Patient-Reported Satisfaction with Single-Tooth Implants in the Maxillary Esthetic Zone and an Exploratory Assessment of PES/WES Reliability
-
Davood Nodehi
,
Seyed Hamidreza Seyedhosseini
,
Hamidreza Rajati Haghi
,
Armaghan Salehi
,
Pouria Soltani Nezhad
,
Ali Mirzaei
Abstract
Introduction: To provide a preliminary assessment of patient-reported satisfaction with single-tooth implant restorations in the maxillary esthetic zone and, as an exploratory objective, to evaluate the inter-rater reliability of clinician-rated Pink Esthetic Score (PES) and White Esthetic Score (WES) assessments. Materials and Methods: This preliminary analytical cross-sectional study included 20 adults with a single implant-supported crown in the maxillary esthetic zone. The originally calculated sample size was 27 participants, but recruitment was curtailed to 20 due to COVID-19-related restrictions. Patient satisfaction was assessed using a six-item questionnaire adapted from a previously published instrument. Standardized clinical photographs were independently scored by two experienced prosthodontists using PES/WES. Inter-rater reliability was assessed using Cohen’s kappa coefficients. Because the ratings did not demonstrate adequate reliability, PES/WES scores were treated as exploratory and were not used for clinical classification or confirmatory correlation analyses. Results: Fourteen participants (70%) reported very high overall satisfaction, three (15%) reported high satisfaction, and three (15%) reported moderate satisfaction. No participant selected the very low or low category for any questionnaire item. Overall satisfaction did not differ significantly between women and men (p = 0.750). Kappa coefficients for the individual PES/WES parameters ranged from -0.30 to 0.29, and none demonstrated statistically significant agreement beyond chance. Conclusion: Patient-reported satisfaction with single-tooth implant restorations in the maxillary esthetic zone was generally high. However, PES/WES scoring showed inadequate inter-rater reliability in this sample and could not support conclusions about clinician-rated esthetic outcomes or their relationship with patient satisfaction. These preliminary findings should be interpreted as hypothesis-generating rather than definitive. Future studies should use calibrated evaluators, prespecified reliability criteria, and validated patient-reported outcome measures. Keywords: Dental implants; Esthetics; Dental; Patient satisfaction; Patient-reported outcome measures; Reproducibility of results.
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10. Yıldırım B, Koca C. Esthetic outcome and oral health-related quality of life after restoration with single anterior maxillary implants. Balkan J Dent Med. 2021;25:80-86. doi:10.2478/bjdm-2021-0013.
11. Jemt T. Restoring the gingival contour by means of provisional resin crowns after single-implant treatment. Int J Periodontics Restorative Dent. 1999;19(1):20-29.
12. Meijer HJA, Stellingsma K, Meijndert L, Raghoebar GM. A new index for rating aesthetics of implant-supported single crowns and adjacent soft tissues-the Implant Crown Aesthetic Index: a pilot study on validation of a new index. Clin Oral Implants Res. 2005;16(6):645-649. doi:10.1111/j.1600-0501.2005.01128.x.
13. Morton D, Chen ST, Martin WC, Levine RA, Buser D. Consensus statements and recommended clinical procedures regarding optimizing esthetic outcomes in implant dentistry. Int J Oral Maxillofac Implants. 2014;29(Suppl):216-220. doi:10.11607/jomi.2013.g3.
14. Siu G. Improving the ability of PES/WES in predicting patient satisfaction of anterior implant restorations [master's thesis]. Chicago (IL): University of Illinois at Chicago; 2015.
15. Fava J, Lin M, Zahran M, Jokstad A. Single implant-supported crowns in the aesthetic zone: patient satisfaction with aesthetic appearance compared with appraisals by laypeople and dentists. Clin Oral Implants Res. 2015;26(10):1113-1120. doi:10.1111/clr.12412.
16. Bonde MJ, Stokholm R, Schou S, Isidor F. Patient satisfaction and aesthetic outcome of implant-supported single-tooth replacements performed by dental students: a retrospective evaluation 8 to 12 years after treatment. Eur J Oral Implantol. 2013;6(4):387-395.
17. Al-Dosari A, Al-Rowis R, Moslem F, Alshehri F, Ballo AM. Esthetic outcome for maxillary anterior single implants assessed by different dental specialists. J Adv Prosthodont. 2016;8(5):345-353. doi:10.4047/jap.2016.8.5.345.
2. 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. Int J Implant Dent. 2019;5(1):2. doi:10.1186/s40729-018-0153-3.
3. den Hartog L, Huddleston Slater JJR, Vissink A, Meijer HJA, Raghoebar GM. Treatment outcome of immediate, early and conventional single-tooth implants in the aesthetic zone: a systematic review to survival, bone level, soft-tissue, aesthetics and patient satisfaction. J Clin Periodontol. 2008;35(12):1073-1086. doi:10.1111/j.1600-051X.2008.01330.x.
4. 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. doi:10.11607/ijp.8032.
5. Cosyn J, Thoma DS, Hämmerle CHF, De Bruyn H. Esthetic assessments in implant dentistry: objective and subjective criteria for clinicians and patients. Periodontol 2000. 2017;73(1):193-202. doi:10.1111/prd.12163.
6. 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. Clin Oral Implants Res. 2005;16(6):639-644. doi:10.1111/j.1600-0501.2005.01193.x.
7. 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. J Periodontol. 2009;80(1):140-151. doi:10.1902/jop.2009.080435.
8. Chang M, Odman PA, Wennström JL, Andersson B. Esthetic outcome of implant-supported single-tooth replacements assessed by the patient and by prosthodontists. Int J Prosthodont. 1999;12(4):335-341.
9. Afrashtehfar KI, Assery MKA, Bryant SR. Aesthetic parameters and patient-perspective assessment tools for maxillary anterior single implants. Int J Dent. 2021;2021:6684028. doi:10.1155/2021/6684028.
10. Yıldırım B, Koca C. Esthetic outcome and oral health-related quality of life after restoration with single anterior maxillary implants. Balkan J Dent Med. 2021;25:80-86. doi:10.2478/bjdm-2021-0013.
11. Jemt T. Restoring the gingival contour by means of provisional resin crowns after single-implant treatment. Int J Periodontics Restorative Dent. 1999;19(1):20-29.
12. Meijer HJA, Stellingsma K, Meijndert L, Raghoebar GM. A new index for rating aesthetics of implant-supported single crowns and adjacent soft tissues-the Implant Crown Aesthetic Index: a pilot study on validation of a new index. Clin Oral Implants Res. 2005;16(6):645-649. doi:10.1111/j.1600-0501.2005.01128.x.
13. Morton D, Chen ST, Martin WC, Levine RA, Buser D. Consensus statements and recommended clinical procedures regarding optimizing esthetic outcomes in implant dentistry. Int J Oral Maxillofac Implants. 2014;29(Suppl):216-220. doi:10.11607/jomi.2013.g3.
14. Siu G. Improving the ability of PES/WES in predicting patient satisfaction of anterior implant restorations [master's thesis]. Chicago (IL): University of Illinois at Chicago; 2015.
15. Fava J, Lin M, Zahran M, Jokstad A. Single implant-supported crowns in the aesthetic zone: patient satisfaction with aesthetic appearance compared with appraisals by laypeople and dentists. Clin Oral Implants Res. 2015;26(10):1113-1120. doi:10.1111/clr.12412.
16. Bonde MJ, Stokholm R, Schou S, Isidor F. Patient satisfaction and aesthetic outcome of implant-supported single-tooth replacements performed by dental students: a retrospective evaluation 8 to 12 years after treatment. Eur J Oral Implantol. 2013;6(4):387-395.
17. Al-Dosari A, Al-Rowis R, Moslem F, Alshehri F, Ballo AM. Esthetic outcome for maxillary anterior single implants assessed by different dental specialists. J Adv Prosthodont. 2016;8(5):345-353. doi:10.4047/jap.2016.8.5.345.
| Files | ||
| Issue | Vol 13, No 2 (Spring 2026) | |
| Section | Original Article(s) | |
| Keywords | ||
| Dental implants; Esthetics; Dental; Patient satisfaction; Patient-reported outcome measures; Reproducibility of results. | ||
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How to Cite
1.
Nodehi D, Seyedhosseini SH, Rajati Haghi H, Salehi A, Soltani Nezhad P, Mirzaei A. Patient-Reported Satisfaction with Single-Tooth Implants in the Maxillary Esthetic Zone and an Exploratory Assessment of PES/WES Reliability. J Craniomaxillofac Res. 2026;2026(2):203-209.
