of patients with an endocarditis risk, and also in the case of patients with an orthopedic prosthesis, implants should be placed with some reluctance. If the decision is made for treatment, then consultation with the treating specialist is recommended. Beside absolute counter-indications, there are also conditions which compromise the success of an implant treatment, such as radiation of the jaw or long-term smoking. Concerning the effect which medical conditions have on the life-expectancy of the implant, little is known. There appear to be few existing factors which actually have a negative influence on the chance that an implant will survive.

At the present time, treatment of the extremely atrophic mandible consists largerly of the insertion of endosseous implants, which provide retention and stability to fixed or removable dentures. In some cases the insertion of short implants, without surgical pretreatment, in the interforaminal area of the mandible is possible. If the bone volume is considered to be insufficient there are several techniques and materials to augment the extremely atrophic mandible, making the insertion of longer implants possible. Dilemmas in the surgical treatment of the extremely atropfic mandible are whether endosseous implants should be employed, whether the mandible needs te be augmented and which technique should be chosen. An insufficient number of copmarable clinical studies have been published to justify identifying any one method of treatment as the preferable on. The innovations in imaging techniques and the accompanying software will lead to advances in surgical treatment. The precise placement of implants will as a result become more exact, thereby possibly avoiding augmentation procedures and so diminishing complication and morbidity rates.

Limited alveolar bone height prevents the placement of dental implants. Sinus floor elevation is an internal augmentation of the maxillary sinus that allows implants to be placed. The principle of this surgical procedure is the preparation of a ‘top hinge door’, that is raised together with the Schneiderian membrane in the cranial direction. The space which created under this lid is filled with a bone transplant. Autogenous bone is the standard transplant material, despite the fact that a second surgery site is necessary. Under certain circumstances bone substitutes can be used, with a longer healing phase. If sufficient alveolar bone height is available to secure implant stability, simultaneous implantation and sinus floor elevation are possible. Considering the significant anatomical variation in the region of the maxillary sinus, a sound knowledge of the anatomy is of great importance.

In cases of oral cavity cancer a reliable diagnostic technique is needed to detect occult regional lymph node metastases and to avoid futile elective neck dissections as well as undertreatment. The first studies revealed a sensitivity of 94%. However, the sentinel node procedure is not yet a routinely performed procedure in oral cancer.