Multivariate CART for survival with dental applicaions

由于牙周病或龋齿导致的牙齿脱落困扰着大多数成年人的一生。专业牙科治疗和个人口腔健康自我护理的目标是防止牙齿脱落并保持自然牙列处于舒适和功能状态。为了制定适当的牙科治疗计划，牙科保健专业人员必须权衡保留每颗牙齿的长期前景与每种治疗方案所涉及的成本和不适，患者和第三方付款人必须对建议的牙科治疗的成本进行价值判断，以对抗这些治疗长期成功的可能性。在制定任何牙科治疗计划时，利用牙科预后是至关重要的。目标：本研究的主要目标是进一步开发多变量CART生存和应用这种新的扩展形式的CART生存一个大的，完善的数据库，努力开发全球牙齿预后指标，是基于实际的牙齿脱落。主题：这一假设将在多达1231名参加VA规范性老化研究的牙科纵向研究部分的有齿男性中进行测试，这是一个已建立的男性队列，随访时间长达30年，每三年进行一次口腔和医学检查。请注意，这些男性不是VA患者，所有受试者都接受私营部门各种从业人员的牙科和医疗护理。可用的历史数据：牙齿脱落，临床修复措施，临床牙周指数，医疗状况，吸烟，饮酒，行为和其他参数的数据已收集了30年。在所有邻间部位的牙槽骨丢失的变化也已被测量，从每个主题至少6个连续的全口电影集，跨越至少15年，已被数字化与计算机辅助图像转换技术。还可以测量剩余骨的百分比和牙槽骨丢失的平均速率。重要性：多变量CART生存的发展可以应用于其他牙科数据，本研究的结果将提供客观的标准分配的全球牙科预后指标，是基于实际的牙齿脱落。

Tooth loss from periodontal disease or dental caries afflicts most adults over the course of their lives. Goals of professional dental treatment and of personal oral health self-care are to prevent tooth loss and maintain the natural dentition in a state of comfort and function. In order to develop appropriate dental treatment planning, dental health care professionals must weigh the long-term outlook for retention of each tooth against the cost and discomfort involved with each treatment option, and patients and third-party payers must make value judgments about the cost of suggested dental treatments against the probability of long-term success for those treatments Hence, it is essential to utilize dental prognosis in the development of any dental treatment plan. Goals: The primary goals of this study are to further develop multivariate CART for survival and apply this newly extended form of CART for survival to a large, well-established database in an effort to develop global dental prognostic indicators that are based on actual tooth loss. Subjects: This hypothesis will be tested on up to 1231 dentate men who were enrolled in the Dental Longitudinal Study component of the VA Normative Aging Study, an established cohort of men followed for up to 30 years with triennial oral and medical examinations. Note that these men are not VA patients, and all subjects receive dental and medical care from a variety of practitioners in the private sector. Available historical data: Data for tooth loss, clinical restorative measures, clinical periodontal indices, medical status, smoking, alcohol, behavioral, and other parameters have been collected triennally over 30 years. Change in alveolar bone loss at all interproximal sites has also been measured from at least 6 sequential sets of full-mouth films per subject spanning a minimum of 15 years, which have been digitized with a computer-assisted image transformation technique. Measures of percent remaining bone and mean rates of alveolar bone loss are also available. Significance: Development of multivariate CART for survival can be applied to other dental data, and results of this study will provide objective criteria for assignment of global dental prognostic indicators that is based on actual tooth loss.