Establishment of a nomogram model to predict the risk of peri-implantitis in patients with diabetes mellitus

doi:10.19439/j.sjos.2021.05.013

Abstract

Abstract: PURPOSE: To explore the risk factors of peri-implantitis after dental implants in diabetic patients, and establish a related nomogram prediction model. METHODS: The clinical data of diabetic patients undergoing dental implant restoration from January 2016 to December 2018 were retrospectively analyzed, and cluster random sampling method was used to divide the data into training set (n=153) and validation set (n=104). Univariate and Logistic regression were used to analyze the independent risk factors of peri-implantitis in diabetic patients. At the same time, the relevant nomogram prediction model was established, and the model was internally verified by Bootstrap method. The external verification was completed by self sampling method of verification set. SPSS 22.0 software package was used for statistical analysis. RESULTS: Smoking index>200 cigarettes(OR=6.364, 95%CI: 1.943-20.840), HbA1c>7%(OR=4.680, 95%CI: 1.497-14.628), periodontal history (OR=3.779, 95%CI: 1.359-10.507), anterior teeth implantation(OR=7.183, 95%CI: 2.371-21.756), tooth brushing frequency ≤1 time/day (OR=4.796, 95%CI: 1.471-15.637) and unscheduled cleaning (OR=4.994, 95%CI: 1.745-14.295) were independent risk factors for peri-implantitis after dental implantation in diabetic patients (P<0.05). Based on the above 6 risk factors, a nomogram model to predict the occurrence of peri-implantitis in diabetic patients was established. The calibration curve verification showed that the predicted values of the training set and the verification set were basically the same as the actual measured values, and ROC curve verification showed C-index indexes of the training set and the verification set were 0.867 and 0.822, respectively, indicating that the nomogram model had good prediction accuracy. CONCLUSIONS: Smoking index>200 cigarettes, HbA1c>7%, periodontal history, anterior dental implantation, brushing frequency ≤1 time/day and unscheduled cleaning are independent risk factors for peri-implantitis in diabetic patients based on the above risk factors. The line graph model can intuitively and accurately predict the probability of peri-implantitis in diabetic patients.

Key words: Diabetes, Dental implant, Peri-implantitis, Nomogram model

CLC Number:

R782.1

ZHANG Rui, MA Jun-tao. Establishment of a nomogram model to predict the risk of peri-implantitis in patients with diabetes mellitus[J]. Shanghai Journal of Stomatology, 2021, 30(5): 517-521.

References

[1] 谢艳婷, 江鹭鹭, 何晶, 等. 美学区单颗牙即刻种植和延期种植的短期红色美学和种植体边缘骨吸收的临床效果比较及影响因素分析[J]. 上海口腔医学, 2019, 28(2): 148-153.
[2] 李冬仙, 李琴琴, 王杨红, 等. 种植体周围炎导致早期种植牙失败的原因分析和防治策略的探究[J]. 中国药物与临床, 2019, 19(9): 1519-1520.
[3] Muñoz V, Duque A, Giraldo A, et al.Prevalence of peri-implant disease according to periodontal probing depth and bleeding on probing: a systematic review and meta-analysis[J]. Int J Oral Maxillofac Implants, 2018, 33(4): e89-e105.
[4] Pérez-Losada FL, Estrugo-Devesa A, Castellanos-Cosano L, et al.Apical periodontitis and diabetes mellitus type 2: a systematic review and meta-analysis[J]. J Clin Med, 2020, 9(2): E540-E551.
[5] Turri A, Rossetti PH, Canullo L, et al.Prevalence of peri-implantitis in medically compromised patients and smokers: a systematic review[J]. Int J Oral Maxillofac Implants, 2016, 31(1): 111-118.
[6] 吴家馨, 裴锡波. 糖尿病患者的牙种植体周围炎[J]. 中国组织工程研究, 2019, 23(34): 5558-5564.
[7] Xiong Z, Deng G, Huang X, et al.Score for the survival probability in metastasis breast cancer: a nomogram-based risk assessment model[J]. Cancer Res Treat, 2018, 50(4): 1260-1269.
[8] Ma X, Zhang YL, Ji Q, et al.Diagnostic criteria for diabetes in China: are we pushing too much beyond evidence?[J]. Eur J Clin Nutr, 2017, 71(7): 812-815.
[9] 宋忠臣. 种植体周围疾病的诊断和治疗[C]. 北京: 中国国际口腔学术研讨会, 2017.
[10] Zhou X, Zhang W, Liu X, et al.Interrelationship between diabetes and periodontitis: role of hyperlipidemia[J]. Arch Oral Biol, 2015, 60(4): 667-674.
[11] 宫苹. 牙缺失种植修复并发症与咬合[J]. 中华口腔医学杂志, 2018, 53(12): 800-804.
[12] Teeuw WJ, Kosho MX, Poland DC, et al.Periodontitis as a possible early sign of diabetes mellitus[J]. BMJ Open Diabetes Res Care, 2017, 5(1): e000326.
[13] Pushparani DS.Zinc and type 2 diabetes mellitus with periodontitis-a systematic review[J]. Curr Diabetes Rev, 2014, 10(6): 397-401.
[14] Artese HPC, Foz AM, Rabelo MDS, et al.Periodontal therapy and systemic inflammation in type 2 diabetes mellitus: a meta-analysis[J]. PLoS One, 2015, 10(5): e0128344.
[15] 黄萧瑜, 李明云, 周学东, 等. 全身及局部因素对种植体周围稳态的影响[J]. 国际口腔医学杂志, 2019, 46(6): 730-734.
[16] 沈意涵,邹多宏,吴轶群.牙种植体周围炎相关因素和治疗新进展[J].上海口腔医学, 2014, 23(6): 763-768.
[17] Mazel A, Belkacemi S, Tavitian P, et al.Peri-implantitis risk factors: a prospective evaluation[J]. J Investig Clin Dent, 2019, 10(2): e12398.
[18] 唐伟华, 李蕾, 曹煜隆. 吸烟与种植体周围炎发病风险相关性Meta分析[J]. 中国实用口腔科杂志, 2018, 11(6): 361-364.
[19] 金晓华, 冯剑颖, 张剑. 慢性牙周炎及吸烟对后牙局部种植义齿修复患者种植体周围炎发生的影响[J].中华医院感染学杂志, 2018, 28(9): 1398-1400.
[20] Monje A, Catena A, Borgnakke WS.Association between diabetes mellitus/hyperglycemia and peri-implant diseases: systematic review and meta-analysis[J]. J Clin Periodontol, 2017, 44(6): 636-648.
[21] 靳东思奇, 廖雁婷, 和璐, 等. 糖尿病前期患者的牙周状况研究[J]. 中华口腔医学杂志, 2019, 54(3): 157-163.
[22] Stacchi C, Berton F, Perinetti G, et al.Risk factors for peri- implantitis: effect of history of periodontal disease and smoking habits. a systematic review and meta-analysis[J]. J Oral Maxillofac Res, 2016, 7(3): e3-e16.
[23] 花菲. 种植体周围炎的发病率及相关因素的研究[J].山西医药杂志, 2018, 47(10): 1128-1131.
[24] Hong M, Kim HY, Seok H, et al.Prevalence and risk factors of periodontitis among adults with or without diabetes mellitus[J]. Korean J Intern Med, 2016, 31(5): 910-919.
[25] Jianyong L, Zhihui L, Rixiang G, et al.Using a nomogram based on preoperative serum fibrinogen levels to predict recurrence of papillary thyroid carcinoma[J]. BMC Cancer, 2018, 18(1): 390-398.