RESUMEN
OBJECTIVES: To validate the reproducibility and inter/intra-observer variability of the Pink Esthetic Score/White Esthetic Score (PES/WES) of single tooth-supported prostheses in the maxillary esthetic zone (13-23). MATERIALS AND METHODS: Forty-five patients were randomly assigned to one of the three treatment options (15 patients per group) receiving each one a different crown type: Porcelain fused to metal (PFM), monolithic zirconia, and lithium disilicate. Eight observers from each of four different specialties (Prosthodontists, Orthodontists, Periodontists, and Oral Surgeons) were recruited and assessed twice and four weeks apart (i.e., T1 and T2) 45 photographs of the single tooth-supported prosthesis using PES/WES and compared them with contralateral teeth. RESULTS: According to the ANOVA and post hoc tests, the zirconia crown type obtained the highest mean score by all observers, with a mean value of 16.70 ± 2.94. The prosthodontists and oral surgeons assigned the lowest mean score to PFM crowns, 13.03 ± 3.47 and 13.80 ± 3.17, respectively. Notably, the prosthodontists awarded the highest scores, specifically 17.50 ± 2.81 for the zirconia crowns. Intraobserver agreement was calculated utilizing the paired t-test. Pairwise comparisons between observers of different specialties revealed significant intraobserver agreement. Interclass correlation coefficient (ICC) scores were statistically significant among four specialties. No difference was detected concerning the interobserver agreement. CONCLUSIONS: The PES/WES index remains consistent across various observers from different specializations, yielding uniform results in the overall esthetic evaluation. Consequently, in light of the presented preliminary positive results, its use might also be considered for the esthetic assessment of single-tooth-supported prostheses. CLINICAL SIGNIFICANCE: The PES/WES index may be employed clinically to evaluate single tooth-supported prostheses as it emerged as a reproducible esthetic scoring system.
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Estética Dental , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Coronas , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , CirconioRESUMEN
Purpose: Evaluate the esthetic outcome of ridge augmentation using cancellous bone-block allografts, late implant placement, and immediate loading in the atrophic anterior maxilla, by PES (pink esthetic score) and WES (white esthetic score) indexes. Materials and Methods: Retrospective cohort study. Inclusion criteria were bone loss of at least 3 mm horizontally and 3 mm vertically according to preliminary CBCT; ridge augmentation using cancellous bone-block allografts; six months later the implant insertion and immediately loaded. PES-WES index was used for esthetic assessment of soft tissues surrounding the final implant-supported prosthesis (ISP). Results: All twenty-five successive individuals were included. The mean follow-up was 12.1 ± 56 months (range, 42−90 months). The mean PES index and WES index were 7 ± 1.74 (range: 5−10) and 8.4 ± 2.12 (range: 5−10), respectively. The mean total combination of PES index and WES index (PES/WES) was 15.3 ± 2.85 (range: 12−20). All ISPs had an overall score >12 (the defined threshold of clinical acceptability). Conclusions: Ridge augmentation in the atrophic anterior maxilla using cancellous bone-block allografts and immediate loading allows a stable esthetic result of the soft and hard tissues over the years (follow-up of 42−90 months).
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Aumento de la Cresta Alveolar , Maxilar , Estética Dental , Humanos , Maxilar/cirugía , Prótesis e Implantes , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: A successful implant reconstruction with optimal esthetics consists of a visually pleasing prosthesis and complete and healthy surrounding soft tissue. In the current literature, numerous indices used to qualitatively assess esthetics have been described. However, studies comparing the indices and their reproducibility are scarce. PURPOSE: The aim of this study was to compare three different esthetic indices for the evaluation of single implant-supported crowns. MATERIALS AND METHODS: A total of 10 prosthodontists (P), 10 orthodontists (O), 10 general dentists (G), and 10 lay people (L) independently performed the same assessment using 30 photographs and corresponding casts with three different esthetic indices (Peri-Implant and Crown Index [PICI], Implant Crown Aesthetic Index [ICAI], "Pink Esthetic Score/White Esthetic Score [PES/WES]) and repeated the evaluations 4 weeks later. RESULTS: The PES/WES and the PICI showed significantly higher esthetic scores (pink, white, total) and clinical acceptance compared with the ICAI in all four groups and in both assessments. The highest intraobserver agreement was achieved using the PES/WES and the least with the ICAI. The mean Kappa per group ranged from 0.18 (group L with ICAI) to 0.63 (group G with PICI). CONCLUSION: In comparison with the ICAI, the PES/WES and PICI were more reproducible. Therefore, PES/WES and PICI seem to be more suitable as esthetic indices for single implant crowns.
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Coronas , Implantes Dentales de Diente Único , Estética Dental , Diseño de Prótesis Dental , Humanos , Maxilar/cirugía , Variaciones Dependientes del Observador , Satisfacción del Paciente , Reproducibilidad de los ResultadosRESUMEN
The definition of failure for dental implants has evolved from lack of osseointegration to increased concern for other aspects, such as esthetics. However, esthetic failure in implant dentistry has not been well defined. Although multiple esthetic indices have been validated for objectively evaluating clinical outcomes, including failure of an implant-supported crown, only one author has determined a failure threshold. On the basis of objective indices, esthetic failures in implant dentistry can be categorized as pink-tissue failures and white-tissue failures. This article discusses esthetic failures, the factors involved in these failures, and their prevention and treatment.
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Implantes Dentales , Fracaso de la Restauración Dental/clasificación , Estética Dental , Coronas , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Encía/anatomía & histología , Humanos , Oseointegración/fisiología , Satisfacción del Paciente , Resultado del TratamientoRESUMEN
El éxito de la rehabilitación de piezas dentarias anteriores con implantes involucra no sólo la utilización de técnicas adecuadas quirúrgicas o protésicas, sino el criterio del profesional para elegir el camino terapéutico correcto para alcanzar los resultados deseados, sustentados en la evidencia. Tratamientos poco invasivos, con aplicación de emergentes simultáneos y carga inmediata del implante colocado, favorecen la maduración de los tejidos, con resultados predecibles. La elección de un protocolo de carga inmediata dependerá, entre varios factores, del resultado de los procesos de contacto ósea primario y secundario, la existencia de un hueso nativo de alta calidad y cantidad y la utilización de materiales de restauración cerámicos que permitan la optimización de resultados estéticos favorables con índices objetivos, como el PES-WES. Este artículo describe la resolución quirúrgico-protética de un caso clínico, en el cual se realizó la exodoncia de un incisivo central superior, con reabsorción dentinaria externa posterior. Se utilizó un protocolo de carga inmediata con colocación de emergente de zirconia definitivo y su provisionalización. Superado el tiempo de la oseointegración, se realizó la corona definitiva en disilicato de litio...