Risk Factors for Dental Implant Failure in Private Practice: A Multicenter Survival Analysis.

Abstract

The objective of this study was to quantify the probability of implant failure over time from intrinsic patient factors using a population of patients from multiple private practices. The records for this retrospective, multicenter cohort study were randomly selected from eight private practices. The primary outcome variable was time to event (implant failure or last known follow-up). The included independent variables were age, sex, diabetes status, smoking status, and arch location. Analyses were performed with Cox proportional hazards on three models: univariate, full multivariate, and systemic factor multivariate. The probability of implant survival at 1, 5, and 10 years was calculated using univariate time-to-event modeling on log-normal distribution with 95% CIs and Cox proportional hazard tests for significance. The Kaplan-Meier survival curve was calculated for patients < 71 years of age. Eight hundred thirty-five implant-level records from 378 patients were collected for analyses. The mean patient age was 60 years, and 48% were men, 15% reported a history of smoking, and 16% reported having diabetes. The follow-up time was as long as 17 years, with a mean of 23.1 months, and a median of 7 months. The hazard ratio (HR) for implant failure due to sex (HR = 1.18; 95% CI: 0.52 to 2.66), smoking (HR = 1.30; 95% CI: 0.49 to 3.46), diabetes (HR = 1.17; 95% CI: 0.35 to 3.86), and arch location (HR = 2.13 to 3.39) failed to reach the threshold within any Cox proportional hazards model (P > .05). The implant survival probability for patients ≤ 70 years of age is 86.4% at 10 years in the course of routine private practice by experienced providers. Cautious interpretation of these results is critical, as the effects of known systemic risk factors are likely tempered by effective modifications in clinical decisions and protocols with short- and long-term follow-up maintenance.