Esthetic index for anterior maxillary implant-supported restorations

The aim of this study is to develop and validate a complex esthetic index (CEI) designed for rating the esthetics of anterior maxillary implant-supported restorations with respect to the surrounding soft and hard tissues.

Fifty patients (31 males and 19 females; age: 18 to 50 years; mean age +/- SD: 32.4 +/- 9.1 years) previously treated with dental implants were evaluated regarding the esthetic results of their restorations using the proposed CEI. Two calibrated oral surgeons did the evaluation and recording. The evaluation was carried out twice by each of the examiners 2 weeks apart. The weighted Cohen's kappa was used to calculate the intra- and interobserver agreement.

An analysis of CEI for 50 anterior maxillary implant-supported restorations showed good intra- and interobserver agreement for the soft tissue index (S) and implant-supported restoration index (R). Only the interobserver agreement for the overall R was rated as moderate (0.54 and 0.52). The single-parameter analysis showed that the lowest (moderate) intra- and interobserver agreement was with the subjective parameters of S (soft tissue color and texture variations) and R (crown surface roughness and ridges and color and translucency). An adequate CEI of S100, P100, and R100 was scored by both examiners in 10% and 12% of cases for evaluations I and II, respectively.

This study presents evidence that this newly developed CEI, which incorporates the implant restoration and adjacent soft and hard tissue parameters, is a reproducible tool for scoring anterior implant esthetic predictably. However, prospective clinical trials involving examiners with different training backgrounds are needed to further validate the long-term stability of this index.