DISCUSSION.
It is widely held that the choice of an augmentation material is an important factor in determining the outcome of a bone augmentation procedure. The last question of this survey invited comments on the survey. Forty-four respondents (16%) who identified themselves as clinicians whose practice is restricted to the restorative phases of implantology stated that the choice of augmentation materials rests solely with those surgeons who insert dental implants. It, therefore, follows that a relatively small number of surgeons decide which materials (and presumably techniques) are chosen for bone augmentation in relation to oral implant procedures. The majority of surgeons participating in this survey preferred to use autogenous bone. DFDB was the second most frequent choice. This survey found that 26.3% of the participants that use autogenous bone as their preferred augmentation material indicated that there was at least one RCT with histological evidence to support its use. At the same time, a large proportion of users (43%) stated that they were uncertain of the evidence available to support the autogenous bone as an augmentation material.
With regard to DFDB, 30.5% of surgeons who favor its use stated there was at least one RCT with histological evidence to support its use. Only a small proportion indicated that they were uncertain of the levels of supporting evidence. The efficacy of DFDB remains disputed. On the one hand it has been reported that it does not contribute to bone healing and that it remains in the tissue as an inert foreign body. On the other hand, it has been reported that implanted DFDB is resorbed by osteoclasts and that new bone is apposed to the material. A wide range of particulate materials is currently available for use in the correction of localized alveolar ridge defects. It is widely accepted that the size and morphology of a bone defect influences the method of augmentation chosen and might affect the implant success rates achieved in grafted sites. However, there seem to be few if any scientific publications that have defined the volume and morphology of bone defects that can be predictably corrected by using specified augmentation materials. With regard to alloplastic and allogenic mate rials, the majority of participants involved in augmentation procedures (51.6%) stated that these materials should only be used for the correction of small bone defects. At the same time, a significant proportion supported the statement that these materials should be used as volume expanders in conjunction with autogenous bone.
Bone collectors are devices that are used to retain the bone debris produced during dental implant surgery or bone surgery. Autogenous bone is widely regarded as the gold standard for bone augmentation. Therefore, the use of collected bone debris might be expected to be widespread. However, 42.3% of the implant surgeons in this survey do not use these devices, perhaps because of concerns that have been raised over the bacterial contamination of bone debris collected in the oral cavity. More recently, both a stringent aspiration protocol and the use of a preoperative chlorhexidine rinse have been shown to significantly reduce the bacterial contaminants in collected bone debris. This survey has established that collected bone debris continues to be used as an immediate autograft to correct dehiscences and fenestrations around dental implants.

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