Comprehensive Esthetic Evaluation of Maxillary Central Incisor Single-Tooth Implant: Utilizing Visual Analogue Scale and Assessing Alignment with PES/WES Criteria by Dental Specialists
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Abstract
Introduction: Single-tooth implants are a common dental treatment, with a growing emphasis on esthetic out-comes due to their high survival and success rates, especially in esthetic areas. This study assessed consensus among specialists using the Visual Analogue Scale (VAS), focusing on the objective criteria of Pink Esthetic Score (PES) and White Esthetic Score (WES). Materials and Methods: This cross-sectional study evaluated the esthetic aspects of a maxillary central single-tooth implant using VAS, involving 18 prosthodontists, 11 restorative specialists, 12 periodontists, and 11 Oral Maxillofacial Surgeons. A photo of an ideally contoured implant-supported restoration, taken three months post-delivery, underwent alterations to create 15 variations based on PES/WES criteria. Specialists provided VAS scores (0 to 10) for restoration esthetics and soft tissue surrounding the implant. Scores were compared with PES/WES, and Pearson correlation coefficients determined relationships. The significance level of the p-value is 0.05. Results: Prosthodontists showed a strong correlation with PES (0.86±0.09), WES (0.88±0.07), and PES/WES (0.88±0.08). Restorative specialists exhibited correlations of PES (0.73±0.25), WES (0.73±0.29), and PES/WES (0.74±0.28). Periodontists demonstrated correlations with PES (0.87±0.07), WES (0.84±0.08), and the ratio of PES to WES (0.86±0.07). OMF surgeons had correla-tions of PES (0.83±0.11), WES (0.85±0.09), and PES/WES (0.85±0.1). Inter-group correlations did not significantly differ (P Value>0.05). Conclusion: Robust correlations exist among specialists in evaluating implant esthetics using VAS and PES/WES, with restorative and surgical specialists displaying a stricter approach. Keywords: White esthetic score; Pink esthetic score; Visual analog scales; Implant-supported single crown.
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3.Albrektsson T, Zarb G, Worthington P, Eriksson A. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int j oral maxillofac implants. 1986;1(1):11-25.
4.Wang, II, Barootchi S, Tavelli L, Wang HL. The peri-implant phenotype and implant esthetic complications. Contemporary overview. J Esthet Restor Dent. 2021;33(1):212-23.
5.Fürhauser R, Florescu D, Benesch T, Haas R, Mailath G, Watzek G. Evaluation of soft tissue around single‐tooth implant crowns: the pink esthetic score. Clinical oral implants research. 2005;16(6):639-44.
6.Altay MA, Sindel A, Tezerişener HA, Yıldırımyan N, Özarslan MM. Esthetic evaluation of implant-supported single crowns: a comparison of objective and patient-reported outcomes. International journal of implant dentistry. 2019;5(1):2-.
7.Hartlev J, Kohberg P, Ahlmann S, Andersen NT, Schou S, Isidor F. Patient satisfaction and esthetic outcome after immediate placement and provisionalization of single‐tooth implants involving a definitive individual abutment. Clinical oral implants research. 2014;25(11):1245-50.
8.Hof M, Umar N, Budas N, Seemann R, Pommer B, Zechner W. Evaluation of implant esthetics using eight objective indices—Comparative analysis of reliability and validity. Clinical oral implants research. 2018;29(7):697-706.
9.Chander NG. Visual analog scale in prosthodontics. The Journal of Indian Prosthodontic Society. 2019;19(2):99.
10.Tettamanti S, Millen C, Gavric J, Buser D, Belser U, Brägger U, et al. Esthetic Evaluation of Implant Crowns and
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12.Belser UC, Grütter L, Vailati F, Bornstein MM, Weber HP, Buser D. Outcome evaluation of early placed maxillary anterior single‐tooth implants using objective esthetic criteria: a cross‐sectional, retrospective study in 45 patients with a 2‐to 4‐year follow‐up using pink and white esthetic scores. Journal of periodontology. 2009;80(1):140-51.
13.Afrashtehfar KI, Assery MKA, Bryant SR. Aesthetic Parameters and Patient-Perspective Assessment Tools for Maxillary Anterior Single Implants. Int J Dent. 2021;2021:6684028.
14.Godani A, Iyer J, Nadgere J, Mohite A, Gaikwad A. Impact of immediate interim restoration on peri-implant tissues around immediately placed single dental implants in the esthetic region: A systematic review and meta-analysis. J Prosthet Dent. 2024.
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16.Lyu XL, Shi JY, Qian SJ, Lai HC. [Short-term comparison of the clinical efficacy of angulated screw-retained implant crowns and cemented implant crowns in esthetics region]. Shanghai Kou Qiang Yi Xue. 2022;31:423-8.
17.Padhye NM, Calciolari E, Zuercher AN, Tagliaferri S, Donos N. Survival and success of zirconia compared with titanium implants: a systematic review and meta-analysis. Clin Oral Investig. 2023;27(11):6279-90.
18.Genetti L, Ercoli C, Kotsailidi EA, Feng C, Tsigarida A, Russo LL, et al. Clinical Evaluation of Pink Esthetic Score of Immediately Impressed Posterior Dental Implants. J Prosthodont. 2022;31(6):496-501.
19.Han X, Qi C, Guo P, Zhang S, Xu Y, Lv G, et al. Whole-Process Digitalization-Assisted Immediate Implant Placement and Immediate Restoration in the Aesthetic Zone: A Prospective Study. Med Sci Monit. 2021;27:e931544.
20.Merchant A, Maiti S, Rajaraman V, Velayudhan A, Ganapathy DM. Comparative analysis of pink and white esthetics of anterior full veneer crown: Indian scenario. J Adv Pharm Technol Res. 2022;13(Suppl 1):S282-S7.
21.Chen Z, Zhang S, Zhou J, Liang H. Immediate versus Delayed Implantation for Single-Tooth Restoration of Ma-xillary Anterior Teeth: A Comparative Analysis on Efficacy. Comput Math Methods Med. 2022;2022: 4490335.
22.Yang JW, Jia PY, Qiu LX, Lu C, Jiang T. [Feasibility analysis of visual analogue scale in esthetic evaluation of anterior implant-supported single crown in maxilla]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2021;56(4):324-8.
23.Kniha K, Kniha H, Grunert I, Edelhoff D, Holzle F, Modabber A. Esthetic Evaluation of Maxillary Single-Tooth Zirconia Implants in the Esthetic Zone. Int J Periodontics Restorative Dent. 2019;39(5):e195-e201.
24.Cho HL, Lee JK, Um HS, Chang BS. Esthetic evaluation of maxillary single-tooth implants in the esthetic zone. J Periodontal Implant Sci. 2010;40(4):188-93.
25.Rupchandani R. Do immediately placed implants have better outcomes when placed with a minimal split-thickness envelope flap? Evid Based Dent. 2021;22(4):126-7.
26.Gjelvold B, Kisch J, Chrcanovic BR. A Randomized Clinical Trial Comparing Immediate Loading and Delayed Loading of Single-Tooth Implants: 5-Year Results. J Clin Med. 2021;10(5).
27.Cho HL, Lee JK, Um HS, Chang BS. Esthetic evaluation of maxillary single-tooth implants in the esthetic zone. Journal of periodontal & implant science. 2010;40(4):188.
28.Jones AR, Martin W. Comparing pink and white esthetic scores to layperson perception in the single-tooth implant patient. Int J Oral Maxillofac Implants. 2014;29(6):1348-53.
29.Boon L, De Mars G, Favril C, Duyck J, Quirynen M, Vandamme K. Esthetic evaluation of single implant restorations, adjacent single implant restorations, and implant-supported fixed partial dentures: A 1-year prospective study. Clin Implant Dent Relat Res. 2020;22(1):128-37.
30.Zhang CN, Zhu Y, Zhang YJ, Jiang YH. Clinical esthetic comparison between monolithic high-translucency multilayer zirconia and traditional veneered zirconia for single implant restoration in maxillary esthetic areas: Prosthetic and patient-centered outcomes. J Dent Sci. 2022;17(3):1151-9.
31.Hamdane K, Nasri W. Esthetic evaluation of single implant-supported prostheses: Comparative analysis of the reliability of the esthetic indices. J Esthet Restor Dent. 2022;34(4):680-8.
32.Foong ALY, Tey VHS, Tan KBC, Teoh KH, Tan K. Esthetic Evaluation of Anterior Implant-Supported Single Crowns: A Comparison Between Patients and Dentists. Int J Prosthodont. 2022;35(4):396-404.
33.Deng XL, Yuan S, Zhu DT, Shi L. [Evaluation of red and white aesthetic effects of porcelain veneers in the restoration of developmental anterior dental gaps]. Shanghai Kou Qiang Yi Xue. 2023;32(3):276-9.
34.Pollini A, Morton D, Arunyanak SP, Harris BT, Lin WS. Evaluation of esthetic parameters related to a single implant restoration by laypeople and dentists. J Prosthet Dent. 2020;124(1):94-9.
35.Chen L, Li DL, Yang Y, Liu XQ, Tan JG. [Esthetic evaluation of conventional and socket shield technique immediate implant restoration]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2022;57(4):346-51.
36.Al-Dosari A, Ra'ed Al-Rowis FM, Alshehri F, Ballo AM. Esthetic outcome for maxillary anterior single implants assessed by different dental specialists. The journal of advanced prosthodontics. 2016;8(5):345.
37.Balasubramaniam AS, Raja SV, Thomas LJ. Peri-implant esthetics assessment and management. Dental research journal. 2013;10(1):7-14.
38.Sikri VK. Color: Implications in dentistry. Journal of conservative dentistry : JCD. 2010;13(4):249-55.
39.CJ Kazilek KC. "Rods and Cones of the Human eye". ASU - Ask A Biologist 2010.
2.Sabri R. The eight components of a balanced smile. J Clin Orthod. 2005;39(3):155-67.
3.Albrektsson T, Zarb G, Worthington P, Eriksson A. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int j oral maxillofac implants. 1986;1(1):11-25.
4.Wang, II, Barootchi S, Tavelli L, Wang HL. The peri-implant phenotype and implant esthetic complications. Contemporary overview. J Esthet Restor Dent. 2021;33(1):212-23.
5.Fürhauser R, Florescu D, Benesch T, Haas R, Mailath G, Watzek G. Evaluation of soft tissue around single‐tooth implant crowns: the pink esthetic score. Clinical oral implants research. 2005;16(6):639-44.
6.Altay MA, Sindel A, Tezerişener HA, Yıldırımyan N, Özarslan MM. Esthetic evaluation of implant-supported single crowns: a comparison of objective and patient-reported outcomes. International journal of implant dentistry. 2019;5(1):2-.
7.Hartlev J, Kohberg P, Ahlmann S, Andersen NT, Schou S, Isidor F. Patient satisfaction and esthetic outcome after immediate placement and provisionalization of single‐tooth implants involving a definitive individual abutment. Clinical oral implants research. 2014;25(11):1245-50.
8.Hof M, Umar N, Budas N, Seemann R, Pommer B, Zechner W. Evaluation of implant esthetics using eight objective indices—Comparative analysis of reliability and validity. Clinical oral implants research. 2018;29(7):697-706.
9.Chander NG. Visual analog scale in prosthodontics. The Journal of Indian Prosthodontic Society. 2019;19(2):99.
10.Tettamanti S, Millen C, Gavric J, Buser D, Belser U, Brägger U, et al. Esthetic Evaluation of Implant Crowns and
Peri-Implant Soft Tissue in the Anterior Maxilla: Comparison and Reproducibility of Three Different Indices. Clinical Implant Dentistry and Related Research. 2015;18.
11.Sanchez-Perez A, Nicolas-Silvente AI, Sanchez-Matas C, Molina-García S, Navarro-Cuellar C, Romanos GE. Primary stability and PES/WES evaluation for immediate implants in the aesthetic zone: a pilot clinical double-blind randomized study. Scientific Reports. 2021;11(1):20024.
12.Belser UC, Grütter L, Vailati F, Bornstein MM, Weber HP, Buser D. Outcome evaluation of early placed maxillary anterior single‐tooth implants using objective esthetic criteria: a cross‐sectional, retrospective study in 45 patients with a 2‐to 4‐year follow‐up using pink and white esthetic scores. Journal of periodontology. 2009;80(1):140-51.
13.Afrashtehfar KI, Assery MKA, Bryant SR. Aesthetic Parameters and Patient-Perspective Assessment Tools for Maxillary Anterior Single Implants. Int J Dent. 2021;2021:6684028.
14.Godani A, Iyer J, Nadgere J, Mohite A, Gaikwad A. Impact of immediate interim restoration on peri-implant tissues around immediately placed single dental implants in the esthetic region: A systematic review and meta-analysis. J Prosthet Dent. 2024.
15.Amorfini L, Pesce P, Migliorati M, Drago S, Storelli S, Romeo E, et al. Implant rehabilitation of the esthetic area: A five-year retrospective study comparing conventional and fully guided surgery. Clin Implant Dent Relat Res. 2023;25(3):438-46.
16.Lyu XL, Shi JY, Qian SJ, Lai HC. [Short-term comparison of the clinical efficacy of angulated screw-retained implant crowns and cemented implant crowns in esthetics region]. Shanghai Kou Qiang Yi Xue. 2022;31:423-8.
17.Padhye NM, Calciolari E, Zuercher AN, Tagliaferri S, Donos N. Survival and success of zirconia compared with titanium implants: a systematic review and meta-analysis. Clin Oral Investig. 2023;27(11):6279-90.
18.Genetti L, Ercoli C, Kotsailidi EA, Feng C, Tsigarida A, Russo LL, et al. Clinical Evaluation of Pink Esthetic Score of Immediately Impressed Posterior Dental Implants. J Prosthodont. 2022;31(6):496-501.
19.Han X, Qi C, Guo P, Zhang S, Xu Y, Lv G, et al. Whole-Process Digitalization-Assisted Immediate Implant Placement and Immediate Restoration in the Aesthetic Zone: A Prospective Study. Med Sci Monit. 2021;27:e931544.
20.Merchant A, Maiti S, Rajaraman V, Velayudhan A, Ganapathy DM. Comparative analysis of pink and white esthetics of anterior full veneer crown: Indian scenario. J Adv Pharm Technol Res. 2022;13(Suppl 1):S282-S7.
21.Chen Z, Zhang S, Zhou J, Liang H. Immediate versus Delayed Implantation for Single-Tooth Restoration of Ma-xillary Anterior Teeth: A Comparative Analysis on Efficacy. Comput Math Methods Med. 2022;2022: 4490335.
22.Yang JW, Jia PY, Qiu LX, Lu C, Jiang T. [Feasibility analysis of visual analogue scale in esthetic evaluation of anterior implant-supported single crown in maxilla]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2021;56(4):324-8.
23.Kniha K, Kniha H, Grunert I, Edelhoff D, Holzle F, Modabber A. Esthetic Evaluation of Maxillary Single-Tooth Zirconia Implants in the Esthetic Zone. Int J Periodontics Restorative Dent. 2019;39(5):e195-e201.
24.Cho HL, Lee JK, Um HS, Chang BS. Esthetic evaluation of maxillary single-tooth implants in the esthetic zone. J Periodontal Implant Sci. 2010;40(4):188-93.
25.Rupchandani R. Do immediately placed implants have better outcomes when placed with a minimal split-thickness envelope flap? Evid Based Dent. 2021;22(4):126-7.
26.Gjelvold B, Kisch J, Chrcanovic BR. A Randomized Clinical Trial Comparing Immediate Loading and Delayed Loading of Single-Tooth Implants: 5-Year Results. J Clin Med. 2021;10(5).
27.Cho HL, Lee JK, Um HS, Chang BS. Esthetic evaluation of maxillary single-tooth implants in the esthetic zone. Journal of periodontal & implant science. 2010;40(4):188.
28.Jones AR, Martin W. Comparing pink and white esthetic scores to layperson perception in the single-tooth implant patient. Int J Oral Maxillofac Implants. 2014;29(6):1348-53.
29.Boon L, De Mars G, Favril C, Duyck J, Quirynen M, Vandamme K. Esthetic evaluation of single implant restorations, adjacent single implant restorations, and implant-supported fixed partial dentures: A 1-year prospective study. Clin Implant Dent Relat Res. 2020;22(1):128-37.
30.Zhang CN, Zhu Y, Zhang YJ, Jiang YH. Clinical esthetic comparison between monolithic high-translucency multilayer zirconia and traditional veneered zirconia for single implant restoration in maxillary esthetic areas: Prosthetic and patient-centered outcomes. J Dent Sci. 2022;17(3):1151-9.
31.Hamdane K, Nasri W. Esthetic evaluation of single implant-supported prostheses: Comparative analysis of the reliability of the esthetic indices. J Esthet Restor Dent. 2022;34(4):680-8.
32.Foong ALY, Tey VHS, Tan KBC, Teoh KH, Tan K. Esthetic Evaluation of Anterior Implant-Supported Single Crowns: A Comparison Between Patients and Dentists. Int J Prosthodont. 2022;35(4):396-404.
33.Deng XL, Yuan S, Zhu DT, Shi L. [Evaluation of red and white aesthetic effects of porcelain veneers in the restoration of developmental anterior dental gaps]. Shanghai Kou Qiang Yi Xue. 2023;32(3):276-9.
34.Pollini A, Morton D, Arunyanak SP, Harris BT, Lin WS. Evaluation of esthetic parameters related to a single implant restoration by laypeople and dentists. J Prosthet Dent. 2020;124(1):94-9.
35.Chen L, Li DL, Yang Y, Liu XQ, Tan JG. [Esthetic evaluation of conventional and socket shield technique immediate implant restoration]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2022;57(4):346-51.
36.Al-Dosari A, Ra'ed Al-Rowis FM, Alshehri F, Ballo AM. Esthetic outcome for maxillary anterior single implants assessed by different dental specialists. The journal of advanced prosthodontics. 2016;8(5):345.
37.Balasubramaniam AS, Raja SV, Thomas LJ. Peri-implant esthetics assessment and management. Dental research journal. 2013;10(1):7-14.
38.Sikri VK. Color: Implications in dentistry. Journal of conservative dentistry : JCD. 2010;13(4):249-55.
39.CJ Kazilek KC. "Rods and Cones of the Human eye". ASU - Ask A Biologist 2010.
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| Issue | Vol 12, No 1 (Winter 2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| White esthetic score; Pink esthetic score; Visual analog scales; Implant-supported single crown. | ||
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How to Cite
1.
Atri F, Sarabi M, Abbasnia Tehrani MM, Eftekhar M, Rouzmeh N. Comprehensive Esthetic Evaluation of Maxillary Central Incisor Single-Tooth Implant: Utilizing Visual Analogue Scale and Assessing Alignment with PES/WES Criteria by Dental Specialists. J Craniomaxillofac Res. 2025;12(1):33-41.
