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


OBJECTIVE
The aim of this study was to compare three different esthetic indices for the evaluation of single implant-supported crowns.


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).


CONCLUSIONS
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.
Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
Sandro
S
Tettamanti
Department of Restorative Dentistry, Edinburgh Dental Institute, Edinburgh, Scotland.
Christopher
C
Millen
Department of Fixed Prosthodontics and Occlusion, School of Dental Medicine, University of Geneva, Geneva, Switzerland.
Jelena
J
Gavric
Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
Daniel
D
Buser
Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
Urs C
UC
Belser
Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
Urs
U
Brägger
Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.|Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA, USA.
Julia-Gabriela
JG
Wittneben
D003442:Crowns; D019250:Dental Implants, Single-Tooth; D017267:Dental Prosthesis Design; D004955:Esthetics, Dental; D006801:Humans; D008437:Maxilla / Q000601:surgery; D015588:Observer Variation; D017060:Patient Satisfaction; D015203:Reproducibility of Results
ICA; ICAI; PES/WES; PICI; aesthetic; dental implant; esthetic; esthetic index; implant crown; implant-supported crown; pink; white