Esthetic evaluation of maxillary single-tooth implants in the esthetic zone

Abstract

PurposeThe aim of this study is to assess the influence exerted by the observer's dental specialization and compare patients' opinion with observers' opinion of the esthetics of maxillary single-tooth implants in the esthetic zone.MethodsForty-one adult patients, who were treated with a single implant in the esthetic zone, were enrolled in this study. Eight observers (2 periodontists, 2 prosthodontists, 2 orthodontists and 2 senior dental students) applied the pink esthetic score (PES)/white esthetic score (WES) to 41 implant-supported single restorations twice with an interval of 4 weeks. We used a visual analog scale (VAS) to assess the patient's satisfaction with the treatment outcome from an esthetic point of view.ResultsIn the PES/WES, very good and moderate intraobserver agreements were noted between the first and second rating. The mean total PES/WES was 11.19 ± 3.59. The mean PES was 5.17 ± 2.29 and mean WES was 6.02 ± 1.96. In the total PES/WES, the difference between the groups was not significant. However, in the WES, the difference between the groups was significant and prosthodontists were found to have assigned poorer ratings than the other groups. Periodontists gave higher ratings than prosthodontists and senior dental students. Orthodontists were clearly more critical than the other observers. The statistical analysis revealed statistically significant correlation between patients' esthetic perception and dentists' perception of the anterior tooth. However, the correlation between the total PES/WES and the VAS score for the first premolar was not statistically significant.ConclusionsThe PES/WES is an objective tool in rating the esthetics of implant supported single crowns and adjacent soft tissues. Orthodontists were the most critical observers, while periodontists were more generous than other observers. The statistical analysis revealed a statistically significant correlation between patients' esthetic perception and dentists' perception of the anterior tooth.

Esthetic outcome for maxillary anterior single implants assessed by different dental specialists

“…It has been reported that the use of oral photographs in the assessment of single-tooth peri-implant soft tissue permitted accurate and objective measurements 3435. In this study, we have reported a strong correlation between the esthetic evaluation performed by the dentist (PES/WES) and by the patient (VAS), which was comparable with the results of the study performed by Cho et al20 Cho et al compared patient's perception on aesthetic appearance with the perception of five trained prosthodontists and concluded that professionals might be much more critical towards the aesthetic outcome than the patients. This result was in contradiction to other studies, in which no correlation was observed 16…”

“…In another study, the aesthetic implant crown index was used, and this index was related to the implant restoration itself and the surrounding soft tissues 14. The results of the present study showed that the mesial and distal papilla scores were slightly less favorable (1.5 and 1.4, respectively) in comparison with other studies 1620. It is difficult to compare the papilla level between the studies because each study followed a different surgical protocol.…”

“…The effects of the observer's specialization were further investigated in the study by Cho et al20 using PES/WES index, which was the only study to recruit periodontists. However, the study had limitations due to the small number of the examiners from each specialty group and no oral surgeons involved in the study.…”

End points and assessments in esthetic dental treatment

“…Fuhauser et al reported that orthodontists were the most critical among twenty observers (five prosthodontists, five oral surgeons, five orthodontists, and five dental students) who assessed the PES of the soft tissue of 30 single-tooth implant crowns [29]. Cho et al mentioned that periodontists were the most generous and prosthodontists were the most critical of eight observers (two periodontists, two prosthodontists, two orthodontists, and two dental students) who assessed the PES and WES of 41 implant-supported single restorations [30]. Careful attention should be paid to the assessments of different observers, especially in different fields, when using the PES and WES.…”

Principles of Soft Tissue Management in Dental Implants

“…The PES is a composite score of the tooth volume/outline [2], mesio-gingival papilla, distal gingival papilla, labial margin curvature, labial edge height, and the color and texture of soft tissue.…”