Overseas delegates were impressed by the quality of the auditorium itself, whilst the catering left nothing to be desired. Indeed, all delegates departed feeling extremely well fed on a diet of high quality food as well as top level science. An interesting start on the Sunday afternnon had all the audience participating in an interactive treatment planning session. Cases were presented and discussed by Dr Viv Ward, Professor Jan Wennstrom and Dr Ken Hemmings under the able chairmanship of President Richard Palmer. The use of this technology enabled the participants to disagree withn the speakers from the comfort of their seat and, if they wished, in total anonimity! However, there was an excellent debate from the floor which provided a very useful insight into the complexities of some of the treatment issues, as well as often pointing to a simple solution. After an evening feasting on the many culinary delights that Birmingham is able to provide, Chairman for the Monday session, Professor Ian Chapple reminded delegates that they should ensure that they do just that and challenged all to sample the local speciality, the Balti, if they could understand the local dialect where this is pronounced 'kooray'! A feast of good science followed, commencing with a thorough look at refractory disease by Professor Ken Kornman from Harvard, USA, who challenged us all to question whether there really is such a being as a 'refractory patient'. He was followed by Professor Jan Wennstrom from Gothenburg who dealt with non-surgical therapy, an old 'chestnut' but with a fresh new emphasis. He reviewed questions of full-mouth versus quadrant approaches to instrumentation, concluding that a full-mouth ultrasonic debridement session could achieve as much as 4 quadrant root planing sessions but was 65% more efficient in doing so. It soon became clear that patient behaviour was going to be a key issue and the next 2 speakers from London dealt with this. Professor Tim Newton spoke about communication and provided models for improving compliance in our patients, whilst Professor Ray Croucher covered similar issues but in relation to smoking cessation. It was pleasing to see this emphasis on the key role of patient behaviour in therapeutic outcomes. The final part of this series of presentations on the refractory or recalcitrant patient was given at the start of the afternoon by Professor Kornman who discussed systemic investigation and management, indicating again the crucial importance of the patient. A fruitful discussion followed. By now, the audience had been well and truly warmed up in readiness for Dr Markus Huerzeler's 2 presentations on periodontal plastic surgery with exciting video sequences of some of the techniques that he is using in Munich, including some novel approaches to tunnel preparations for grafts to permit root surface coverage. The audience were reluctant to leave at the end of the day, even though an excellent dinner was waiting for them that evening. Tuesday started with a key presentation by Professor Paul Sharpe from GKT, London who excited the audience with his work and insight into development of a tertiary dentition. He described his group's study of the genetic mechanisms that detemine the shape, position and size of teeth and showed that essentially this was a simple process with relatively few genes actually determing these factors in the appropriate cells. He showed suitable sources for collection of these cells and that it is feasible that the process of tooth development could be achieved in the adult. A lot of hard work is now in prospect as the laboratory principles are turned into a clinical reality, but surely this can not be far away now. It was perhaps appropraiate to hear this before the next presentations on implants. Dr Hugo de Bruyn from Malmo, Sweden and also Brussels, covered the topic of implant versus tooth in the periodontally suceptible patient. He reviewed a number of studies showing that it is indeed possible to place implants in such patients, but indicated that the answers to this question are far from clear as infection and failure does continue to occur. In particular, it was observed that there was a significantly lower success rate for implants placed in periodontally compromised patients but that this was only really detectable after 5 years. This theme was taken up in a masterful presentation by Professor Maurizio Tonetti from the Eastman in London, who enthralled the audience with his clear understanding. In discussion, he recognised how the pendulum which had been swinging over recent years towards implant-based therapies had swung perhaps too far, and that it was now starting to swing back towards management of the periodontal lesion per se, again with patient-based plaque control at the heart of treatment. After another excellent lunch, Professor Lindon Cooper from the University of North Carolina, USA, described his work in translating an understanding of bone bology and behaviour into improved outcomes for implant therapies. Use of surface midification (amusingly including the BSP gene - bone sialoprotein) could enhance results, but he felt that implants need to be rough right to the top. Attention to such detail produced a number of high quality clinical examples for the audience to view. Finally, Dr Mithridade Davarpanah from Paris took a broad look at the systemic conditions that may adversely affect implant treatment outcomes. It was interesting just how few of the conditions he reviewed, including osteoporosis, cardio-vascular disease and ectodermal dysplasia have any significant effect, whilst it was not surprising to note that smoking and uncontrolled diabetes were of relevance. He concluded with a comment on the beneficial effects of hyperbaric oxygen for patients that had undergone radiotherapy affecting the jaws. The Society's President and Scientific Committee are once again to be applauded for organising such a successful meeting. An excellent balance was achieved in the programme and the speakers all achieved the educational aims set before them. In terms of learning outcomes, participants left with a much clearer understanding of many of the issues involved in the day to day management of periodontal disease in practice, and the event served not just to educate but to inspire and motivate the particpants. Finally, thanks are due to the BSP Administrative Manager, Mrs Anne Hallowes and in particular to The BSP Conference Manager, Mrs Ghilaine Ower for there imense hard work in getting the conference to run so efficiently.