During the last 10 years the initial concept of osseointegrated implant dentistry as essentially treatment of the heavily resorbed edentulous mandible in older patients has expanded to encompass almost every combination of prosthetic problem. Many factors must be taken into account when planning treatment to ensure a flexible approach which is necessary given the uncertainty in predicting the outcome of difficult cases. The complex, and therefore inherently costly, nature of implant dentistry will inevitably lead the patient to have very high expectations of treatment. It is extremely important for the operator to determine these expectations at an early stage, and if there is any doubt about being able to satisfy them then he or she may be wiser not to proceed (as in all other areas of dentistry, skillful case selection is the key to success). In any event, the patient must be fully appraised of the complications, the potential risks and the benefits of treatment so that they can proceed on the basis of informed consent.