The recent consensus meeting in London a few months ago was interesting. The evidence on treating is as scarce as ever with a limited number of papers out there. What is common is the level of disagreement among the experts on what works. We have treated many cases were there has been crestal loss and in my opinion hard tissue augmentation is unpredictable. Better results where obtained with open flab debridement and yes there are some soft tissue compromise but the tissues are healthy in the intermediate term. Again optimal hygiene is absolutely required.