Performance evaluation of survival regression models in analysing Swedish dental implant complication data with frailty

• Published in: PloS one Vol. 16; no. 1; p. e0245111
• Main Authors: Fagbamigbe, Adeniyi Francis, Karlsson, Karolina, Derks, Jan, Petzold, Max
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07.01.2021; Public Library of Science (PLoS)
• Subjects: Aged; Aged, 80 and over; Biology and Life Sciences; Biomaterials Science; Biomaterialvetenskap; Complications; Complications and side effects; Confidence intervals; Dental implants; Dental Implants - adverse effects; Dentistry; Engineering and Technology; Estimates; Evaluation; Female; flexible parametric models; Frailty; framework; Gum disease; Health risks; Humans; Implant dentures; Jaw; Male; Medical prognosis; Medical research; Medicine; Medicine and Health Sciences; Middle Aged; mixture models; Models, Biological; Odontologi; Odontology; Patients; Performance evaluation; Peri-Implantitis - etiology; Peri-Implantitis - mortality; Periodontics; Periodontitis; Periodontitis - mortality; Periodontitis - surgery; Physical Sciences; Postoperative Complications - mortality; Regression analysis; Regression models; Science & Technology - Other Topics; Statistical analysis; Survival; Survival analysis; Sweden - epidemiology; Teeth; time; Transplants & implants; Sweden; United Kingdom > UK
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0245111

The use of inappropriate methods for estimating the effects of covariates in survival data with frailty leads to erroneous conclusions in medical research. This study evaluated the performance of 13 survival regression models in assessing the factors associated with the timing of complications in implant-supported dental restorations in a Swedish cohort. Data were obtained from randomly selected cohort (n = 596) of Swedish patients provided with dental restorations supported in 2003. Patients were evaluated over 9 years of implant loss, peri-implantitis or technical complications. Best Model was identified using goodness, AIC and BIC. The loglikelihood, the AIC and BIC were consistently lower in flexible parametric model with frailty (df = 2) than other models. Adjusted hazard of implant complications was 45% (adjusted Hazard Ratio (aHR) = 1.449; 95% Confidence Interval (CI): 1.153-1.821, p = 0.001) higher among patients with periodontitis. While controlling for other variables, the hazard of implant complications was about 5 times (aHR = 4.641; 95% CI: 2.911-7.401, p<0.001) and 2 times (aHR = 2.338; 95% CI: 1.553-3.519, p<0.001) higher among patients with full- and partial-jaw restorations than those with single crowns. Flexible parametric survival model with frailty are the most suitable for modelling implant complications among the studied patients.