Validity and reliability of a proposed anterior implant esthetic index (AIEI)

Patient satisfaction and esthetic acceptance are important factors in predicting the success of implant therapy in the anterior maxilla. A standardized esthetic index to evaluate implant esthetic outcomes is still lacking.

The purposes of this study were to describe the newly developed images that correlate to the pink esthetic score and white esthetic score (PES/WES) for improved standardized documentation and to evaluate the validity and reliability of the proposed anterior implant esthetic index (AIEI) with patient satisfaction scores.

A photograph deemed ideal (perfect score of 2) using the PES/WES criteria was acquired and digitally altered to represent scores of 1 (minor discrepancy) and 0 (major discrepancy) according to the PES/WES guidelines. A pilot study enrolled prosthodontists and periodontists to review and verify the representations. A 29-question survey was developed and distributed to 33 participants on a tablet computer to evaluate the photographs. The participants were asked about their satisfaction level with the photographs on a visual analog scale from 0 to 100. Data were extracted, and ANOVA was used to compare mean satisfaction scores. Post hoc Tukey tests were used to analyze the differences within each variable (α=.05).

Standardized sets of 14 altered PES and 14 altered WES photographs were generated. The interrater reliability (n=5) of the pilot study showed moderate agreement with κ=0.453 (95% CI: 0.431-0.476) for all and individual scores. Based on the patient survey, 5 of the 14 factors of the PES/WES showed no significant difference and were eliminated when constructing the index. Using scores and percentages, the anterior implant esthetic index was developed for scores of 0, 1, and 2 for each of the remaining 9 criteria. The maximum score for the index was 20 points.

Photographic representation of each criterion within the PES/WES standardized the patient's ability to evaluate anterior implant esthetics. An anterior implant esthetic index was developed, and a moderate interrater reliability agreement and good validation with patient satisfaction scores were obtained.