Patient-Reported Satisfaction with Single-Tooth Implants in the Maxillary Esthetic Zone and an Exploratory Assessment of PES/WES Reliability

Abstract

Introduction: To provide a preliminary assessment of patient-reported satisfaction with single-tooth implant restorations in the maxillary esthetic zone and, as an exploratory objective, to evaluate the inter-rater reliability of clinician-rated Pink Esthetic Score (PES) and White Esthetic Score (WES) assessments.

Materials and Methods: This preliminary analytical cross-sectional study included 20 adults with a single implant-supported crown in the maxillary esthetic zone. The originally calculated sample size was 27 participants, but recruitment was curtailed to 20 due to COVID-19-related restrictions. Patient satisfaction was assessed using a six-item questionnaire adapted from a previously published instrument. Standardized clinical photographs were independently scored by two experienced prosthodontists using PES/WES. Inter-rater reliability was assessed using Cohen’s kappa coefficients. Because the ratings did not demonstrate adequate reliability, PES/WES scores were treated as exploratory and were not used for clinical classification or confirmatory correlation analyses.

Results: Fourteen participants (70%) reported very high overall satisfaction, three (15%) reported high satisfaction, and three (15%) reported moderate satisfaction. No participant selected the very low or low category for any questionnaire item. Overall satisfaction did not differ significantly between women and men (p = 0.750). Kappa coefficients for the individual PES/WES parameters ranged from -0.30 to 0.29, and none demonstrated statistically significant agreement beyond chance.

Conclusion: Patient-reported satisfaction with single-tooth implant restorations in the maxillary esthetic zone was generally high. However, PES/WES scoring showed inadequate inter-rater reliability in this sample and could not support conclusions about clinician-rated esthetic outcomes or their relationship with patient satisfaction. These preliminary findings should be interpreted as hypothesis-generating rather than definitive. Future studies should use calibrated evaluators, prespecified reliability criteria, and validated patient-reported outcome measures.