Research and Development, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA.
Dental Clinic, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA.
Clin Implant Dent Relat Res. 2024 Jun;26(3):604-614. doi: 10.1111/cid.13320. Epub 2024 Mar 24.
Approximately, 5.5 million dental implants are estimated to be surgically placed in the United States yearly, with an anticipated long-term failure rate ranging from 3% to 10%. At the Salt Lake City Dental Clinic within the Department of Veterans Affairs (VHA), specific protocols have been established to mandate that clinicians present every dental implant case for review by a committee. To understand the effectiveness of this approach, a comparative data analysis was undertaken to compare local dental implant failure data against national VHA data.
Leveraging electronic health records of veterans spanning from 2000 to 2021, we gathered procedural records related to dental implant placement or failure, demographic information, and medical history for individuals who received dental care at various dental clinics within the nationwide VHA network. Subsequently, statistical analyses were conducted using mixed-effects Poisson regression models with cluster-robust standard errors. Incident rate ratios (IRRs) for Utah-specific and nationwide cohorts were ascertained.
The Utah VHA dental clinical data showed that there was a slightly lower prevalence of implant failure at 6.7% compared to the national cohort, which had a rate of 6.9%. The implant level failure rates were also low, with 4.20 (confidence interval [CI]: 3.68, 4.81) per 1000 implant placements per year for Utah cohorts. The adjusted IRR indicated a relative 16% reduction in risk among Utah Veterans (IRR 0.84, 95% CI [0.76-0.92]; p < 0.001).
The stringent protocols in place at Salt Lake City, which integrate evidence-based practices and expert opinion for evaluating patient suitability for dental implant placement and subsequent care, contributed to the reduced risk among Utah Dental Clinic veterans pool compared to veterans of other states.
据估计,美国每年约有 550 万颗牙种植体被手术植入,预计长期失败率在 3%至 10%之间。在退伍军人事务部(VA)的盐湖城牙科诊所,已经制定了具体的协议,要求临床医生将每一个牙种植体病例提交委员会审查。为了了解这种方法的有效性,我们进行了对比数据分析,将当地的牙种植体失败数据与全国 VA 数据进行了比较。
利用 2000 年至 2021 年退伍军人的电子健康记录,我们收集了与牙种植体放置或失败相关的程序记录、人口统计学信息和医疗史,这些信息来自于全国 VA 网络中各个牙科诊所的患者。随后,使用混合效应泊松回归模型和聚类稳健标准误差进行了统计分析。确定了犹他州特定和全国队列的发病率比值(IRR)。
犹他州 VA 牙科临床数据显示,种植体失败的患病率略低,为 6.7%,而全国队列的患病率为 6.9%。种植体水平的失败率也较低,犹他州队列每年每 1000 个种植体中有 4.20 个(置信区间[CI]:3.68,4.81)失败。调整后的 IRR 表明,犹他州退伍军人的风险相对降低了 16%(IRR 0.84,95%CI [0.76-0.92];p < 0.001)。
盐湖城实施的严格协议,整合了循证实践和专家意见,用于评估患者是否适合牙种植体放置和后续护理,这有助于降低犹他州牙科诊所退伍军人群体的风险,与其他州的退伍军人相比。