Esthetic evaluation of maxillary anterior single-tooth implant by dental specialists and non-dental personnel

Background: Implant therapy in partially edentulous patients has become a wellestablished treatment modality, in general, and anterior single-tooth replacement has become a highly predictable solution. However, the current literature is scarce when it comes to objective outcome evaluation from an esthetic point of view. Aim: The aim of this study was to assess the correlation between non-dental personnel’s perception of single-tooth implant restoration (STIR) with pink esthetic score (PES)/ white esthetic score (WES) grading given by different dental specialists. Materials and Methods: A total of 20 photographs with one implant restoration in the esthetic zone (maxillary canine to canine) surrounded by virgin teeth were included in the study. A total of 20 specialists (4 periodontists; 4 prosthodontists; 4 oral surgeons; 4 endodontists; and 4 senior general dental practitioners) evaluated the photographs for PES and WES scores. Same photographs were presented to 25 laypeople. They were instructed to identify which tooth was STIR and also record what factor influenced their decision for selecting STIR (surrounding peri-implant soft tissue or implant restoration). Results: Among the dental specialists, oral surgeons were very generous in PES/WES scores followed by endodontists, periodontists, general practitioners, and least scores were assigned by prosthodontists. The difference between all five groups was statistically significant. Furthermore, a negative correlation was observed between mean PES/WES scores assigned by specialists with positive identification of STIR by laypeople. Conclusion: Achieving good consistent anterior esthetics is a challenge. The hard and soft tissues, as well as the crown portion, have to be in harmony for acceptable results. In this study, highest score was given by oral surgeons and prosthodontists were very critical. Furthermore, it was observed that laypeople identified white esthetic deficiencies more frequently than pink esthetic deficiencies. Clinical Significance: Anterior maxillary single-tooth implant replacement is a successful and predictable treatment modality. PES/WES index are valuable objective assessment tools for evaluating anterior esthetics. However, the dentist’s assessment may be different from that of the patient, because the latter is more subjective. Thus, a combination of subjective and objective assessment tools is essential while evaluating anterior esthetics.