title: Agreement of quantitative subjective evaluation of esthetic changes in implant dentistry by patients and practitioners.
abstract: OBJECTIVE
  To evaluate the agreement of quantitative subjective evaluation of esthetic changes in implant dentistry and differences in perception among patients and practitioners.
  
  
  METHODS
  Four standardized clinical preoperative and postoperative pictures placed in random order were shown to 30 patients treated with dental implants, on two separate occasions, to subjectively evaluate the esthetic changes using both a graded scale and a visual analogue scale (VAS). The photographs included the front views of the overall smile and, when available, magnified pictures of the area treated including the two neighboring teeth. The same photographs were shown to 10 independent clinicians, who used the same scoring system. Agreement was assessed by evaluating intraobserver and interobserver agreement with a weighted Kappa statistic.
  
  
  RESULTS
  In general, agreement was moderate to substantial among patients but only fair among clinicians, with only one practitioner being consistently reproducible. Patients had better agreement than clinicians, but they only evaluated themselves, whereas the clinicians each had to evaluate 30 patients. The agreement of all patients together compared to each individual clinician was poor. The overall agreement between clinicians was also poor.
  
  
  CONCLUSIONS
  This study of evaluations of pretreatment and posttreatment photographs by 30 patients and clinicians showed that: (1) patient responses were more in agreement, but patients evaluated only their own results; (2) practitioner responses were less in agreement than patient response, but clinicians evaluated all 30 patients; and (3) agreement between patients and clinicians was poor.
authors.affiliation: Oral and Maxillofacial Surgery, School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester M15 6FH, UK. espositomarco@hotmail.com
authors.forename: Marco
authors.initials: M
authors.lastname: Esposito
authors.forename: Maria Gabriella
authors.initials: MG
authors.lastname: Grusovin
authors.forename: Helen V
authors.initials: HV
authors.lastname: Worthington
mesh_terms: D001291:Attitude of Health Personnel; D015921:Dental Implants / Q000523:psychology / Q000592:standards*; D003793:Dental Restoration, Permanent / Q000523:psychology / Q000592:standards*; D003815:Dentists / Q000523:psychology; D004955:Esthetics, Dental / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D017063:Outcome Assessment, Health Care / Q000592:standards; D017060:Patient Satisfaction; D015203:Reproducibility of Results
chemical_list: D015921:Dental Implants