Multivariate CART for survival with dental applicaions

牙周病或龋齿导致的牙齿脱落折磨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保健的目标是防止牙齿脱落，保持牙列自然舒适和功能。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每颗牙齿的长期保留前景与每种治疗方案的成本和不适，患者和第三方付款人必须对所建议的牙科治疗的成本和这些治疗的长期成功概率做出价值判断。因此，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发展多变量CART的生存，并将这种新扩展形式的CART应用于一个大型的、完善的数据库，以开发基于实际牙齿脱落的全球牙齿预后指标。受试者：这一假设将在1231名有牙齿的男性身上进行测试，这些男性参加了VA规范老龄化研究的牙齿纵向研究部分，这是一个建立的男性队列，随访长达30年，每三年进行一次口腔和医学检查。请注意，这些人不是退伍军人管理局的病人，所有受试者都从私营部门的各种从业人员那里接受牙科和医疗护理。可获得的历史资料：30多年来，每三年收集一次牙齿脱落、临床修复措施、临床牙周指标、医疗状况、吸烟、饮酒、行为等参数的数据。所有近端间牙槽骨丢失的变化也可以通过每个受试者至少15年的6组连续全口片来测量，这些全口片已经通过计算机辅助图像转换技术进行了数字化。测量剩余骨的百分比和平均牙槽骨丢失率也可用。意义：多变量生存CART的发展可以应用于其他牙科数据，本研究的结果将为基于实际牙齿脱落的全球牙科预后指标的分配提供客观标准。

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.