Esthetic Evaluation of Implant Crowns and Peri‐Implant Soft Tissue in the Anterior Maxilla: Comparison and Reproducibility of Three Different Indices

Abstract

Background A successful implant reconstruction with optimal esthetics consists of a visually pleasing prosthesis and complete and healthy surrounding soft tissue. In the current literature, numerous indices used to qualitatively assess esthetics have been described. However, studies comparing the indices and their reproducibility are scarce. Purpose The aim of this study was to compare three different esthetic indices for the evaluation of single implant‐supported crowns. Materials and Methods A total of 10 prosthodontists (P), 10 orthodontists (O), 10 general dentists (G), and 10 lay people (L) independently performed the same assessment using 30 photographs and corresponding casts with three different esthetic indices (Peri‐Implant and Crown Index [PICI], Implant Crown Aesthetic Index [ICAI], “Pink Esthetic Score/White Esthetic Score [PES/WES]) and repeated the evaluations 4 weeks later. Results The PES/WES and the PICI showed significantly higher esthetic scores (pink, white, total) and clinical acceptance compared with the ICAI in all four groups and in both assessments. The highest intraobserver agreement was achieved using the PES/WES and the least with the ICAI. The mean Kappa per group ranged from 0.18 (group L with ICAI) to 0.63 (group G with PICI). Conclusion In comparison with the ICAI, the PES/WES and PICI were more reproducible. Therefore, PES/WES and PICI seem to be more suitable as esthetic indices for single implant crowns.

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

“…Other means to assess the esthetic outcome of single implant-supported restorations are various indices, such as implant aesthetic crown index (ICA), subjective esthetic score (SES), peri-implant and crown index (PICI), and comprehensive index comprising pink and white esthetic score (PES/WES) 14151617…”

Influence of the fixed implant‐supported provisional phase on the esthetic final outcome of implant‐supported crowns: 3‐year results of a randomized controlled clinical trial

“…Analyzing the volume changes within the mucosa and emergence profile before and after soft tissue conditioning with an implant-supported provisional-a significant difference was documented. The use of the PES/WES index is highly recommended for clinical studies, as it represents the most frequently used esthetic index for implant-supported crowns, one of the most reproducible index and the most userfriendly esthetic index 16. Therefore, the implementation of a distinct provisional phase was recommended.The findings of the present randomized clinical trial underline these outcomes.…”

Clinical Application of the PES/WES Index on Natural Teeth: Case Report and Literature Review

“…We have reported in this case report a strong correlation between the esthetic evaluation performed by the dentist (PES/WES) and by the patient (VAS) as other studies have reported it [21, 22]. PES/WES like PICI seemed to be more suitable than ICAI as esthetic indices; they are reproducible esthetic indices that are not influenced by different observers and present similar outcomes in the overall esthetic evaluation and because of this, they are recommended for clinical use [20]. In this study we want to show how this index is reliable even for the aesthetic evaluation of hard and soft tissues in the prosthetic rehabilitation of the natural tooth and how this index can be a clinical aid in controlling the maintenance of pink and white tissue over time as shown in the follow-up of 5 years in Figure 6.…”

“…Other means to assess the esthetic outcome of single-implant-supported restorations are various indices, such as implant aesthetic crown index (ICA), subjective esthetic score (SES), Peri-Implant and Crown Index (PICI), and comprehensive index comprising Pink and White Esthetic Score (PES/WES) [17–20]. Fürhauser et al introduced an excellent index termed Pink Esthetic Score (PES) for evaluation of the soft tissue around single-implant crowns that might change over time; PES could be a useful tool for monitoring long-term soft tissue alterations [18].…”

“…The limitations of the study by Meijer et al were the small sample size and recruitment of only two specialists (oral surgeon and prosthodontist). According to a recent study comparing the indices and their reproducibility, PES/WES and PICI seemed to be more suitable than ICAI as esthetic indices for single-implant-supported crowns [20]. The main aim of this study is to describe the PES/WES index and its clinical application on natural teeth.…”