Tehran University of Medical Sciences Journal of Craniomaxillofacial Research 2345-5489 2026 2 2026 08 25 203 209 Davood Nodehi Dental Research Center, Department of Prosthodontics, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran. Seyed Hamidreza Seyedhosseini Dentist, Mashhad, Iran. Hamidreza Rajati Haghi Department of Prosthodontics, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran. Armaghan Salehi School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran. Pouria Soltani Nezhad Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran. Ali Mirzaei Student Research Committee, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran. 2025 12 16 2026 08 08 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. https://jcr.tums.ac.ir/index.php/jcr/article/view/605 https://jcr.tums.ac.ir/index.php/jcr/article/download/605/499