Establishing a Clinically Acceptable PES/WES Threshold for Single-Tooth Implant Restorations

Abstract

Purpose: To determine the esthetic success of single-tooth implant restorations (STIRs) through pink and white esthetic scores (PES/WES). This study aimed to utilize PES/WES to (1) establish threshold scores based on detectability and acceptability of a STIR by layperson perception, (2) evaluate the difference in the ability of laypeople and dentists to detect the presence of a STIR, and (3) assess the pink and white deficiencies in relation to the detectability of a STIR. Materials and Methods: A total of 38 calibrated photographs of STIRs in the anterior region were scored with PES/WES by three prosthodontists. Next, 100 laypeople and 60 dentists were instructed to identify the STIR among the anterior teeth and provide reasoning behind the identification (based on pink and white esthetic criteria). The acceptance of the STIR was recorded. A receiver operating characteristics (ROC) analysis was performed to determine the threshold scores. Results: At the PES/WES score of 17, 71% of laypeople could not correctly identify the STIR, and at the PES/WES score of 12, 80% of laypeople accepted the implant. Out of 3, 800 occasions, laypeople correctly identified the STIR in 1, 770 (46.58%) of those occasions. Among the correctly identified STIRs, 751 (42.43%) of those occasions were identified with pink deficiencies and 1, 019 (57.57%) of those occasions were identified with white deficiencies. Out of 2, 280 occasions, dentists correctly identified the STIR in 1, 869 (81.98%) of those occasions. Conclusions: A PES/WES score of 12 indicates the clinically acceptable threshold, and a score of 17 indicates the detectable threshold for an exceptional esthetic outcome. Laypeople tend to accept the implant despite its detectability. For both laypeople and dentists, root convexity/soft tissue color and texture are the most focused criteria of PES/WES, followed by overall white deficiencies, which remain influential. Compared to laypeople, dentists tend to have a higher ability to detect STIRs. Int J Oral Maxillofac Implants 2024;39:904–910. doi: 10.11607/jomi.10801