title: Clinician assessments and patient perspectives of single-tooth implant restorations in the esthetic zone of the maxilla: A systematic review.
abstract: BACKGROUND
  Esthetic outcomes associated with implant dentistry are important to both clinicians and patients. However, esthetic satisfaction may vary between the 2 groups. In order to evaluate the current publications relating to this topic, the following focused question was developed, "what are the quantitative and qualitative differences between clinician evaluations and patient perspectives in the assessment of single-tooth implant outcomes in the esthetic zone?"
  
  
  OBJECTIVE
  The purpose of this systematic review was to identify differences in esthetic satisfaction between clinicians and patients when evaluating single-tooth implant-supported restorations.
  
  
  METHODS
  An electronic search of the Medline database and Cochrane Central Register of Controlled Trials (2000 to 2014) was performed. The search was supplemented by a manual search of specific journals. A quality assessment of full-text articles was performed according to Cochrane Collaboration's tool and Newcastle-Ottawa scale for risk of bias assessment. Information regarding outcomes was collected and compared.
  
  
  RESULTS
  The search term combinations identified 555 titles. Subsequent to further review, 11 publications, including 2 randomized controlled trials, were selected for inclusion. Because of the heterogeneity of the study designs, study interventions, and esthetic assessment methods, no meta-analysis was performed. The clinicians identified a satisfactory outcome in 51% to 100% for peri-implant soft tissue and 62% to 90% for implant restorations. Patients showed a mean range score of 43% to 93% for peri-implant soft tissue and 81% to 96% for implant restorations. The visual analog scale score of the dentists was always lower than that of the patients. The review identified correlations between subjective and objective assessments for the Pink Esthetic Score (PES), the Papilla Index (PI), the Implant Crown Aesthetic Index (ICAI), and the modified (mod-ICAI) indices.
  
  
  CONCLUSIONS
  Clinicians are more critical of esthetic outcomes than patients. The PES and the PI correlated with the patients' responses concerning the peri-implant soft tissue. The ICAI and the mod-ICAI showed a correlation of both the peri-implant mucosa and implant-supported crown satisfaction. Thus, a comprehensive and practical index should be developed to assess the esthetic outcomes for single-tooth implant restorations in the esthetic zone.
authors.affiliation: Lecturer, Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand; and Former ITI Scholar, Department of Oral Health and Rehabilitation, School of Dentistry, University of Louisville, Louisville, Ky.
authors.forename: Sirikarn P
authors.initials: SP
authors.lastname: Arunyanak
authors.affiliation: Resident, Graduate Prosthodontics, Department of Oral Health and Rehabilitation, School of Dentistry, University of Louisville, Louisville, Ky.
authors.forename: Adrien
authors.initials: A
authors.lastname: Pollini
authors.affiliation: Private practice, Fredericksburg, Va; and former Assistant Professor, Department of Oral Health and Rehabilitation, University of Louisville, School of Dentistry, Louisville, Ky.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Ntounis
authors.affiliation: Professor and Chair, Department of Prosthodontics, School of Dentistry, Indiana University, Indianapolis, Ind. Electronic address: deamorto@iu.edu.
authors.forename: Dean
authors.initials: D
authors.lastname: Morton
mesh_terms: D003442:Crowns; D016208:Databases, Factual; D003758:Dental Implantation, Endosseous; D019250:Dental Implants, Single-Tooth; D019094:Dental Prosthesis, Implant-Supported; D004955:Esthetics, Dental; D006801:Humans; D008437:Maxilla / Q000601:surgery*; D017060:Patient Satisfaction