Received: 24 April 2020 Revised: 23 November 2020 Accepted: 26 November 2020

DOI: 10.1111/cid.12967

ORIGINAL ARTICLE

Comparing factors affecting dental-implant loss between age

groups: A retrospective cohort study

Obida Boboeva DDS, MD | Tae-Geon Kwon DDS, PhD | Jin-Wook Kim DDS, PhD |
Sung-Tak Lee DDS, PhD | So-Young Choi DDS, PhD

Department of Oral and Maxillofacial Surgery,

School of Dentistry, Kyungpook National
University, Daegu, South Korea
Correspondence
So-Young Choi, DDS, PhD, Department of
Oral and Maxillofacial Surgery, School of
Dentistry, Kyungpook National University
2177 Dalgubeol-daero, Jung-gu, Daegu 41940,
South Korea.
Email: dentalchoi@knu.ac.kr
Abstract
Background: There is a growing interest in factors leading to implant failure in older
people as the population aged 65 years or older continues to expand.
Purpose: We sought to identify differences of results in the implant survival rate and
the influence of certain factors on implant failure in the older (≥65 years) and youn-
ger (<65 years) patients.
Materials and Methods: Patients who underwent their first dental-implant surgery
between July 2008 and June 2018 were included. Data on age, sex, smoking habits,
medical conditions, implant location, implant size, and the presence and type of bone
graft and membrane were collected and analyzed according to age group. Moreover,
cumulative survival rates of implants (by Kaplan-Meier analysis) and hazard ratios
(HR) of each factor (using Cox regression analysis with shared frailty) in each group
were assessed and results compared between groups.
Results: A total of 628 implants in 308 patients and 1904 implants in 987 patients in
the older and younger groups, respectively, were assessed, with failure rates of 3.9%
and 3.4%. Per Kaplan-Meier analysis, the 11-year patient-level cumulative survival
rate of implant treatment was 95.3% (95% CI: 0.91-0.97) in the older and 93.9%
(95% CI: 0.88-0.97) in the younger group. The HR for implant failure of the variables,
except diameter of dental implants, were not statistically significant in both groups.
Conclusion: The outcomes of implant treatment were not considerably different
between the age groups.

KEYWORDS

dental implants, implant failure, older patients, survival rate

1 | I N T RO DU CT I O N As the proportion of aged individuals relative to the total popula-

Over the last several decades, living standards have improved sub-
stantially worldwide, leading to an increase in the global life expec-
tancy. According to a report by the World Economic Forum, in 2018,
the percentage of the global population aged 65 years or older was
1
increased relative to that of those younger than 5 years. The Repub-
lic of Korea in particular is considered an aging society, with 15.1% of
the overall population estimated to be older than 65 years in 2019.2
tion continues to increase, the problem of tooth loss and the demand
for rehabilitation is also expected to increase proportionately.3 In
2014, the national healthcare insurance policy of South Korea
included implant treatment for those aged older than 75 years; how-
ever, in 2017, the minimum eligible age was reduced to 65 years and
two implants per patient were allowed.4 Consequently, Korea
witnessed a considerable increase in the treatment of tooth loss using
dental implants in 2018.5 This trend has, as a result, provided

Clin Implant Dent Relat Res. 2020;1–8. wileyonlinelibrary.com/journal/cid © 2020 Wiley Periodicals LLC 1
2 BOBOEVA ET AL.

researchers with relatively large samples to use to investigate the out-

comes of implant treatment in older patients.
What is known:
It has been frequently debated whether implant failure is associ-
• Few studies reporting a comparison of older (>65) and
ated with age.6,7 Several studies have concluded that chronological
younger (<65) age groups treated with implants can be
age by itself is not a factor leading to implant failure.8-10 In contrast,
found in the literature.
Salonen et al11 and Moy et al12 reported a possible association
• Most of these studies have shortcomings such as a small
between advanced age and implant failure.
sample size or short follow-up period.
Studies that have compared the outcomes of dental-implant
treatment between young and old patients have revealed high survival
What this study adds:
rates existed in both groups. In a 5-year follow-up study conducted
• This study provides results suggesting relatively similar
by Engfors et al,6 the cumulative survival rate of implants in the max-
outcomes of dental implant treatment regarding survival
illa was 93% among patients aged 80 years or older and 92.6% in
rate and hazard ratio of several factors in a relatively large
those younger than 79 years old; meanwhile, for implants in the man-
sample of older and younger patients followed up for 1
dible, the rates were 99.5% and 99.7%, respectively. Bryant and
to 11 years.
Zarb13 compared implant success rates between closely matched sub-
jects aged older than 60 years and younger than 49 years, respec-
tively, recording implant success rates of 92% for the older group and
86.5% for the younger one. Furthermore, Hoeksema et al14 reported
a 10-year implant survival rate of 93.4% in the older group (aged
60-80 years) as compared with that of 97.1% in the younger group
(aged 35-50 years).
Hence, interest has been growing in discerning the specific fac-
tors leading to implant failure in the older population. Compton
et al15 suggested sex, location, periodontal disease, and bone aug-
mentation to be significant risk factors of implant failure from their
research conducted involving patients older than 60 years of age.
Meanwhile, Park et al,16 investigated the association of implant loss
with different variables in patients older than 65 years of age, but
only the type of implant manufacturer was found to be statistically
significant. Many existing studies have limitations, such as small sam-
ple sizes, short follow-up periods, or homogeneity of implant-related
characteristics (eg, same size or manufacturer), that make it difficult
F I G U R E 1 Comparison of 11-year cumulative survival curves of
to apply their results to clinical practice.17,18 Recently, different pat- the older and the younger patient groups using Kaplan-Meier analysis.
terns of implant survival for different age groups undergoing implant Cumulative survival rates (CSR) are represented in y-axis (y-axis is
surgery were reported in an analysis with a large sample size and truncated), time of analysis calculated in months in x-axis
long-term follow-up.19 In this study, we collected and evaluated data
from a relatively large patient sample and included 11-year follow-
up data and implants from a variety of manufacturers inserted at the Oral and Maxillofacial Surgery, the Dental Hospital of the Kyungpook
Kyungpook National University Dental Hospital. Our main focus was National University, Daegu, South Korea (Figure 1).
to elucidate differences in relationships between implant failure and Most of the patients at the clinic directly visit without reference.
other parameters between older (≥65 years) and younger (<65 years) However, a few patients were referred from other dental clinics or
patients. the Department of Prosthodontics. The two-stage surgery was the
protocol that was mostly used despite performing immediate place-
ment of implants in some patients. A bone-regeneration procedure
2 | MATERIALS AND METHODS (with or without membrane) was, conditionally performed.
All patients were followed up at the Department of Oral and
2.1 | Data Maxillofacial Surgery, Dental Hospital of the Kyungpook National Uni-
versity and were recalled for regular checkups after implant surgery
This research was designed as an 11-year follow-up retrospective and implant prosthesis. The first follow-up period after loading of
study of all patients who underwent first dental implant surgery implants was 3 months and every 6 months thereafter. All patients
between July 2008 and June 2018 at a single institution; the surgeries were regularly examined clinically and radiographically (panorama or
were performed by five oral and maxillofacial surgeons, all who had periapical view) free of cost. Besides, the patients were urged to con-
more than 10 years of professional experience, in the Department of tact the clinic in case of any discomfort regarding the implant.
BOBOEVA ET AL.
This study sought to involve all patients treated with implants
during a given period to minimize selection bias. Only the first surgical
events per patient were included in the analysis, whereas the implants
placed in the next visits were excluded. Data variables included
patient-related, implant site-related, and implant-related information
such as age at implantation, sex, general diseases (eg, diabetes, osteo-
porosis, cardiovascular diseases, and arthritis), health status (at least
one general disease = 1; without any diseases = 0), smoking habits,
dates of implant loading and failure, implant site and jaw, implant
manufacturer, implant size, performance of bone grafting, bone graft
material, placement of membrane, and type of membrane. These data
were retrieved from the patients' dental records stored in the elec-
tronic medical records database program of Kyungpook National Uni-
versity Dental Hospital.
Initially, data from 1372 patients who underwent at least one
dental-implant treatment during the given period were collected;
however, 77 of these patients (with 162 implants) who had records
with missing details related to the variables of interest and/or did not
appear during regular follow-ups were excluded from this study. Con-
sequently, a total of 1295 patients with 2532 implants were finally
enrolled in the trial. Figure A1 shows the proportions of patients
included according to age at implantation.
The evaluation of extracted data was planned to be performed
according to patient age; the older group included patients aged
65 years or older and the younger group included those aged younger
than 65 years.
This research design complied with and was approved by the
Kyungpook National University Dental Hospital Institutional Review
Board (reg. no. KNUDH-2019-10-01-00).
2.2 | Implants and other materials
Implant size was entered separately as two different variables for
diameter and length. The diameter of the implants ranged from 3.0 to
6.0 mm (median: 4.0; interquartile range [IQR]: 0.10), whereas the
length ranged from 5.0 to 15.0 mm (median: 10.0; IQR: 1.50).
The implant location was recorded as one of six nominal values
by sorting cases into the three positions—anterior, premolar, and
molar—for each jaw (ie, maxilla and mandible).
Both age groups received implants from six different companies
(Astra Tech, AB, Mölndal, Sweden; Dentis, Daegu, South Korea; Den-
tium, Seoul, South Korea; Straumann, Zürich, Switzerland; Megagen
Implant, Gyeongsan, South Korea; and Osstem Implant, Seoul, South
Korea).
For bone substitution, autogenous, xenograft (Bio-Oss; Geistlich
Biomaterials, Wolhusen, Switzerland), and alloplastic (MBCP; Bio-
matlante, Vigneux, France) materials and bone morphogenetic pro-
teins (Novosis; CGBio, Seongnam, South Korea) were used, while
seven different brands of resorbable membrane (BioMend from
Zimmer Dental, Carlsbad, California; Biodesign from Cook Medical,
Bloomington, Indiana; Bio-Gide from Geistlich Biomaterilas,
Wolhusen, Switzerland; CGDerm from CGBio, Seongnam, South
3
Korea; Collatape from Zimmer Dental, Warsaw, Indiana; Ossix Plus
from Datum Dental, Lod, Israel; and OssGuide from Bioland,
Cheongju, South Korea) and three nonresorbable membrane brands
(Cytoplast from Osteogenics Biomedical, Lubbock, Texas; GoreTex
from W.L. Gore & Associates, Newark, Delaware; Ti-mesh) were
applied mostly via guided bone-regeneration (GBR) procedures.
2.3 | Assessment criteria
Implant failure (event) and survival were the primary study outcomes
of interest during the evaluation process. The main criterion for failure
was the removal and/or re-implantation of the implant for any reason,
whereas all other implants that remained functional in the mouth
were considered as having survived. The patient was recorded as
failed when the first implant failure was experienced by the patient.
Failure time was registered in months from the date of implant
installment.
2.4 | Statistical analyses
All data collected from each group were processed using the Statisti-
cal Package for the Social Science for Windows version 25 software
program (IBM Corporation, Armonk, New York). Findings from the
descriptive analysis of data were expressed in percentages or fre-
quency values with means and medians along with SD and IQR
values.
The cumulative survival rates of implants were estimated using
the Kaplan-Meier survival analysis and compared between the two
groups with the log-rank test.
To obtain the hazard ratios (HR) of factors influencing implant
failure in each group, all variables were input into a multivariable Cox
regression test with shared frailty (Stata version 16; Stata Corpora-
tion, College Station, Texas), which allows the user to observe the
effects of several factors on the cumulative survival rate at the same
time. This mixed-effects survival regression model enables a random
effect of each patient and, thus, all cases within a cluster share the
same degree of random effect on the outcome.20
A P value of less than .05 was considered to be statistically
significant.
3 | RE SU LT S
3.1 | Characteristics of the groups
Overall, 308 patients (628 implants) were included in the older group
and 987 patients (1904 implants) in the younger group. The propor-
tion of the included patients by year of implantation in each group is
demonstrated in Figure A2. The mean follow-up period was
51.3 ± 28.3 (median: 41.0; IQR: 35.6) months for the older group and
57.8 ± 30.3 (median: 54.4; IQR: 48.6) months for the younger group.
4 BOBOEVA ET AL.

TABLE 1 Baseline characteristics of the study groups The maximum number of implants loaded in one patient was

Older group Younger group 9 and mean 2.0 ± 1.3 implants in the older group and 10 with mean
Variable N (%) N (%) 1.9 ± 1.2 implants in the younger group, which were loaded in one
Patient-related surgical procedure.

Total 308 987 Implants manufactured by Osstem Implant predominated in both

the older (47.0%) and younger (41.3%) groups.
Sex
Table 1 presents the overall background information of the study
Male 122 (39.6) 462 (46.8)
cohort.
Female 186 (60.4) 525 (53.2)
Alloplast and xenograft bone-substitution materials were most
Smoker 11 (3.6) 67 (6.8)
commonly used in bone-graft procedures in both the younger and
General disease
older groups. More than half of the used membranes in the GBR pro-
Diabetes 70 (22.7) 71 (7.2) cedure were of the Biodesign brand, followed by Bio-Gide and Bio-
Osteoporosis 70 (22.7) 63 (6.4) Mend in the GBR procedure.
Cardiovascular disease 168 (54.5) 219 (22.2)
Arthritis 60 (19.5) 53 (5.4)
Patients with medical 235 (76.8) 316 (32.0) 3.2 | Failure of implants
conditions
Implant-related Figure A3 demonstrates the incidence of failure rate per 100 patients
Total 628 1904 regarding the age at implantation.
Implant diameter A total of 15 (overall failure rate: 2.4%) implants in 12 (overall fail-
<3.75 mm 78 (12.4) 233 (12.2) ure rate: 3.9%) older patients and 40 (overall failure rate: 2.1%)

3.75-4.1 mm 401 (63.8) 1189 (62.4) implants in 34 (overall failure rate: 3.4%) younger patients were lost
during follow-up period. Three (25%) patients experienced two failed
>4.1 mm 149 (23.7) 482 (25.3)
implants in the older group, two implants were lost in six (17.6%)
Implant length
patients in the younger group, and the remaining patients lost only
≤10.0 mm 454 (72.3) 1158 (60.8)
one implant each.
>10.0 mm 174 (27.7) 746 (39.2)
An analysis of implant failure over time showed that 11 (73.3%)
Implant manufacturer
of the 15 failures that occurred in older patients and 25 (62.5%) of the
Dentium 211 (33.6) 662 (34.8)
40 failures that occurred in younger patients happened before
Straumann 73 (11.6) 272 (14.3) loading.
Osstem 295 (47.0) 787 (41.3)
Others 49 (7.8) 183 (9.6)
Site-related 3.3 | Kaplan-Meier analysis and multivariable Cox
Jaw 318 1019 regression test with shared frailty
Maxilla 131 (41.2) 518 (50.8)
Mandible 187 (58.8) 501 (49.2) The 11-year cumulative survival rate of implanted patients as
assessed by Kaplan-Meier analysis was 95.3% (95% CI: 0.91-0.97) in
Site 419 1294
the older and 93.9% (95% CI: 0.88-0.97) in the younger groups
Anterior maxilla 35 (8.3) 207 (16.0)
(Figure 1). No statistically significant difference in survival function
Premolar maxilla 56 (13.4) 200 (15.4)
was detected between the groups according to the log-rank
Molar maxilla 91 (21.7) 256 (19.8)
test (P = .64).
Anterior mandible 99 (23.6) 101 (7.8)
In the regression analysis, only the difference in the results
Premolar mandible 55 (13.1) 154 (11.9)
between groups was found in the variable of the implant diameter.
Molar mandible 83 (19.8) 376 (29.1) According to the Cox regression analysis with shared frailty, a signifi-
Bone graft (yes) 204 (32.5) 901 (47.3) cantly greater failure risk was observed among implants with a diame-
Membrane use (yes) 133 (21.2) 570 (29.9) ter narrower than 3.75 mm as compared with implants with 3.75 to

Note: Others—Astra Tech, Dentis, Megagen.
The age of the older patients ranged from 65 to 86 years (mean
71.4 ± 5.3 years) and that of the younger patients ranged from 15 to
64 years (mean 46.7 ± 13.2 years). Both groups included more women
than men.
4.1 mm diameter in the older group. The HR was 8.07 (95% CI:
1.20-54.06). However, a significantly less hazard risk was observed
among implants with a diameter wider than 4.1 mm as compared to
those with a diameter 3.75 to 4.1 mm in the younger group (HR: 0.16;
95% CI: 0.04-0.62). No HR of other predictors was found to be signifi-
cant in relation to implant failure in both groups (Table 2). Further-
more, regression analysis of the total study population shows that
BOBOEVA ET AL. 5

TABLE 2 Cox regression model with shared frailty model analysis for implant failure in each group

Older group Younger group

Predictors Hazard ratio 95.0% CI Hazard ratio 95.0% CI

Sex (ref.: Male) Female 0.21 0.28-1.53 0.95 0.39-2.33
Smoker (ref.: Nonsmoker) 0.00 0.00 3.11 0.73-13.29
General disease
Diabetes (ref.: No) Yes 1.17 0.19-7.25 1.97 0.34-11.35
Osteoporosis (ref.: No) Yes 6.63 0.91-48.14 0.32 0.02-4.55
CVD (ref.: No) Yes 0.99 0.44-6.78 0.48 0.07-3.39
Arthritis (ref.: No) Yes 0.78 0.10-6.11 0.34 0.02-6.17
Patients with medical conditions (ref.: No) Yes 1.69 0.11-27.01 2.03 0.22-18.34
Number of implants per patient 1.05 0.65-1.71 0.92 0.69-1.23
Site (ref.: Anterior maxilla)
Premolar maxilla 0.13 0.01-1.55 1.56 0.47-5.21
Molar maxilla 0.25 0.0-2.44 1.41 0.37-5.26
Anterior mandible 0.89 0.12-6.53 0.49 0.08-2.96
Premolar mandible 0.00 0.00 0.77 0.16-3.73
Molar mandible 0.21 0.02-2.71 2.33 0.67-8.08
Diameter (ref.: 3.75-4.1 mm)
<3.75 mm 8.07 1.20-54.06* 0.85 0.25-2.94
>4.1 mm 2.27 0.23-22.53 0.16 0.04-0.62*
Length (ref.: >10.0 mm)
≤10.0 mm 0.67 0.15-3.02 1.02 0.43-2.41
Brand (ref.: Osstem)
Dentium 1.53 0.29-8.16 0.54 0.19-1.49
Straumann 2.81 0.31-25.83 0.46 0.12-1.75
Others 0.00 0.00 1.58 0.43-5.71
Bone graft (ref.: No) Yes 1.46 0.21-10.20 0.78 0.28-2.17
Membrane (ref.: No) Yes 1.42 0.16-12.70 2.03 0.69-5.95

Note: Others—Astra Tech, Dentis, Megagen. *statistically significant (P < .05).

there was no significant impact of the older group on implant failure
accounting the younger group as reference (Table A1).
4 | DISCUSSION
Implant failure is a relatively rare but global concern; therefore, it is
12
important to investigate the factors leading to loss of implants.
primary goal of this study was to examine the outcomes of dental-
implant treatment and factors influencing implant failure according to
age, particularly focusing on whether there are differences in the sur-
vival probability of implants and in factors influencing implant failure in
the older group relative to the younger one. The variables of interest
for comparison between the two groups were characterized by being
related to the patient, implant site, or implant itself. Comparing the
older and younger patients by treatment result seems, generally, inade-
quate because the older patients are exposed to more health-related
issues than younger patients. As expected, proportions showed that
the younger population was healthier than the older population (31.0%
vs 76.8%). Almost all (n = 12; 83.3%) patients had at least one systemic
disease in the older group of patients with implant loss. In contrast,
implants were mostly lost in patients (n = 34; 70.6%) without those
conditions in the younger group. Nevertheless, the 11-year cumulative
survival rate according to Kaplan-Meier analysis did not vary consider-
ably between the groups. Conversely, the older group presented higher
The results with survival rates of 95.3%, while those in the younger popula-
tion were 93.9% during the 11-year observation period. These differ-
ences were not statistically significant and, notably, these findings were
consistent with those of studies reported previously.13,14 Another
study conducted recently, which compared cumulative survival rates of
edentulous jaws treated with implants between young (<45 years),
middle-age (45-64 years), and older (>64 years) patients, reported a
higher 10-year cumulative survival rates (about 90%) among the older
patients.19 Reported 10 to 15-year cumulative survival rate for partially
edentulous jaws was 91.7%,21 whereas survival of single implants for
10 years was assessed to be 95.0%.22
6 BOBOEVA ET AL.
In the present study, we adopted a multivariable Cox regression
test with shared frailty model to investigate the effects of multiple
variables present at the same time on implant failure in the older and
younger patients. We found it necessary to add into the model site-
related and implant-related variables together with patient-specific
variables since there is a possible impact of all these on the out-
comes.23 A significant relationship between implant loss and factors
such as the implant size, the implant site, and the implant brand has
been documented in the literature.16,24-26
Ultimately, in the current study, only the diameter of the implant
was a statistically significant risk indicator for both groups. However,
taking into account the most frequent (3.75-4.1 mm) implant diameter
as a reference in both groups, the older patients were affected by
implants with a diameter narrower than 3.75 whereas no evidence of
a greater risk of failure in this category was noted for younger
26
patients. Prasad et al reported a decreased risk of failure when using
implants with regular and wider diameters as compared with those
with narrow diameters. Similarly, the result obtained in the present
study suggests an increased risk of failure correlates with narrower-
diameter implants. Different aspects such as less osseointegration, the
volume and quantity of the host bone, and local infection have been
linked to the failure of implants with narrower diameters.27 Our find-
ings revealed that most of the failed implants with narrow diameters
(4/5 in the older group) were placed in the augmented bone with
grafting material. This could suggest that an insufficient bone-to-
implant surface may have contributed to implant disintegration in the
older group. In contrast, the risk of implant failure decreased for
implant diameter >4.1 mm compared to the implant diameter of 3.75
to 4.1 mm in the younger group. It appears that younger patients
were facilitated with increased primary stability of implants and less
bone loading stress which is associated with wide-diameter dental
implants because the greater surface of dental implants provides
enhanced bone engagement.28
Consistent with the observations of previous reports, most fail-
ures in our study occurred before loading; this was referred to as early
loss.16,29,30 It is assumed that the efficacy of the healing process in
the jaws is reduced with age16; this may be one reason for early
implant failure. However, this analysis showed equally high incidence
rates of failure before implant loading than after loading in both, the
younger and older, populations. Therefore, the possibility of dental-
implant failure in the initial phase should be considered by clinicians,
irrespective of patient age.
Overall, the results of our study suggest that neither survival
probability nor factors impacting the survival of implants in the
older group differ considerably from those in the younger popula-
tion. This finding could be an effect of the sample size and the
number of variables considered. A larger population with a longer
period of observation including more patient-related variables as
seen in previous studies19 could yield more comprehensive results.
This study population represents mixed clinical conditions (single,
partially edentulous and edentulous) that make the comparisons
more complicated. In addition, the inclusion of more factors such
as reasons for tooth loss31 and for implant removal and design to
pursue surgery may facilitate greater understanding of the differ-
ences inherent in implant therapy between older and younger
patients.
Another possible limitation of this study could be the analysis of
the data in terms of the statistical methods used. No other variables,
except diameter, were found to have a statistically significant impact
on implant failure in both groups in this study. The causal explanation
of implant failure is more complex and is what many studies are trying
to report. It is speculated that failure of an implant may occur as a
result of a combination of multiple factors and the evaluation of this
association may cause variations in the results depending on the cho-
sen statistical method.32 In a recent study, the authors demonstrated
better results were obtained using the Bayesian statistical method rel-
ative to classical statistical analysis.33 It is proposed that, accounting
for the posterior distribution, this method properly deals with uncer-
tainty, offering more realistic results.34 Therefore, further investiga-
tion of the present data using different statistical models may reveal
more insightful results.
Considering the aforementioned limitations, more well-designed
studies are ultimately needed in the future.
In conclusion, the results obtained from this retrospective study
with a follow-up period of 1 to 11 years suggests high survival rates
of implants in the older group similar to those in the younger patients.
Analysis of the predictors, except for the diameter of implant,
included in this study did not demonstrate any potential negative
impact on the implant loss in patients aged >65 years, which was simi-
lar to that observed in younger patients. Thus, implant treatment in
older patients is as successful as it is in the younger population. How-
ever, this notion does not excuse the clinician from considering, as
always, age- and health-related changes in their patients prior to pur-
suing implant treatment.
CONFLIC T OF INT ER E ST
The authors declare no conflict of interest.
AUTHOR CONTRIBU TIONS
So-Young Choi, Obida Boboeva: Conception and design of study. Jin-
Wook Kim, Sung-Tak Lee, Obida Boboeva: Acquisition of data. So-
Young Choi, Tae-Geon Kwon, Obida Boboeva: Analysis and /or inter-
pretation of data. Obida Boboeva, So-Young Choi: Drafting the man-
uscript. Tae-Geon Kwon, Jin-Wook Kim, Sung-Tak Lee, So-Young
Choi: Revising manuscript critically for important intellectual content.
So-Young Choi: Approval of the version of the manuscript to be
published.
DATA AVAILABILITY STAT EMEN T
The authors confirm that the data supporting the findings of this
study are available within the article and its supplementary materials.
OR CID
So-Young Choi https://orcid.org/0000-0002-2563-3539
BOBOEVA ET AL.
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How to cite this article: Boboeva O, Kwon T-G, Kim J-W,
Lee S-T, Choi S-Y. Comparing factors affecting dental-implant
loss between age groups: A retrospective cohort study. Clin
Implant Dent Relat Res. 2020;1–8. https://doi.org/10.1111/
cid.12967
8 BOBOEVA ET AL.

APPENDIX A

T A B L E A 1 Cox regression model with shared frailty model

analysis for implant failure in total sample

Total sample

Hazard
Predictors ratio 95.0% CI
Group (ref.: Younger) Older 1.29 0.52-3.25
Sex (ref.: Male) Female 0.83 0.37-1.82
Smoker (ref.: Nonsmoker) 2.05 0.52-8.12
General disease
Diabetes (ref.: No) Yes 1.83 0.56-5.92
Osteoporosis (ref.: No) Yes 1.94 0.52-7.31
CVD (ref.: No) Yes 0.99 0.29-3.40
Arthritis (ref.: No) Yes 0.55 0.12-2.63
Patients with medical conditions (ref.: 1.00 0.25-4.09
F I G U R E A 1 Proportions of patients by age at implantation
No) Yes
included in the study
Number of implants per patient 0.89 0.70-1.13
Site (ref.: Anterior maxilla)
Premolar maxilla 0.97 0.35-2.70
Molar maxilla 1.00 0.33-3.03
Anterior mandible 0.79 0.24-2.63
Premolar mandible 0.49 0.11-2.10
Molar mandible 1.64 0.56-4.79
Diameter (ref.: 3.75-4.1 mm)
<3.75 mm 1.24 0.48-3.20
>4.1 mm 0.25 0.08-0.74
Length (ref.: >10.0 mm)
≤10.0 mm 0.96 0.47-1.99
Brand (ref.: Osstem)
Dentium 0.72 0.30-1.69
Straumann 0.72 0.25-2.11
FIGURE A2 Proportions of patients included by year in the study
in each group Others 1.23 0.37-4.03
Bone graft (ref.: No) Yes 0.95 0.40-2.27
Membrane (ref.: No) Yes 1.69 0.67-4.28
15.0
Note: Others—Astra Tech, Dentis, Megagen.
Incidence of failure rate per 100 patients (%)

14.0
13.0
12.0
11.0
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
0 10 20 30 40 50 60 70 80 90 100
Age at implantation

F I G U R E A 3 Incidence of overall failure rate per 100 patients (y-

axis) according to age at implantation in 10-year age groups (x-axis) of
the study population