title: Process-based approach to modeling recurrent-event data explicated on the basis of occurrences of tooth losses in two different prosthetic treatment concepts.
abstract: BACKGROUND
  In studies comparing different prosthetic treatment concepts the repeated loss of teeth was chosen as the primary outcome. The resulting data appear to represent a data structure of recurrent events. However, the application of an existing method for recurrent events is far from straightforward. Often only the first event or the final state is analyzed using Kaplan-Meier survival statistics, thereby giving a great deal of information away.
  
  
  METHODS
  The paper presents a strategy for the analysis of recurrent data using a previously published study on the influence of different prosthetic treatment concepts for the shortened dental arch on tooth loss. A method based on cumulative sample history functions of recurrent events was adjusted for tooth loss. The shapes of these cumulative functions suggest a time dependency of the recurrence rate. To keep the model as simple as possible, a tripartite Poisson process (which assumes piecewise time-independent rates) was fitted to the cumulative mean functions stratified by treatment.
  
  
  RESULTS
  Within the middle interval of the three-phasic process, the treatment effects differ significantly, which is interpreted as a delay of tooth loss due to the use of one type of prosthesis (fixed) compared with the other (removable).
  
  
  CONCLUSIONS
  An analysis based on cumulative history functions is based on process, therefore, temporally changing characteristics are better captured than in methods for survival analyses. The presented approach offers useful new insight into the temporal behavior of ongoing tooth loss after prosthetic treatment.
  
  
  BACKGROUND
  The trial has been registered at controlled-trials.com under ISRCTN97265367 (registration date 4 April 2008).
authors.affiliation: Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Institute for Medical Informatics and Biometry, Fetscherstrasse 74, Dresden, D-01307, Germany. hans.diebner@tu-dresden.de.
authors.forename: Hans H
authors.initials: HH
authors.lastname: Diebner
authors.affiliation: Department of Prosthetic Dentistry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dental School, Fetscherstrasse 74, Dresden, D-01307, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Marré
authors.affiliation: Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Institute for Medical Informatics and Biometry, Fetscherstrasse 74, Dresden, D-01307, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Roeder
authors.affiliation: Department of Prosthetic Dentistry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dental School, Fetscherstrasse 74, Dresden, D-01307, Germany.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Walter
mesh_terms: D003724:Dental Arch / Q000601:surgery*; D003757:Dental Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D003830:Denture, Partial, Fixed / Q000009:adverse effects; D003832:Denture, Partial, Removable / Q000009:adverse effects; D006801:Humans; D007576:Jaw, Edentulous, Partially / Q000209:etiology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D015233:Models, Statistical; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D014081:Tooth Extraction; D016388:Tooth Loss / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Cumulative sample history function; Dental prosthesis; Recurrent events; Shortened dental arch