The New Toronto Declaration

Chapter 3: Redefining the outcome

Narrow diameter fixtures are not the solution for thin ridge

The assumption

When faced with a thin ridge, choosing a narrower implant can appear to be the most straightforward solution.

If the implant fits within the available bone, it may seem logical to avoid more extensive surgical intervention.

But fitting the available anatomy does not necessarily mean solving the complete clinical situation.

The question

The Toronto Declaration invites us to reconsider the starting point of this decision:

Is choosing a narrow-diameter implant enough to solve the challenges of a thin ridge?

Or should the treatment decision consider the complete biological, biomechanical and prosthetic environment?

The new perspective

The Declaration encourages clinicians to look beyond implant diameter alone.

The objective is not simply to find an implant that fits within the available space. It is to determine which strategy creates the most favourable conditions for stability, tissue support, restorative possibilities and long-term maintenance.

This may require looking at the ridge, implant design, implant position, surrounding tissues and future restoration as parts of the same treatment decision.

Fitting the ridge is not the same as solving the case.

Why it matters

A solution that appears less invasive or technically simpler at the time of placement should also be considered in the context of the long-term treatment objective.

Implant selection influences more than whether a fixture can physically be placed within the available anatomy.

It becomes part of a broader decision about biological support, mechanical demands, prosthetic possibilities and maintainability over time.

The question therefore moves from:

“Which implant fits?”

to:

“Which treatment strategy creates the most sustainable conditions for this patient?”

Clinical reflection

When treating a thin ridge, what determines your treatment strategy?

Is the decision primarily driven by the amount of available bone and the implant diameter that fits within it?

Or do you first define the biological, mechanical and prosthetic conditions you want to create for the long term?

Watch the film

Discover how the Toronto Declaration challenges the idea that implant diameter alone can solve the complexities of a thin ridge.

▶ Watch the film

Continue the journey

Choosing the right treatment strategy is ultimately about more than successful implant placement.

It leads to an even more fundamental question:

If an implant remains integrated and functional, should that alone be considered a successful treatment?

→ Continue to Principle 12

Implant success should be redefined as zero bone loss

The assumption

Implant success has traditionally been strongly associated with survival.

If an implant remains integrated, stable and functional over time, the treatment may be considered successful.

Survival is undoubtedly important.

But is survival alone still ambitious enough?

The question

The Toronto Declaration raises perhaps one of its most fundamental questions:

Should implant survival remain our primary definition of success?

Or should long-term preservation of the biological environment become part of how we define a successful implant treatment?

The new perspective

The Declaration proposes raising the ambition from implant survival to tissue preservation.

Within this perspective, zero bone loss is not simply an outcome measured at one moment in time. It represents an ambition that encourages us to reconsider decisions throughout the entire treatment journey.

Implant position.
Connection stability.
Soft-tissue support.
Prosthetic design.
Cleanability.
Maintenance.

Each may contribute to the conditions surrounding the implant over time.

Success therefore becomes more than keeping an implant in place.

Survival is the minimum. Tissue preservation is the ambition.

Why it matters

Redefining success changes the perspective from which treatment decisions are made.

Instead of asking whether an implant can survive, clinicians are encouraged to consider how the biological conditions created during treatment can be preserved throughout the lifetime of the restoration.

That connects surgical planning, implant positioning, prosthetic design, soft-tissue management, hygiene and long-term maintenance.

Importantly, within the Toronto Declaration, zero bone loss should be understood as a clinical ambition and direction of thinking rather than a universal guarantee or fixed outcome for every patient.

The principle is powerful precisely because it raises the question of whether our definition of success can become more demanding.

Clinical reflection

How do you define a successful implant treatment in your own practice?

Is survival the endpoint?

Or do you evaluate success by asking how much of the original biological situation has been preserved over time?

And if tissue preservation becomes the ambition, which decisions in your current treatment workflow might deserve another look?

Watch the film

Discover how the Toronto Declaration challenges the traditional definition of implant success and explores long-term tissue preservation as a higher clinical ambition.

▶ Watch the film