HOW TO IDENTIFY SUBGROUPS IN LONGITUDINAL CLINICAL DATA: TREATMENT RESPONSE PATTERNS IN PATIENTS WITH A SHORTENED DENTAL ARCH

Oliver Schierz; Chi Hyun Lee; Mike T John; Angelika Rauch; Daniel R Reissmann; Ralf Kohal; Birgit Marrè; Klaus Böning; Michael H Walter; Ralph Gunnar Luthardt; Heike Rudolph; Torsten Mundt; Wolfgang Hannak; Guido Heydecke; Matthias Kern; Sinsa Hartmann; Julian Boldt; Helmut Stark; Daniel Edelhoff; Bernd Wöstmann; Stefan Wolfart; Florentine Jahn

doi:10.1016/j.jebdp.2022.101794

HOW TO IDENTIFY SUBGROUPS IN LONGITUDINAL CLINICAL DATA: TREATMENT RESPONSE PATTERNS IN PATIENTS WITH A SHORTENED DENTAL ARCH

J Evid Based Dent Pract. 2023 Jan;23(1S):101794. doi: 10.1016/j.jebdp.2022.101794. Epub 2022 Oct 17.

Authors

Oliver Schierz¹, Chi Hyun Lee², Mike T John³, Angelika Rauch⁴, Daniel R Reissmann⁵, Ralf Kohal⁵, Birgit Marrè⁶, Klaus Böning⁶, Michael H Walter⁶, Ralph Gunnar Luthardt⁷, Heike Rudolph⁷, Torsten Mundt⁸, Wolfgang Hannak⁹, Guido Heydecke¹⁰, Matthias Kern¹¹, Sinsa Hartmann¹², Julian Boldt¹³, Helmut Stark¹⁴, Daniel Edelhoff¹⁵, Bernd Wöstmann¹⁶, Stefan Wolfart¹⁷, Florentine Jahn¹⁸

Affiliations

¹ Department of Prosthodontics and Materials Science, Medical Faculty University of Leipzig, Leipzig, Germany.
² Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA.
³ Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN.
⁴ Department of Prosthetic Dentistry, Regensburg University Medical Center, Regensburg, Germany.
⁵ Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
⁶ Department of Prosthetic Dentistry, Technische Universität Dresden, University Hospital Carl Gustav Carus Dental School, Dresden, Germany.
⁷ Department of Prosthetic Dentistry, Center of Dentistry, Universitätsklinikum Ulm, Ulm, Germany.
⁸ Department of Prosthodontics, Gerodontology and Biomaterials, Dental School, University of Greifswald, Greifswald, Germany.
⁹ Charité, Center for Dental and Craniofacial Sciences, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Campus Benjamin Franklin, Berlin, Germany.
¹⁰ University Medical Center Eppendorf, Department of Prosthodontics, Hamburg, Germany.
¹¹ Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University, Kiel, Germany.
¹² Department of Prosthetic Dentistry, Johannes-Gutenberg University of Mainz, Mainz, Germany.
¹³ Department of Prosthetic Dentistry, Julius-Maximilians University of Wuerzburg, Wuerzburg, Germany.
¹⁴ Department of Prosthodontics, Preclinical Education and Dental Materials Science, University of Bonn, Bonn, Germany.
¹⁵ Department of Prosthetic Dentistry, University Hospital, LMU Ludwig-Maximilians-University, Munich, Germany.
¹⁶ Department of Prosthetic Dentistry, Justus-Liebig University of Giessen, Giessen, Germany.
¹⁷ Department of Prosthodontics and Biomaterials, Medical Faculty, RWTH Aachen University, Aachen, Germany.
¹⁸ Department of Prosthetic Dentistry and Dental Material Science, Friedrich-Schiller University of Jena, Jena, Germany.

PMID: 36707170
DOI: 10.1016/j.jebdp.2022.101794

Abstract

Background: When dental patients seek care, treatments are not always successful,that is patients' oral health problems are not always eliminated or substantially reduced. Identifying these patients (treatment non-responders) is essential for clinical decision-making. Group-based trajectory modeling (GBTM) is rarely used in dentistry, but a promising statistical technique to identify non-responders in particular and clinical distinct patient groups in general in longitudinal data sets.

Aim: Using group-based trajectory modeling, this study aimed to demonstrate how to identify oral health-related quality of life (OHRQoL) treatment response patterns by the example of patients with a shortened dental arch (SDA).

Methods: This paper is a secondary data analysis of a randomized controlled clinical trial. In this trial SDA patients received partial removable dental prostheses replacing missing teeth up to the first molars (N = 79) either or the dental arch ended with the second premolar that was present or replaced by a cantilever fixed dental prosthesis (N = 71). Up to ten follow-up examinations (1-2, 6, 12, 24, 36, 48, 60, 96, 120, and 180 months post-treatment) continued for 15 years. The outcome OHRQoL was assessed with the 49-item Oral Health Impact Profile (OHIP). Exploratory GBTM was performed to identify treatment response patterns.

Results: Two response patterns could be identified - "responders" and "non-responders." Responders' OHRQoL improved substantially and stayed primarily stable over the 15 years. Non-responders' OHRQoL did not improve considerably over time or worsened. While the SDA treatments were not related to the 2 response patterns, higher levels of functional, pain-related, psychological impairment in particular, and severely impaired OHRQoL in general predicted a non-responding OHRQoL pattern after treatment. Supplementary, a 3 pattern approach has been evaluated.

Conclusions: Clustering patients according to certain longitudinal characteristics after treatment is generally important, but specifically identifying treatment in non-responders is central. With the increasing availability of OHRQoL data in clinical research and regular patient care, GBTM has become a powerful tool to investigate which dental treatment works for which patients.

Keywords: Developmental trajectories; Non-responder analysis; Oral health-related quality of life; Partially dentate adults; Randomized clinical trial; Tooth loss.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Dental Arch
Denture, Partial, Removable* / psychology
Humans
Molar
Oral Health
Quality of Life*