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A retrospective study on the aesthetic outcomes of anterior implant-supported single crowns
EAO Online Library. Foong A. Oct 9, 2018; 232685; P-PA - 7
Alethea Li Yen Foong
Alethea Li Yen Foong
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Systematic reviews report a lack of studies investigating aesthetic outcomes and patient satisfaction for single implant-supported crowns. There is currently no consensus on the use of aesthetic indices for assessing implant aesthetics, making it difficult to compare between studies. Evaluator specialization has also been shown to impact aesthetic determination. The relationship between patient and clinician evaluation of implant aesthetics still requires further investigation.To compare the aesthetic outcomes of anterior implant-supported single crowns as evaluated by patients and clinicians of different specialties.One hundred and thirty-three patients restored with 138 implant-supported anterior crowns were recalled to rate their satisfaction with the aesthetic outcomes of their restorations using a visual analogue scale (VAS) questionnaire. Three prosthodontically-trained clinicians (PTCs) rated each implant restoration using the modified Pink Esthetic Score White Esthetic Score (PES WES) index, with the aid of photographs and models. Two periodontists, two orthodontists, and two general dentists rated a randomized sample of forty implant-supported anterior crowns with PES WES as well. Statistical analysis was done with the ANOVA, intraclass correlation coefficient (ICC), Kappa, Spearman’s Rank correlation, and Mann-Whitney U tests.Mean scores for PES, WES and PES WES of the 138 implants were 4.7, 5.0, and 9.7, respectively. Based on PES WES criteria, 22 (15.9%) of 138 implants were deemed clinically acceptable (PES WES ≥+ 12). Mean patient satisfaction scores for each VAS question ranged from 79.3 – 84.4. Weak correlation was found between PES WES and patient VAS scores. PTCs had significantly lower mean scores (p < 0.05) for PES, WES and PES WES (4.8, 5.3, 10.0 respectively) than the other three specialties, which had similar scores. ICCs for PES, WES and PES WES were highest for PTCs (r = 0.74, 0.76, 0.86 respectively), followed by periodontists (r = 0.69, 0.70, 0.73), and lowest for orthodontists (r = 0.41, 0.60, 0.50). ICCs for PES and PES WES of orthodontists were significantly lower than PTCs. Kappa scores for PES and WES variables for all specialties ranged from poor to moderate (κ+ = 0.01 – 0.59). When orthodontists were excluded, the highest agreements for PES WES categories were for papilla scores.Although a large percentage of implant-supported anterior crowns did not meet the threshold of clinical acceptability based on PES WES criteria, patients were generally satisfied with their implant restorations. There was weak correlation between patient and clinician assessments. PTCs were the strictest assessors. PTCs and periodontists had the highest ICCs for PES, WES, and PES WES. Training and standardization is recommended prior to using the PES WES index.
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