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White Esthetic Score as a Tool for Esthetic Assessment of Tooth-Supported Restorations: A Comprehensive Review with
Abdulrahman Alshabib1, Silvia Rojas-Rueda2, Jose Villalobos-Tinoco3,4
1Department of Restorative Dental Science, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia.
Background:
The White Esthetic Score (WES) is a standardized clinician-reported index that assesses the esthetic quality of a single-tooth restoration by comparison with a natural reference tooth, typically the contralateral tooth. It evaluates five domains: tooth form, crown outline/volume, color (hue/value), surface texture, and translucency/characterization. Each domain is scored from 0 to 2 (major discrepancy, minor discrepancy, no discrepancy), yielding a total score of 0-10; higher scores indicate a closer match. Although developed for single-tooth implant restorations, WES has also been applied to natural teeth and tooth-supported restorations.
Methods:
This comprehensive review summarizes case-report evidence applying WES to tooth-supported restorations, outlining the concept, scoring method, documentation requirements, and available data on reliability and interpretation. A case illustration is also presented in which a patient received eight anterior veneers; outcomes were assessed using all WES parameters.
Results:
Published reports support WES as a practical qualitative tool to assess esthetic outcomes in tooth-supported restorations. In the presented case, the veneers achieved a WES of 9, reflecting marked improvement in tooth form, crown outline/volume, color, surface texture, and translucency/characterization.
Conclusions:
The comprehensive review indicates WES is feasible for routine clinical use in practice, but agreement varies by parameter and improves with standardized photography and examiner calibration; some components show lower inter-rater agreement than simpler soft-tissue indices. Because correlations between WES and patient satisfaction are inconsistent, WES should be complemented with patient-reported outcome measures. Common thresholds consider WES ≥ 6 acceptable. Clinical use for crowns and veneers should emphasize case selection, standardized records, and combined clinician- and patient-centered outcome reporting.
