Comparing pink and white esthetic scores to layperson perception in the single-tooth implant patient

The pink esthetic score (PES) and white esthetic score (WES) are tools utilized to objectively evaluate single-tooth implant restorations (STIR) in the esthetic zone.1 A questionnaire study was developed to address two objectives: (1) establish a total PES/WES score that is clinically acceptable based on layperson perception and (2) report outcomes in laypeople's perceptions of pink and white deficiencies.

A presentation book of 27 color-calibrated photographs of a STIR in the esthetic zone (canine to canine) surrounded by virgin teeth and one photograph without a STIR (control) was presented to three prosthodontists (evaluators) to conduct a PES/WES evaluation. The same 27 photographs were presented to 101 laypeople. The laypeople were instructed to identify which tooth was the STIR. The laypeople were also instructed to record, based on pink or white esthetics, what factors influenced their decision on the selection of the STIR.

For the evaluator's scores of the 27 cases, the mean PES score was 5.7 (range, 3 to 10). The mean WES score was 6.2 (range, 3 to 10). The mean total PES/WES score was 11.9 (range, 6 to 20). The mean percentage of laypeople unable to correctly identify the STIR was 59.1% (range, 13.9% to 89.2%). When the evaluator's PES/WES score was greater than 12, 79% of the layperson population was not able to identify a STIR (ρ = -0.86). In addition, when the PES score was 6, 90% of the laypeople were not able to perceive a pink deficiency (ρ = -0.65), and when the WES score was 6, 83% of the laypeople were not able to perceive a white deficiency (ρ = -0.57).

Within the limitations of this study, in single-tooth implant restorations, a total PES/WES score greater than 12 would provide a STIR that would be clinically acceptable in the majority of situations. This study also concluded that laypeople identify white esthetic deficiencies more easily than pink esthetic deficiencies.