Implant Esthetics in the Predoctoral Program

Implant esthetics in the maxillary esthetic zone is dictated by multiple factors, including the soft tissue structure and the prosthesis itself. The aim of this study was to assess the ability of predoctoral students to produce esthetically acceptable clinical prostheses for single tooth implants in the esthetic zone. The assessment integrated the Pink Esthetic Score (PES) and White Esthetic Score (WES) to objectively evaluate the outcome of the therapy. A secondary aim was to assess patient experience with therapy using a modified OHIP-14 format and an additional semantic scale. Fifty-three patients were invited to participate after IRB approval was received. To be included in the study, subjects had to be over the age of 18 and had received single tooth implant prostheses placed in the maxillary esthetic zone, from first premolar to first premolar. All prostheses were delivered by predoctoral students and were in place for at least six months prior to recall. A clinical exam was performed which included two patient questionnaires, a periapical radiograph of the implant prosthesis, intraoral photographs and alginate impressions. The photographs were formatted and assessed by three board-certified Prosthodontists, two board-certified Periodontists and two fourth year dental students using the PES and WES. Statistical analyses were performed on all collected data. Twenty-seven patients participated in the study and 27 predoctoral students were involved in restorative treatment. Ten implants were restored with custom abutments, and 17 were prefabricated abutments. Twenty-six prostheses were porcelain fused to metal and only one was all ceramic. The faculty examiners had a moderate agreement between their first and second ratings while the students had fair agreement. Both the PES and WES were in the clinically acceptable range. The OHIP-14 and semantic scale results demonstrated high patient satisfaction. There is no statistically significant correlation between the objective assessments and patient satisfaction. Predoctoral students can provide clinically acceptable implant therapy in the esthetic zone. Patients are satisfied with the treatment provided at the dental school level as well as the quality of life and esthetic outcomes of their treatment. There was no correlation between patient satisfaction and examiner assessment using the PES and WES.