Editor-in-Chief's note: We asked the authors if they wished to respond to R. Adam's letter, ‘Unscientific statements'. They do so below, pointing out that the context of their article was not a compendium of the evidence, but now including comprehensive references to back their case, which we publish in full in this particular circumstance.

Sir, thank you for the opportunity to respond to the feedback from R. Adams. Unfortunately, R. Adams has completely missed the point of this series of very short articles which are experiential tips, rather than a compendium of the evidence. The authors are fully cognisant of basing opinion on evidence and interestingly R. Adams uses one of the author's systematic reviews in his own self-citation, highlighting the importance of utilising quality evidence in clinical decision making.1

It is stated that ARP has been developed to promote retention of the bone and soft tissue topographical contour, not preservation of the original bone.

ARP includes a range of different techniques, including different surgical approaches, guided bone regeneration (GBR) and socket seal (SS) techniques with various membrane or bone grafting materials. Histologically, socket healing is influenced by the procedural risks and the healing times of examination.2,3,4,5,6,7 Both GBR and SS encourage the induction of new bone formation8 promoting the availability and cellular activity of osteogenic cells,9,10 with different ARP materials having a unique effect on healing.11,12,13,14,15

There are limitations in the evidence base, regarding the direct causality of occlusal overload and implant marginal bone loss, but researchers acknowledge an association.16,17,18,19,20,21 The articles raising an objection to this statement do not present a conflicting view. The review by Naert et al.22was inconclusive, with Afrashtefar23 and Bertolini24only reporting on animal studies and Afrashtefar indicating bias and heterogeneity. The EFP World Workshop25 summarises that the effects of occlusal overloading on stable implants are limited and conflicting.

Whilst intrusion of dental implants into the sinus cavity during maxillary implant placement is common, researchers agree that the survival rate of these implants is high (95.6%). Clinical and radiological complications are reported at 3.4% and 14.8%, respectively.26 To compensate for the lack of maxillary bone height, several bone augmentation or sinus lift techniques have been proposed. Membrane perforations represent the most common complication among these procedures,27,28,29 with sinus infection a known risk outcome. The authors were highlighting this as something general dentists should have some awareness of as a cautionary measure.

Peri-implantitis is a plaque-associated disease characterised by inflammation in the peri-implant mucosa and progressive loss of supporting bone, following initial implant healing.

The definition of peri-implant disease is taken directly from the EFP peri-implantitis classification25,30 and case example. The statement agrees with the definition outlined by the respondent.

The EFP S3 clinical treatment priorities for peri-implantitis patients31 indicate: ‘peri-implantitis therapy starts with a non-surgical step, followed by re-evaluation and, depending on the outcomes, progress to the surgical step or to SPIC'.

Successful treatment of the site requires concurrent plaque control and biofilm disruption, with the BSP and EFP suggesting that both non-surgical and surgical techniques can be beneficial.32

The EFP S3 treatment guidelines outline that surgical pocket elimination, bone recontouring, implantoplasty and regenerative techniques are recommended.33,34,35,36

Evidence suggests the effectiveness of the regenerative treatment approaches is influenced by the configuration of the defect, implant surface characteristics, as well as surface decontamination.33,34