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Risk Factors for Dental Implant Failure: A Strategy for the Analysis of Clustered Failure-time Observations
1 Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115; Correspondence: * corresponding author, PO Box 67376, Chestnut Hill Station, Chestnut Hill, MA 02467, schuang{at}hsph.harvard.edu
This study’s objective was to identify, in a statistically valid and efficient manner, the risk factors associated with dental implant failure. We hypothesize that factors exist which can be modified by clinicians to enhance outcome. A retrospective cohort study design was used. Cohort members had
Key Words: survival analysis • dental implants • risk factors • follow-up study • correlation and dependence • Cox regression analysis • clustered survival data • marginal approach
Journal of Dental Research, Vol. 81, No. 8,
572-577 (2002) This article has been cited by other articles:
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one implant placed. Risk factors were classified as demographic, health status, implant-, anatomic-, or prosthetic-specific, and reconstructive variables. The outcome variable was implant failure. The cohort was composed of 677 patients who had 2349 implants placed. Based on the adjusted multivariate model, factors associated with implant failure were tobacco use, implant length, staging, well size, and immediate implants (p 
0.05). In the setting of correlated survival observations, we recommend adjusting for the correlation of the observations to provide statistically valid and efficient results. Three of the identified factors—tobacco use, immediate implants, and implant staging—potentially may be modified to enhance implant survival. 
