J Clin Periodontol 2013; 40: 645651 doi: 10.1111/jcpe.

12101

A comparison of teeth and ystein Fardal1 and Jostein Grytten2

1
2
Private practice, Egersund, Norway;
Institute of Community Dentistry, University

implants during maintenance of Oslo, Blindern, Oslo, Norway

therapy in terms of the number

of disease-free years and costs -
an in vivo internal control study
Fardal , Grytten J. A comparison of teeth and implants during maintenance
therapy in terms of the number of disease-free years and costs an in vivo internal
control study. J Clin Periodontol 2013; 40: 645651. doi: 10.1111/jcpe.12101.

Abstract
Background: Little is known about the cost minimization and cost effectiveness
involved in maintaining teeth and implants for patients treated for periodontal disease.
Materials & Methods: A retrospective study was carried out encompassing all
patients who had initial periodontal treatment followed by implant placement
and maintenance therapy in a specialist practice in Norway. The neighbouring
tooth and the contra-lateral tooth were used as controls. The number of disease-
free years and the extra cost over and above maintenance treatment for both
teeth and implants were recorded.
Results: The sample consisted of 43 patients with an average age of 67.4 years.
The patients had 847 teeth at the initial examination and received 119 implants.
Two implants were removed 13 and 22 years after insertion. The prevalence of
peri-implantitis was 53.5% at the patient level and 31.1% at the implant level.
The prevalence of periodontitis was 53.4% at the patient level and 7.6% at the
tooth level. The mean number of disease-free years was: implants: 8.66; neigh-
bouring tooth: 9.08; contra-lateral teeth: 9.93. These mean values were not statis- View the pubcast on this paper at http://
tically significantly different from each other. The extra cost of maintaining the www.scivee.tv/node/57787
implants was about five times higher for implants than for teeth.
Key words: cost effectiveness; cost
Conclusion: The number of disease-free years was the same for neighbouring minimization; implants; maintenance; peri-
teeth, contra-lateral teeth and implants. However, due to the high prevalence of implantitis; periodontal disease; re-treatment
peri-implantitis, the cost of maintaining implants was much higher than the cost
of maintaining teeth. Accepted for publication 25 February 2013

Periodontal treatment followed by shown to be successful in keeping the
long-term maintenance has been majority of patients teeth (Hirschfeld
& Wasserman 1978, Fardal et al.
2004, Fardal & Linden 2008). Main-
Conflict of interest and source of tenance often involves considerable
funding statement: re-treatment and extra cost (Fardal &
The authors declare that they do not Linden 2005, Fardal et al. 2012). A
have any conflict of interest.
number of studies have reported
The study is self funded by the
fairly high prevalence levels of peri-
authors.
implantitis of 7.8%43.3% (Bergl-
2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
undh et al. 2002, Ferreira et al. 2006,
Roos-Jans
aker et al. 2006, Zitzmann
& Berglundh 2008, Koldsland et al.
2010, Mir-Mari et al. 2012).
A major article estimating cost of
periodontal disease control was pub-
lished by Antczak- Bouckoms &
Weinstein (1987). They introduced
cost effectiveness, decision-making
analysis and utility analysis. In addi-
645
646 Fardal and Grytten
tion, quality-adjusted tooth years
(QUATY) was adapted from qual-
ity-adjusted life years (QUALY)
(Broom 1993). For a number of
years there were few studies that
addressed the economic aspects of
periodontal disease. Recently, a
review article by Gjermo & Grytten
(2009) concluded that there was a
lack of quality studies of the eco-
nomic aspects of periodontal ther-
apy. Since then, cost effectiveness of
adjunctive antimicrobials (Heasman
et al. 2010), regenerative devices
(Listl et al. 2010), sinus lift opera-
tions for implant placement (Listl &
Faggion, 2010), supportive periodon-
tal care (Pennington et al. 2011) and
oral health educational programmes
(Jonsson et al. 2012) have been
investigated. In addition, a review
article re-examining the cost of peri-
odontal treatment has been pub-
lished (Listl & Birch 2013).
However, little is known about
the efforts and cost of maintaining
dental implants in patients treated
for periodontitis. A recent European
Workshop on implant therapy, con-
cluded that there were few studies
on the pathogenesis and treatment
of peri-implantitis. Only 6.4% of 982
studies addressed the issue, and only
two studies that fulfilled the inclu-
sion criteria were carried out on
humans (Vignoletti & Abrahamsson
2012). In a review article it is
pointed out that the following needs
to be improved: the quality of
reporting, case definitions and
methods used to study incidence,
prevalence and risk factors of peri-
implant diseases (Tomasi & Derks
2012).
Few, if any, studies have
addressed the cost effectiveness of
implant therapy for patients treated
Table 1. Description of the patient population
Variable
Baseline values
Number of teeth per patient
Number of implants per patient
Age
Proportion of patients who smoked
Number of cigarettes smoked per day per patient who smoked
Proportion of patients on medication
Changes during the observation period
Number of teeth lost per patient
Number of implants lost per patient
for periodontitis. However, a recent
study related patients direct life cost
to implant and prosthetic replace-
ments (Fardal et al. 2012). The aim
of this article was to compare teeth
and implants during maintenance
therapy in terms of the number of
disease-free years and costs as part
of a quality control measure.
Materials and Methods
Setting and study population
The patients were from one specialist
practice in south-west Norway. The
practice receives referrals from gen-
eral dental practitioners, community
dentists and physicians in rural com-
munities with a total population of
2530,000. The area has approxi-
mately 25 dentists divided evenly
between private practice and the
community dental service. The inves-
tigator is a specialist in periodontol-
ogy, is the only periodontal specialist
in the area and works in two practice
locations (Egersund and Flekkefj-
ord). Data from this practice have
been used in several studies in which
the progress of periodontitis has been
described, and the effect of different
types of periodontal treatment has
been investigated (for example see:
Fardal et al. 2003, 2004, Fardal &
Linden 2008, 2010, Fardal 2006).
Our sample consisted of patients
treated for periodontal disease in this
practice between 1986 and 2012, and
who had received one or several
implants either after completion of
initial periodontal therapy or during
the maintenance phase. All the
implants replaced teeth lost due to
periodontal disease. The implants
were restored with either single
crowns, implant-supported bridges or
Mean/
proportion
19.7
2.8
51
0.63
15.9
0.32
4.0
0.046
2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
a combination of teeth and implant-
supported bridges. To obtain an
adequately long observation time, we
chose only to include patients with
implants that had been in place for
7 years or longer. Our sample
consisted of 43 patients. The analyses
were also carried out on a sample
with patients for whom the observa-
tion period was both longer and
shorter than 7 years. This did not
influence the conclusions. Table 1
presents characteristics of the
patients.
Treatment prior to implant placement
All the patients completed a similar
course of periodontal treatment,
which included non-surgical therapy
and surgical intervention when
appropriate. Initial therapy included
oral hygiene instruction, scaling and
root planing using standard curettes.
In the initial phase, scaling and root
planing were completed without the
use of local anaesthesia. The whole
mouth was treated over a series of
visits at 24 week intervals. Oral
hygiene was reinforced repeatedly
based on individual needs. The
patients received a detailed explana-
tion of periodontal anatomy and the
disease process involved in periodon-
titis. Special emphasis was placed on
the importance of periodontal main-
tenance therapy, following the initial
definitive therapy. Periodontal sur-
gery was prescribed for patients who
had sites with bleeding on probing
or persistent deep pocketing at
reassessment 6 weeks after comple-
tion of the initial therapy. The
decision to have implant therapy
was taken jointly by the patient, the
referring dentist and the periodontist
(F).
Standard Range Number of
deviation patients
5.5 [732] 43
2.0 [18] 43
10.8 [2974] 43
43
5.9 [530] 27
43
3.7 [016] 43
0.21 [01] 43

Maintenance treatment after the implant
placement
Maintenance visits with the specialist
practitioner alternated with visits to
the general dental practitioner, so
that all patients were seen in total
between two and four times per year.
Written instructions were given both
to the referring dentist and the patient
outlining the plans for maintenance
therapy. During each maintenance
visit to the specialist, scaling, root
planing and polishing of teeth and
implants was routinely performed
according to the needs of each
patient. The interval between recall
visits was shortened or lengthened as
appropriate according to the stability
of the periodontal/peri-implant
condition.
During the maintenance period,
sites with increasing probing depth
were treated with repeated scaling
and root planing. Subsequently, if
there were clinical signs of residual
subgingival calculus or persistent
inflammation, surgical intervention
was performed on teeth and/or
implants. Standard flap operations
designed to access diseased root/
implant surfaces for cleaning/irriga-
tions were used. No attempts were
made to regenerate lost tissue. In
addition, systemic or topical antibi-
otic therapy was used in cases of
acute exacerbation of periodontal/
peri-implant disease.
Outcome variables and analyses
Number of disease-free years
On the basis of patient records from
2012, we identified all the patients
with implants that had been in
place for 7 years or more. We also
identified patients who had had
peri-implantitis that had required
comprehensive treatment. For these
patients, we registered the number of
years the implant had been in place
before treatment for peri-implantitis
was required. The diagnosis of peri-
implantitis was based on the follow-
ing criteria: radiographic proximal
bone loss of at least three threads
when compared with bone levels
1 year after loading in addition to the
presence of bleeding and suppuration.
We calculated the sum for the
number of disease-free years for all
the patients implants, and divided
this sum by the number of patients.
2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Comparing maintenance of teeth with implants
Our outcome measure was then the
mean number of disease-free years
per implant per patient. We then cal-
culated the 95% confidence interval
for this mean.
We repeated the same calculation,
including the calculation of a 95%
confidence interval, for the implants
neighbouring tooth and the contra-
lateral tooth. The baseline was the
year the implant was inserted. In this
way, the number of disease-free
years for the implant, the neighbour-
ing tooth and the contra-lateral
tooth was measured from the same
starting point. It was assumed and
verified from the patient records that
periodontal condition was stable
around the neighbouring tooth and
the contra-lateral tooth at the time
the implant was inserted. Implants
and teeth could then be compared
using the time when implants were
inserted as the baseline. If the confi-
dence intervals for the implant, the
neighbouring tooth and the contra-
lateral tooth overlapped, the suscep-
tibility to recurrence of periodontitis
and peri-implantitis would be the
same for the implant and the control
teeth.
In the analyses, we did not
include control variables for the
patient or the dentist. The compari-
son between the number of disease-
free years was done for the implant
and the control teeth for the same
patient. In this way, we automati-
cally control for all patient-specific
characteristics. Also, it was not
necessary to control for specific
characteristics of the dentist, as all
the periodontal treatment and
implant treatment was carried out
by the same clinician (F).
Cost of treatment
In the case of comprehensive treat-
ment of periodontitis and peri-im-
plantitis, we calculated the cost of
treatment of the teeth and the
implants separately. The cost was
based on the same hourly rate of
non-surgical and surgical fees for
both implants and teeth (for further
details about how the specialist ser-
vices for periodontists in Norway
are organized and financed see
Grytten & Skau 2009). The actual
cost per implant was then the total
cost of treatment of peri-implantitis
divided by the number of implants.
Correspondingly, the actual cost per
647
tooth was the total cost of re-treat-
ment of periodontitis divided by the
number of teeth. To adjust for the
variation in time from when the
patient completed his or her initial
treatment to the time when the
patient was re-treated, the cost per
implant/tooth were calculated per
year. The total costs were calculated
based on the fees the patients paid
the periodontal specialist for treat-
ment and the cost for antibiotics has
been included.
Results
Description of the patient population
Table 1 shows descriptive statistics
for the patient population. There
were 18 male patients and 25 female
patients. The mean age at baseline
was 51 years. The oldest patient who
received an implant was 74 years,
the youngest was 29 years. 53.1% of
the patients got peri-implantitis asso-
ciated with one or several implants.
53.4% of the patients got periodonti-
tis associated with one or more
teeth.
Altogether, 119 implants were
inserted for 43 patients: 2.8 implants
per patient. 16 patients received only
one implant, while one patient
received eight implants. Peri-implan-
titis occurred with 37 of the 119
implants: 31.1% of all implants.
Two implants were removed, one
after 13 years and the other after
22 years. There were no differences
in the rate of peri-implantits between
patients with single or multiple
implants.
The numbers of patients (in
brackets) according to type of
implant were: Nobelbiocare TiU
(29), Osseotite 3i (8), Strauman (4),
Screw-Vent (2). The majority of
implants were placed in the anterior
region between the second pre-
molars. There were 12 patients with
single crowns, and seven patients
with implant bridges. 24 patients
had a combination of bridges with
teeth and implants. Seven out of the
twelve single implant crowns (58%)
developed peri-implantitis, while five
out of the seven implant bridges
(71%) and twelve out of 24
combined implant/teeth bridges
(50%) developed peri-implantitis.
Altogether, the 43 patients had
847 teeth at the initial examination:
648 Fardal and Grytten
19.7 teeth per patient. None of the
patients had less than seven teeth.
Periodontal disease developed round
64 of the 847 teeth that were present
at the initial examination, and had
to be treated, i.e. 7.6% of all teeth.
The mean number of teeth that were
lost during the observation period
was 4.0.
At baseline 27 patients smoked.
They smoked on average 15.9 ciga-
rettes per day. There were no differ-
ences in the level of peri-implantitis
between smokers and non-smokers (8
of 16 non-smokers developed peri-im-
plantitis). 14 patients were taking
medication, mainly for cardiovascular
diseases.
Main results
For 37 of the patients it was possible
to compare neighbouring teeth with
the implants. The mean number of
disease-free years was 8.66 for the
implants and 9.08 for the neighbour-
ing teeth. The confidence intervals for
these two means overlapped
(Table 2).
Twenty-nine patients had contra-
lateral teeth that could be compared
with the implants. The mean number
of disease-free years was 8.66 for the
implants and 9.93 for the contra-lat-
eral teeth. These confidence intervals
also overlapped (Table 2).
In Tables 34 we present addi-
tional analyses for smokers versus
non-smokers, and for patients with
single implant restorations versus
patients with multiple implant resto-
rations. Table 3 shows a slightly bet-
ter disease-free period for smokers
than non-smokers. However, this is
an unusual finding. For all subsam-
ples, the confidence intervals for the
mean number of disease-free years
per implant/tooth overlapped. In
addition, the sample is too small to
investigate this further. Table 4
shows that all the confidence inter-
vals for patients with one implant
Table 2. The number of disease-free years for the implant, the neighbouring tooth and the contra-lateral tooth
Type of comparison The mean number of disease-free years per implant/tooth
Implant
Versus
Neighbouring tooth
Implant
Versus
Contra-lateral tooth
versus patients with more than one
implant overlapped.
The total cost of treatment of
peri-implantitis was 13,100 (non-
surgical 5100 and surgical 8000).
The mean cost per implant for the
whole observation period was 110.
After adjusting for the number of
years the implants had been in place,
the cost was 10.2 per implant per
year (Table 5).
The total cost of re-treatment of
teeth was 29,450 (non-surgical
6450 and surgical treatment
23,000). The mean cost per tooth for
the whole observation period was
35. After adjusting for the observa-
tion time, the cost was 2.1 per
tooth per year (Table 5).
There were no differences in the
cost of maintaining the implants
compared with neighbouring or con-
tra-lateral teeth. This follows directly
from Table 2, which shows that
there was no difference in the mean
number of disease-free years per
implant/tooth for implant versus
neighbouring tooth, and for implant
versus contra-lateral tooth.
Discussion
This study was carried out on a sample
of patients who had all been treated
for periodontitis. They had received
one or more implants, and had been
under continual follow-up afterwards.
However, the incidence of recurrent
periodontitis and peri-implantitis was
relatively high, but not markedly dif-
ferent from that reported in other
studies (Berglundh et al. 2002, Fardal
& Linden 2005, Ferreira et al. 2006,
Roos-Jans
aker et al. 2006, Zitzmann
& Berglundh 2008, Koldsland et al.
2010, Mir-Mari et al. 2012).
An important finding was that
the number of disease-free years was
the same for implants and teeth.
This was also the case when the het-
erogeneity in the patient population
was taken into account. None of
95% Confidence interval
8.66
9.08
8.66
9.93
2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
these results for smokers versus non-
smokers, and for patients with one
implant versus patients with more
than one implant were different from
when the analyses were done on the
whole sample. However, the costs
for re-treatment was markedly
higher if implants were inserted com-
pared to if patients kept their own
teeth. This is because there were
more implants with peri-implantitis
than teeth with recurrent periodonti-
tis: when all teeth were compared
with all implants there was a signifi-
cantly lower prevalence of recurrent
periodontitis than that of peri-
implantitis. This is in agreement with
a systematic review reporting better
long-term outcomes for teeth than
for implants (Tomasi et al. 2008).
The underlying assumption for
our analyses is that the risk of peri-
implantits around a fixture which
has been placed where a tooth has
been lost is similar to the risk of
re-emergence of periodontal infec-
tion around a tooth that remains in
situ. This assumption may be ques-
tionable. To our knowledge, there
are no studies where this assumption
has been examined. One strength of
our study is that we use a research
design that takes into account the
possibility that the risk may vary
according to local factors (by com-
paring implant versus neighbouring
tooth), according to site specificity/
tooth morphology (by comparing
implant versus contra-lateral tooth)
and the mouth as a whole (by com-
paring the total number of implants
with the total number of teeth).
However, in spite of these compari-
sons, the clinical conditions may still
be different. Even though teeth were
lost due to periodontal disease, this
does not necessarily imply identical
clinical conditions at implant sites
and sites where teeth could be main-
tained. On the other hand, one
advantage with our study is that we
use three different comparison
Range Number of patients
[7.33, 9.99] [217]
37
[7.96, 10.20] [227]
[7.39, 9.93] [217]
29
[8.49, 11.37] [322]
 Comparing maintenance of teeth with implants 649

Table 3. The number of disease-free years for the implant, the neighbouring tooth and the contra-lateral tooth for smokers and non-smokers
The mean number of disease-free 95% Confidence Number of
Type of comparison years per implant/tooth interval Range patients

Smokers
Implant 9.50 [8.08, 10.90] [417]
Versus 24
Neighbouring tooth 9.75 [8.53, 11.00] [222]
Implant 9.28 [7.69, 10.80] [417]
Versus 18
Contra-lateral tooth 10.61 [8.56, 12.66] [622]
Non-smokers
Implant 7.15 [5.51, 8.79] [212]
Versus 13
Neighbouring tooth 7.84 [6.30, 9.37] [212]
Implant 7.64 [5.63, 9.65] [212]
Versus 11
Contra-lateral tooth 8.82 [7.11, 10.53] [313]

Table 4. The number of disease-free years for the implant, the neighbouring tooth and the contra-lateral tooth for patients with single
implant restoration and for patients with multiple implant restoration
Type of comparison The mean number of disease-free years per implant/tooth 95% Confidence interval Range Number of patients

Single implant restoration

Implant 8.17 [6.28, 10.06] [413]
Versus 12
Neighbouring tooth 8.83 [6.28, 11.38] [217]
Implant 8.17 [6.27, 9.99] [313]
Versus 12
contra-lateral tooth 10.08 [8.03, 12.13] [717]
Multiple implant restorations
Implant 8.92 [7.50, 10.43] [217]
versus 25
neighbouring tooth 9.20 [7.62, 10.78] [222]
Implant 9.00 [7.29, 10.71] [217]
versus 17
contra-lateral tooth 9.82 [7.78, 11.80] [322]

Table 5. Costs for treatment of peri-implantiitis and re-treatment of periodontitis in Euro
Implants (mean) Teeth (mean)
Total costs 13, 100 29, 450
Number of implants/teeth 119 847
Costs per implant/tooth the whole observation period 110 35
Observation period (in years) 10 16
Costs per implant/tooth per year 10.2 2.1
groups, and the results are similar Different types of implant sys-
independent of which group is used. tems were used during the study
In this study, the total failure of period from 1986 to 2012. The
implants was very low in spite of a difference in surface characteristics
high prevalence of peri-implantitis. could have influenced the results in
Only two implants were removed this study as suggested by Renvert
after 13 and 22 years, suggesting et al. (2011). However, as the vast
that a very active maintenance majority of fixtures used were
therapy including surgical treatment Nobelbiocare TiU this study did not
of peri-implantitis was successful in lend itself to a comparison between
maintaining implants previously systems. No apparent differences
exposed to disease. The importance were observed clinically between the
of maintenance therapy for implants systems.
has also been reported previously A relatively high tooth loss rate
(Rocuzzo et al. 2010). from periodontal disease was found
2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
in this population when compared
with previous reports from the same
practice setting (Fardal et al. 2004).
This underlines the fact that the
patients in this study were high-risk
patients with marked loss of peri-
odontal support. In spite of mainte-
nance therapy over a number of
years, these patients lost several teeth.
Some of these teeth were replaced by
implants after a healing period.
It is difficult to verify the results
from this study due to a lack of
comparable studies. Another study
from the same practice setting calcu-
lated direct life-time patient costs for
periodontal treatment (Fardal et al.
2012). However, a number of the
outcomes were extrapolated from
shorter-term studies. Gaunt et al.
(2008) examined the cost of
periodontal maintenance treatment,
however, this study was not done in
real time. The strength of this study
is that it is done in real time with no
650 Fardal and Grytten
extrapolations, the patients served as
their own internal controls and the
same experienced clinician carried
out all the treatment.
In any health economic analysis,
it is important to adhere to underly-
ing welfare economic theories (Vern-
azza et al. 2012). Usually, it is
debatable which tools are best suited
for a particular clinical study. It is
therefore important to examine the
reasons why the specific tools were
chosen for this study. First of all, it
was decided to define the variables
as a measure of technical efficiency,
and therefore to utilize cost minimi-
zation and cost effectiveness. How-
ever, cost minimization analysis
ideally should only be used when the
interventions or strategies being
compared are already known to have
equal effectiveness. In this study, the
assumption is that the effectiveness
of re-treatment of periodontal dis-
ease is the same as for treatment of
peri-implantitis. This suggestion has
not been verified by other studies,
but from a clinical standpoint and
from the results of the study, it
seems reasonable to use this as a
hypothesis. A recent Cochrane sys-
tematic review (Esposito et al. 2012)
reported clinical improvements from
the treatment of peri-implantitis.
However, they did not find that
complex interventions were more
effective than control therapies with
surgical debridement as chosen for
this study. Furthermore, a study
from the same clinical setting as in
this study reported that a very active
maintenance therapy often including
surgical retreatment for the recur-
rence of periodontal disease was
effective in the long term, in terms
of tooth loss (Fardal & Linden
2005). Second, cost effectiveness is
usually measured in natural units,
and in this study, disease-free years
were used. However, these measure-
ments do not take into account the
impact on the patients in a wider
sense, and do not answer any ques-
tions of allocative efficiency. In a
practical sense it is difficult to
employ methods like standard gam-
ble, time trade off and quality
adjusted tooth years in a private
practice setting. A willingness to pay
approach has previously been
described for periodontal therapy
(Matthews et al. 1999). This method
was considered for this study, how-
ever, it was feared that the patients
would misunderstand this approach
and use it to bargain with the dental
fees quoted.
The results of this study should
be interpreted keeping in mind that
they were obtained in a single pri-
vate practice in a particular geo-
graphic area with a relatively small,
heterogeneous sample with a large
proportion of smokers. Thus, gener-
alizing may not be appropriate.
Regardless of this, our findings show
that the number of disease-free years
was the same for neighbouring teeth,
contra-lateral teeth and implants.
However, due to the high prevalence
of peri-implantitis, the cost of main-
taining implants was much higher
than the cost of maintaining teeth.
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Clinical Relevance
Scientific rationale for the study:
Little is known about the efforts
and cost of maintaining dental
implants in patients treated for
periodontitis and how this com-
2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Comparing maintenance of teeth with implants
Tomasi, C., Wennstr om, J. & Berglundh, T.
(2008) Longevity of teeth and implants- a sys-
temic review. Journal of Oral Rehabil 35(Suppl.
1), 2332.
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of reporting of experimental research in
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outcome assessment and model validation.
Journal of Clinical Periodontology 39, 627.
pares with the active maintenance of
teeth.
Principle findings: Neighbouring
teeth and contra-lateral teeth and
implants have the same susceptibility
to recurrence of periodontal disease
651
Zitzmann, N. U. & Berglundh, T. (2008) Defini-
tion and prevalence of peri-implant diseases.
Journal of Clinical Periodontology 35, 286291.
Address:
ystein Fardal
Kvednabekkvn 4
N-4370 Egersund
Norway
E-mail: fardal@odont.uio.no
and peri-implantitis under the same
oral conditions.
Practical implications: Active main-
tenance treatment is important for
the long-term success of implants for
patients treated for periodontal disease.