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

STATEMENT OF PROBLEM: 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. PURPOSE: 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. MATERIAL AND METHODS: 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 (alpha=.05). RESULTS: 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 kappa=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. CONCLUSIONS: 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.