title: The influence of professional competence on the inter- and intra-individual esthetic evaluation of implant-supported crowns in the anterior maxilla.
abstract: OBJECTIVE
  Evaluation of the influence of professional competence on esthetic predictability of implant-supported crowns in the anterior maxilla and identification of objective factors allowing predictable planning for esthetic results.
  
  
  METHODS
  Sixty patients with 82 implants in the esthetic zone were included in this study. Width of keratinized mucosa, biotype, recessions, and papilla index according to Jemt as well as radiological bone loss were assessed. Study casts and photographs were obtained. Each patient as well as people with different level of expertise (laypersons, students and dentists) rated the esthetic satisfaction after final restoration on a scale (1-10). Correlations between esthetic assessments and previously documented clinical parameters were tested.
  
  
  RESULTS
  The study failed to show a significant relationship between the raters' level of dental expertise and their subjective esthetic evaluation. However, patients rated themselves much more favorable than the three evaluator groups did. A comparison of the clinical parameters with the esthetic evaluation revealed significantly more favorable ratings by the lay group in the presence of a wide attached gingiva (P = 0.021) than by the other groups and by the laypersons (P = 0.002), the dentists (P = 0.003), and students (P = 0.009) in the absence of recessions. The ratio of the implant crown length to the length of the contralateral crown had a negative effect on ratings for all three groups ([laypersons P < 0.001], [students P < 0.001] and [dentists P = 0.001]). The papilla index of the mesial papilla correlated significantly with laypersons' ratings (P = 0.036).
  
  
  CONCLUSIONS
  Earlier investigations are confirmed. Width of keratinized mucosa is a risk factor for esthetic predictability of implant-supported crowns in the anterior maxilla in laypersons' ratings. Furthermore, there is an association between the discrepancy of lengths of implant-supported single crowns to their contralateral natural teeth and esthetic satisfaction for all expertise levels.
authors.affiliation: Department of Periodontology, Centre for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt/Main, Germany.|Private Practice, Soest, Germany.
authors.forename: Hari
authors.initials: H
authors.lastname: Petsos
authors.affiliation: Department of Prosthodontics, Centre for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt/Main, Germany.|Department of Oral Surgery and Implantology, Centre for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt/Main, Germany.
authors.forename: Georgia
authors.initials: G
authors.lastname: Trimpou
authors.affiliation: Department of Periodontology, Centre for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt/Main, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Eickholz
authors.affiliation: Department of Prosthodontics, Centre for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt/Main, Germany.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Lauer
authors.affiliation: Department of Prosthodontics, Centre for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt/Main, Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Weigl
mesh_terms: D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000175:diagnosis; D002983:Clinical Competence; D003442:Crowns; D019094:Dental Prosthesis, Implant-Supported; D004955:Esthetics, Dental; D005260:Female; D005889:Gingival Recession / Q000175:diagnosis; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008875:Middle Aged; D015588:Observer Variation; D017060:Patient Satisfaction; D013223:Statistics as Topic
keywords: bone implant interactions; clinical assessment; clinical research; clinical trials; diagnosis; patient centered outcomes; soft tissue implant interactions