Improving the Ability of PES/WES in Predicting Patient Satisfaction of Anterior Implant Restorations

Objectives: The Pink Esthetic Score (PES) and the White Esthetic Score (WES) provide practitioners and researchers a new method to objectively evaluate implant esthetics. However, patients often perceive esthetics differently than dental professionals. If the PES/WES can accurately predict patient satisfaction of anterior implant restorations, then these esthetic indices provide a standardized method to compare the esthetic outcomes of different treatment modalities and biomaterials. This study aims to (1) create a more objective and standardized way to determine PES/WES scores, (2) determine how each esthetic parameter in the PES/WES affect patient satisfaction, (3) modify and improve the PES/WES to better predict patient satisfaction. Materials/Methods: 29 digitally altered photographs of anterior implant restorations were created to varying scores for each of the 14 criteria in the modified PES/WES. These photographs were agreed upon and verified by a group 5 prosthodontists and periodontists. A digital survey containing these altered photographs (N = 198) was given to patients on standardized iPads and to the general public in a web-based format. The study was approved by the institutional review board office. Subjects reported their satisfaction of the photographs on a visual analog scale. Data on perceptibility and acceptability was also collected. Independent samples t-test, ANOVA and post hoc test, and linear regression analyses were performed when appropriate (α=0.05). Results: 9 of the 14 esthetic parameters had a significant effect on satisfaction scores. 4 of the parameters influenced satisfaction only in extreme situations while only 1 parameter, alveolar process, did not have a significant influence on patient satisfaction scores. Crown color, low crown value, mesial papilla, soft tissue margin and soft tissue color appeared to have 2 times the effect on satisfaction than the other parameters. Conclusion: The PES/WES was modified and more detailed descriptions for scoring were established. A set of standardized reference photographs illustrating the varying scores in the modified PES/WES was developed for future users of the PES/WES. Esthetic parameters that had greater effect on patient satisfaction scores were given more weight in the modified PES/WES in order to improve the correlation between dentist-determined esthetic scores and patient satisfaction scores.