Multilevel Modeling of Periodontal Data (III)

MLM

After a long hiatus due to other projects, final exams and, well, some vacation, the next chapter of my multilevel modeling manual was overdue, but here it comes.

MULTILEVEL MODELING OF PERIODONTAL DATA

Manual version 2014.1

Hans-Peter Müller

3 Time Series Models

In the two previous chapters, observations have been modeled which had been made at teeth which were nested in subjects. Now, consider that observations had been repeated in a longitudinal way, for example after therapy. For that purpose, we want to define a lower level (one) as repeated measures, or occasion, while teeth and subjects would define levels two and three, respectively. 

Consider, for instance changes of the entire gingival unit after the implantation of a bio-resorbable membrane for surgical root coverage employing the principle of guided tissue regeneration. Apart from achievable root coverage, the implantation of the membrane and concomitant coronal advancement of the mucoperiosteal flap leads to an immediate increase in thickness of gingiva and later in width of keratinized tissue. Of course, the mucogingival border is displaced but may re-establish itself later in its original position. Note that these alterations at teeth are non-linear and, since wound healing proceeds and regenerated tissue matures over time, non-monotonic (see example (C) in Fig. 13.1 in Rasbash et al. 2012). And they certainly depend on the subject. So, we have a three-level structure with a sample of subjects in which we study gingival dimensions at teeth, which have been surgically treated, over time. The data had been analyzed by multilevel modeling in some detail by Müller (2008).

In this chapter we want to introduce the data set which had been created in a longitudinal study (Müller et al. 2000d) and set up several multilevel models further elaborating the basic time series model.

3.1 Repeated Measures Data on Gingival Dimensions after Surgical Root Coverage

The data set consists of observations which have been made in 14 patients who had presented with a large variety of recession types at altogether 31 teeth. They had been treated according to the principles of guided tissue regeneration employing a bio-resorbable membrane. Surgical root coverage consisted, after periosteal dissection, of a coronally advanced flap which was secured with sling sutures. Several preoperative clinical parameters and intrasurgical observations were assessed. Patients were followed up for 1 year, and re-examinations of the clinical situation were carried out after 3, 6, 9 and 12 months.

Continue reading.

14 August 2014 @ 8:01 am.

Last modified August 14, 2014.

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