The Effect of the Lips and Face on Esthetic Outcomes of Anterior Implant Restorations

Purpose: The purposes of this study were (1) to determine the effect of the lips and face on patient satisfaction, perceptibility, and acceptability of anterior implant restorations and (2) to determine the effect of lips and face on satisfaction, perceptibility and acceptability between dentists and patients. Both purposes to be tested using a new modified PES/WES esthetic index. Methods: The diagnostic tool to analyze the PES and WES was developed and verified. 51 photographs were digitally modified to represent a score of 0,1 and 2 (ideal) for selected esthetic factors in the PES and WES that were observable within the ideal photo subject’s smile line. The photos consisted of three different views: only teeth, lips and facial portrait. A survey using these altered photos of a single implant anterior restoration was given to patients and dentists at University of Illinois Chicago (UIC) on an iPad (Apple Inc., California) or delivered to non UIC participants via a web-based format. Participants were asked to report their satisfaction scores using a 100mm visual analog scale, as well as state their perceptibility and acceptability of the single restoration. Data analysis was performed comparing satisfaction scores of the teeth versus the lips versus the face using a one-way ANOVA for both dentists and patients. Satisfaction scores for the lips and face in dentists versus patients were analyzed using the Independent t- test. Chi squared tests with Yates Correction and/or Fisher’s Exact tests were used for perceptibility and acceptability comparisons between dentists and patients for each PES/WES factor. Statistical significance is defined as p ≤ 0.05. Results: The survey was taken by a total of 44 participants. All participants were able to correctly identify all four of the Ishihara plates and were deemed to pass the colorblindness test. This made the final number of participants 44 for data analysis. Out of the 44 participants, 17 were dentists and 27 were patients. Analysis was performed and the effects of the lips and face on patient and dentist satisfaction, perceptibility and acceptability of implant restorations was determined. Patient satisfaction score was significantly different with the addition of the lips for two factors: score 1 of tooth translucency/value high and tooth color. The addition of the face affected patient satisfaction score significantly in 3 factors: score 1 of tooth translucency/value high and low and score 0 of tooth translucency/value high. The presence of the face increased the satisfaction score of the wide tooth form for dentists. The dentist satisfaction scores were influenced by the addition of the lips and the face but were significantly different in other criteria when compared to patient satisfaction scores. Patients were more tolerant of soft tissue deficiencies around the implant restoration as well as having an abnormal size/shape of the implant crown. Despite adding the face to the photo, dentists were still aware of the distal papilla deficiency and the wide tooth form. Despite adding the lips, dentists still perceived papillae changes and tooth form/surface more so than patients. 0-6% of dentists would accept a major mesial or distal papilla deficiency where less than 50% of the papilla is filled from zenith to contact point and only about half of the patients stated that they would not accept this result. Conclusion: The addition of the lips and the face influenced the satisfaction scores of patients and dentists. The presence of the face increased satisfaction scores of the tooth form for dentists. The most important parameters for patients are those for tooth color and value. Dentists appear to value tooth form more than patients. Dentists perceived papillae changes more so than patients. Lastly, dentists tend to have lower acceptability compared to patients.