Aesthetic Outcome Assessment in Implant Dentistry:An Educational Prospective
Implant success is traditionally assessed by means of implant survival, prosthesis stability, amount of bone loss, and absence of infection in the peri-implant soft tissues. Little has been done to objectively assess the aesthetic outcomes of implant treatment, which is a key aspect of treatment success in the anterior area. In 2009, Belser et al proposed an aesthetic outcome assessment measure (PES/WES) that is based on established tools (the Pink Esthetic Score -PES; and the White Esthetic Score -WES) previously proposed by Furhauser (2005) and Belser (2009) respectively. A minimum score of 12 of 20 is required to consider the implant successful from an aesthetics point of view. The new scoring system (figures 1-2-3-4) facilitates a qualitative objective assessment of the implant’s aesthetic outcome, and enables clinicians to measure their performance against a set target. This potentially leads to improvement in the performance and ultimately the outcomes.
Methods: A group of four general dentists attended the “State of the Art in Implant Dentistry” course organized by the ITI and the University of Sharjah in May 2010, and discussed the outcomes of implant cases previously placed in the anterior maxilla region. Cases (figures 5-8) that had been considered successful according to the traditional assessment criteria were peer-reviewed using the PES/WES scoring system. Many cases were found not to meet the new assessment criteria. The dentists developed a checklist based on the scoring criteria to improve treatment planning, placement procedure and prosthetic design. The same group met recently to examine their performance on recently completed cases (figures 9-12) using the same criteria.
Result and discussion:
A significant improvement in the aesthetic outcome was noted in the group performance in response to the higher challenge raised by the combined scoring system. A unified scale is needed to standardize the evaluation process and data collection. Despite criticism to the PES/WES system, in terms of poor to moderate correlation with patient satisfaction, and the fact that it does not take Implant survival into consideration, the PES/WES scoring system has shown to be a good educational tool. A tool that helps improve the practitioners’ critical thinking in developing treatment plan and designing the final restoration. Furthermore, in healthcare systems where practice is not always based on evidence from research, mentorship plays an important role in improving the dental profession performance.