Rudolf Furhauser Evaluation of soft tissue around

Dionisie Florescu
Thomas Benesch
single-tooth implant crowns: the pink
Robert Haas esthetic score
Georg Mailath
Georg Watzek

Authors affiliations: Key words: esthetic score, peri-implant soft tissue, single-tooth implant
Rudolf Furhauser, Dionisie Florescu, Department of
Prosthodontics, Dental School, Medical University
of Vienna, Vienna, Austria Abstract
Thomas Benesch, Department of Medical Statistics, Aim: In this study, the reproducibility of a newly developed pink esthetic score (PES) for
Medical University of Vienna, Vienna, Austria
Robert Haas, Georg Mailath, Georg Watzek, evaluating soft tissue around single-tooth implant crowns was assessed. The effect of
Department of Oral Surgery, Dental School, observer specialization was another point of interest.
Medical University of Vienna, Vienna, Austria
Material and methods: Twenty observers (five prosthodontists, five oral surgeons, five
Correspondence to: orthodontists and five dental students) were given photographs of 30 single-tooth implant
Rudolf Furhauser crowns. Seven variables were evaluated vs. a natural reference tooth: mesial papilla, distal
Cottagestrasse 9
A-1140 Vienna papilla, soft-tissue level, soft-tissue contour, alveolar process deficiency, soft-tissue color and
Austria texture. Using a 0-1-2 scoring system, 0 being the lowest, 2 being the highest value, the
Tel.: 43 676 705 64 06
e-mail: rudolf@fuerhauser.at
maximum achievable PES was 14. Each observer was requested to make two assessments at
an interval of 4 weeks. At the second assessment, the photographs were scored in the
reverse order.
Results: The mean PES of evaluations at the first assessment (n 600) was 9.46 (
3.81 SD),
and 9.24 (
3.8 SD) at the second one. The difference between these two means was not
significant statistically (P 0.6379). Implant-related mean PES for single-tooth implants
varied from 2.28 to 13.8, with standard deviations between 0.46 and 3.51. Very poor and
very esthetic restorations showed the smallest standard deviations. The mean total PES was
10.6 for the prosthodontists, 9.2 for the oral surgeons, 9.9 for the dental students and 7.6
for the orthodontists.
Conclusions: The PES reproducibly evaluates peri-implant soft tissue around single-tooth
implants. Thus, an objective outcome of different surgical or prosthodontic protocols can
be assessed. Orthodontists were clearly more critical than the other observers.

Date:
Accepted 4 April 2005
To cite this article:
Furhauser R, Florescu D, Benesch T, Haas R, Mailath G,
Watzek G. Evaluation of soft tissue around single-tooth
implant crowns: the pink esthetic score.
Clin. Oral Impl. Res. 16, 2005; 639644
doi: 10.1111/j.1600-0501.2005.01193.x
Copyright r Blackwell Munksgaard 2005
Single-tooth implants have become a stan-
dard in dentistry and are considered state of
the art (Tarnow & Eskow 1995) and stan-
dard care (Newman 1999). As implant
survival and success rates are high (Avivi-
Arber & Zarb 1996; Scheller et al. 1998;
Haas et al. 2002), the esthetic outcome has
become the main focus of interest in esthe-
tically sensitive areas. To achieve an opti-
mal esthetic outcome, implants must be
placed in an optimal position and inclina-
tion (de Lange 1995; Phillips & Kois 1998).
Ideally, successful implant-supported re-
storations should imitate the appearance
of natural teeth (Belser et al. 2004). The
condition of the peri-implant soft tissue
appears to be the critical determinant (Gar-
ber 1996). The implant-supported restora-
tion should be in symmetry with the
reference tooth. The level of the peri-im-
plant soft tissue, which influences the
crown length, and its color and texture

639
Furhauser et al . Esthetic score
are decisive for the natural appearance of
implant-supported single-tooth replace-
ments (Chang et al. 1999).
Albrektssons criteria of success (Al-
brektsson et al. 1986) were extended by
Smith and Zarb: To be considered a suc-
cess, an implant must allow placement of a
restoration with adequately esthetic appear-
ance (Smith & Zarb 1989). But objective
criteria defining what is adequately es-
thetic have so far not been available. The
range of subjective impressions of the be-
holder is well known and depends on the
specialization (Kokich et al. 1999; Rosen-
stiel et al. 2000). While criteria for assessing
bone quality (Lekholm & Zarb 1985; Nor-
ton & Gamble 2001), bone loss (Fallschus-
sel 1986; Cawood & Howell 1991),
perception of bone drilling procedures
(Misch 1993; Enquist et al. 1998) and a
papilla score (Jemt 1997) are used in im-
plant dentistry, an overall score for evaluat-
ing peri-implant soft tissues has so far not
been available. In the Consensus State-
ments and Recommended Clinical Pro-
cedures Regarding Esthetics in Implant
Dentistry (Belser et al. 2004), measurement
of esthetic outcomes is proposed for use in
clinical studies. A selective assessment of
peri-implant soft tissues with an objective
score would help to evaluate implant-sup-
ported restorations and to objectify the soft-
tissue esthetic outcome of different surgical
or prosthodontic treatment protocols.
In the current study, the peri-implant
soft tissue of 30 maxillary single-tooth
replacements was evaluated by 20 dentists
using a new defined pink esthetic score
(PES). The reproducibility of the score and
a potential effect of observer specialization
on evaluating the esthetic outcome were
the points of interest.
Material and methods
Photographs of 30 single-tooth implants in
the esthetically sensitive area of the max-
illa (including the first premolars) were
evaluated. Of these, 10 replaced the right
and five the left central incisor, five the
right and six the left lateral incisor and four
the right first premolar. For the sake of
statistical correctness, both poor and esthe-
tically satisfactory restorations were in-
cluded in the assessment. Twenty-seven
s
of the implants were Branemark fixtures
640 | Clin. Oral Impl. Res. 16, 2005 / 639644
(Nobel Biocare AB, Gothenborg, Sweden),
s
with nine CeraOne -titanium and 18 Cer-
s
Adapt -aluminaoxide abutments, two
s
were Replace implants (Nobel Biocare
s
AB), with CerAdapt abutments, and one
s
was a Semados implant (Bego Goldschla-
gerei, Bremen, Germany), with a gold alloy
abutment. At the time of the study, the
implants had been in place for 15143
months.
Each single-tooth implant was photo-
graphed with a digital camera (D100, Nik-
kor Medical Objective circular flash;
Nikon Corporation, Tokyo, Japan). For
assessing anterior tooth replacements, the
reference tooth had to be visible well en-
ough to ensure comparability. The im-
plant-supported restorations in the region
of the right first premolars were photo-
graphed to ensure comparison with the
second premolar. The photographs were
magnified to twice the original size and
printed out on DIN A4 sheets together
with the list of variables. Implant-sup-
ported crowns were marked by arrows.
All photographs were developed and pro-
cessed by the same person. The question-
naire was handed to 20 individuals of
variable specialization (five prosthodon-
tists, five oral surgeons, five orthodontists
and five dental students), in order to assess
the potential effects of observer specializa-
tion on PES scoring. Assessments were
made twice at an interval of 4 weeks. To
reduce any bias from the first viewing, the
order of the photographs was reversed for
the second viewing.
Assessment criteria PES
The PES is based on seven variables: mesial
papilla, distal papilla, soft-tissue level, soft-
tissue contour, alveolar process deficiency,
soft-tissue color and texture (Fig. 1). Each
variable was assessed with a 2-1-0 score,
with 2 being the best and 0 being the
poorest score.
The mesial and distal papilla were eval-
uated for completeness, incompleteness or
absence. All other variables were assessed
by comparison with a reference tooth, i.e.
the corresponding tooth (anterior region)
or a neighboring tooth (premolar region)
(Table 1).
The highest possible score reflecting a
perfect match of the peri-implant soft tis-
sue with that of the reference tooth was 14.
Fig. 1. Pictorial view of pink esthetic score vari-
ables.
Statistical analysis
Differences between the two assessments
were evaluated with the w2 test. Simple
analysis of variance with the Tukey test
was used for assessing observer specializa-
tion. Po0.05 was considered to be signifi-
cant. All statistical analyses were run on
the Statistics Package SAS (SAS System for
Windows, Cary, NC, USA).
Results
In each of the two assessments, 20 obser-
vers rated 30 cases, i.e. a total of 600 PESs/
assessments. All in all, 1200 PESs with
8400 single variables were available for
analysis. The mean PES was 9.46
(
3.81 SD) in the first assessment and
9.24 (
3.8 SD) in the second assessment.
The difference was not significant statisti-
cally (P 0.6479). An analysis of the 1200
PESs showed that the highest achievable
score of 14 was assigned 94 times in the
first assessment (15.67%) vs. 70 times in
the second assessment (11.67%) (Table 2).
A score of 13 was assigned 66 times in the
first assessment (11%) vs. 74 times in the
second assessment (12.33%). The lowest
score of 0 was assigned eight times in the
first assessment (1.33%) vs. 10 times in
the second one (1.67%). A score of 1 was
assigned 13 and 17 times, respectively
(2.17% vs. 2.83%).
Single-variable analysis
The highest possible score of 2 was as-
signed to the mesial papilla in 62% of cases
and 58.8% in the second assessment, to
the distal papilla in 56% and 51.67%,
respectively (Table 3). The alveolar process
was rated as well restored in 54% (49.17%)
of cases. The soft-tissue texture was rated
as indistinguishable from the reference
tooth, and was assigned a score of 2 in
 Furhauser et al . Esthetic score

Table 1. Variables of the pink esthetic score

Variables
Mesial papilla
Distal papilla
Level of soft-tissue margin
Soft-tissue contour
Alveolar process
Soft-tissue color
Soft-tissue texture
0 1 2
Shape vs. reference tooth Absent Incomplete Complete
Shape vs. reference tooth Absent Incomplete Complete
Level vs. reference tooth Major discrepancy 42 mm Minor discrepancy 12 mm No discrepancy o1 mm
Natural, matching reference tooth Unnatural Fairly natural Natural
Alveolar process deficiency Obvious Slight None
Color vs. reference tooth Obvious difference Moderate difference No difference
Texture vs. reference tooth Obvious difference Moderate difference No difference

Table 2. Summation scores for assessments 1 and 2

PES scores Assessment 1 Assessment 2 Total
No. % No. % No. %
0 8 1.33 10 1.67 18 1.5
1 13 2.17 17 2.83 30 2.5
2 23 3.83 21 3.50 44 3.67
3 13 2.17 13 2.17 26 2.16
4 30 5 25 4.17 55 4.95
5 16 2.67 19 3.17 35 2.92
6 28 4.67 35 5.83 63 5.25
7 43 7.17 44 7.33 87 7.25
8 36 6 36 6 72 6
9 42 7 56 9.33 98 8.17
10 63 10.5 46 7.67 109 9.09
11 59 9.83 68 11.33 127 10.58
12 66 11 66 11 132 11
13 66 11 74 12.33 140 11.66
14 94 15.67 70 11.67 164 13.66
Total 600 100 600 100 1200 100

PES, pink esthetic score.

Fig. 2. (a) Twenty-one-year-old male: Immediate

s
implant (Replace Select Tapered , Nobel Biocare
Table 3. Frequency of variable assessment of score 2 (highest score)
AB) in the region of the right central incisior.
Variable Assessment 1 Assessment 2 SD Diff 1/2 (%) s
Procera aluminum oxide abutment (Nobel Biocare
No. % No. % AB), 3 months after immediate loading and tempor-
izing. (b) Highest PES and lowest standard deviation
Mesial papilla 372 62 353 58.8 0.38  3.2
of all single-tooth implant crowns evaluated. Re-
Distal papilla 336 56 310 51.6 0.45  4.4 s
storation with Procera crown (Nobel Biocare AB),
Alveolar process 323 54 295 49.1 0.54  4.9
13 months after implant insertion.
Soft-tissue texture 319 53.1 295 49.1 0.57 4
Soft-tissue contour 288 48 286 47.6 0.48  0.4
Soft-tissue color 272 45.3 223 37.1 0.55  8.2
Level of soft-tissue margin 252 42.3 267 44.5 0.51 2.2
Table 5. Mean tooth-related PES (40 rat-
ings) for implant restoration in Fig. 2
Mean SD
Table 4. Frequency of variable assessments of score 0 (lowest score)
Mesial papilla 2 0
Variable Assessment 1 Assessment 2 Diff 1/2 (%)
Distal papilla 2 0
No. % No. % Level of soft-tissue 1.88 0.33
margin
Level of soft-tissue margin 131 21.8 119 19.8 2
Soft-tissue contour 2 0
Soft-tissue color 131 21.8 113 18.8 2
Alveolar process 1.98 0.16
Soft-tissue contour 108 18 118 19.6 1.6
Color 2 0
Alveolar process 94 15.6 107 17.8 2.2
Texture 1.95 0.22
Soft-tissue texture 93 15.5 104 17.3 1.8
Sum total (max. 14) 13.8 0.46
Mesial papilla 85 14.1 83 13.8  0.3
Distal papilla 44 7.3 40 6.6  0.7 PES, pink esthetic score.

53.1% (49.17%) of cases. Comparable
percentages for the other variables were
48% (47.6%) for soft-tissue contour,
45.3% (37.1%) for soft-tissue color and
42.3% (44.5%) for soft-tissue level. A
score of 0 was most often assigned to the
peri-implant soft-tissue level (19.8% and
21.8% of cases) and soft-tissue color
(21.8% and 18.8% of cases) as shown in
Table 4. The standard deviation was lowest
(0.38) for the mesial papilla followed by the
distal papilla (0.45), the soft-tissue contour
(0.51), the soft-tissue level (0.51), bone loss
(0.54), soft-tissue color (0.55) and soft-tis-
sue texture (0.57).

641 | Clin. Oral Impl. Res. 16, 2005 / 639644

Furhauser et al . Esthetic score

was chosen deliberately, because more de-

Fig. 3. Lowest pink esthetic score (PES) score of all
single-tooth implant crowns evaluated in a 35-year-
s
old male: Semados implant in place for 25 months,
precious metal abutment. Note the severe recession
clinically.
Table 6. Mean tooth-related PES (40 rat-
ings) for implant restoration in Fig. 3
Mean
Mesial papilla 0.58
Distal papilla 1.28
Level of soft-tissue 0 0
margin
Soft-tissue contour 0 0
Alveolar process 0.08
Color 0.05
Texture 0.3
Sum total (max. 14) 2.28
PES, pink esthetic score.
Mean tooth-related PES
Each single-tooth replacement was as-
sessed twice by 20 observers, and analysis
of 40 PES by the teeth replaced showed the
highest mean PES score of 13.8 (
0.46
SD) to be assigned to a right central incisor
(Fig. 2a and b, Table 5). The lowest mean
PES score of 2.28 (
1.26 SD) was also
assigned to a right central incisor (Fig. 3,
Table 6). The standard deviation for the
mean tooth-related PES varied between
0.46 and 3.51. The highest standard devia-
tion of 3.51 was related to a left lateral
incisor, which scored 7.2 (Fig. 4, Table 7).
The standard deviations were lower for
both high and low PESs than for intermedi-
ate PESs.
Effect of specialization
The mean total PES was 10.6 for the
prosthodontists, 9.2 for the oral surgeons,
9.9 for the dental students and 7.6 for the
orthodontists. The difference between the
groups was highly significant on simple
analysis of variance (P 0.001). In the
Tukey test, orthodontists were found to
tailed ratings are problematic in the inter-
mediate category. This problem is reported
by Trisi & Rao (1999) in bone scoring. The
hand-felt perception of the drilling resis-
tance failed to correlate in the intermediate
classes of histomorphometric bone density
according to Lekholm & Zarb (1985).
The Papilla Index of Jemt (1997) distin-
guishes five gradations. Focused on the
papilla, it is helpful for special questions
Fig. 4. Highest standard deviation of all evaluated
of papilla reconstruction. However, more
single-tooth implant crowns. Fifty-five-year-old fe-
male: Branemark fixture in place for 112 months, variables are responsible for the natural
appearance of implant-supported single-
baseline asymmetry (including level of gingival
margin 11 vs. 12), aplasia of right lateral incisor, tooth replacements. The PES integrates
mismatch of maxillary and mandibular midline. the height and level as well as the color
Regeneration of papilla difficult because of diasthe-
and texture of the peri-implant soft tissue,
mas and poorly evaluable. Criticism: Distal papilla
defies evaluation. and is thus based on seven variables for a
SD
simple and practice-oriented evaluation
0.59 using a 3-score rating system. Notwith-
0.55
Table 7. Mean tooth-related PES (40 rat- standing the statistical reproducibility, the
ings) for implant restoration in Fig. 4 highest score of 14 was less often assigned
Mean SD
in the second assessment, while the lowest
0.35 Mesial papilla 0.83 0.71 scores of 0 and 1 were slightly more often
0.22 Distal papilla 1.63 0.54
0.52 assigned in the second run, suggesting that
Level of soft-tissue margin 0.95 0.85
1.26 Soft-tissue contour 1.13 0.76 the observers tended to become more
Alveolar process 0.93 0.66 critical.
Color 0.63 0.63 In roughly 60% of 1200 assessments,
Texture 1.13 0.69
the mesial papilla was assigned the highest
Sum total (max. 14) 7.2 3.51
score of 2 with the lowest standard devia-
PES, pink esthetic score. tion (0.38), and thus appears to be evalu-
able more reproducibly than the other
variables. The distal papilla was assigned
have assigned significantly poorer ratings a score of 2 in roughly 50% of 1200
than any other group. Prosthodontists gave assessments. The higher standard devia-
significantly higher ratings than surgeons, tion for the ratings of the distal papilla
while the ratings of students did not differ may well be because of the type of photo-
significantly from those of prosthodontists graphs presented, which were taken in face.
and surgeons. On these, the lateral incisors are particu-
larly less well observable and evaluable.
Orthograde photographs of both the im-
Discussion plant-supported replacements and the
neighboring teeth would appear to be eva-
An analysis of 1200 PESs assigned to im- luable with better reproducibility. The one
plant-supported single-tooth replacements variable reported to be most important for
showed no statistically significant differ- peri-implant esthetics in the literature, i.e.
ences between the two assessments the papilla, was most often restored to
(P 0.6379). As a result, the PES is a match that of natural teeth. This may
suitable instrument for reproducibly evalu- well suggest that awareness of the impor-
ating soft tissue around single-tooth im- tance of a peri-implant soft-tissue variable
plant crowns. A score of several single improves therapeutic approaches and out-
variables is less sensitive to misjudgments comes. The advantage of this score could
than a single-variable rating. If misjudged, lie in the fact that, also, the other variables
a single variable has a more dramatic effect are consciously noticed, leading to differ-
(100%) than one of seven variables entiated therapeutic procedure.
(14.2%). A simple rating by three cate- The level of the peri-implant soft-tissue
gories, i.e. goodfair to middlingpoor, margin came to lie within 1 mm of the

642 | Clin. Oral Impl. Res. 16, 2005 / 639644


reference tooth in no more than 44% of the
implant-supported replacements. In 20%
of cases, the difference vs. the reference
tooth was more than 2 mm. This factor is
of special interest, as both pre- and post-
treatment soft-tissue height and recession
need consideration. Scheller et al. (1998)
reported stable soft tissues in 75% of the
implant-supported single-tooth replace-
ments that they evaluated, and recessions
in 10%. Thus, the PES may change over
time and can be a useful tool for monitor-
ing long-term soft-tissue alterations. The
color of the peri-implant soft tissue
matched that of the reference tooth in no
more than just over one-third of cases, and
showed major discrepancies in 20%. The
level of the soft-tissue margin and the color
of the peri-implant soft tissue fared worst
in the assessments. Consequently, tooth-
colored ceramic abutments would appear to
play an important role. But as the higher
standard deviations (0.55 and 0.57) suggest,
reproducible assessments of color and tex-
ture are problematic.
Esthetically very good and very poor
outcomes presented fewer assessment pro-
blems than intermediate outcomes. This
was reflected by the low standard devia-
tions for high and low PESs (Figs 2b and 3),
and the high standard deviations for PESs
in the intermediate range. The example in
Fig. 4 with the highest standard deviation
illustrates the problems inherent in the
score and in an unbiased assessment:
asymmetry at baseline with aplasia of
tooth 12, diasthemas and midline shift. In
the presence of diasthemas, an evaluation
of the completeness and shape of the pa-
pilla is fraught with problems. Ideally, a
score should help to address critical pro-
blems that are easily overlooked in a gen-
eral assessment. These include recessions,
and the color and texture of the peri-im-
plant soft tissue.
The comparison of specialty groups re-
vealed what effect specialization has.
Orthodontists, who are at best marginally
involved in implant-supported restorations,
were clearly more critical in their judg-
ments. Unaware of the problems en-
countered in achieving an esthetically
satisfactory appearance of the peri-implant
tissue, they approach its assessment with-
out bias. As they are trained to focus on
natural esthetics, orthodontists could
thus serve as critical arbiters of the esthetic
outcome of implant-supported tooth repla-
cements. Prosthodontists, surgeons and
dental students, who all scored the out-
come significantly more generously,
should make sure to heed this point. Cri-
tical assessment of peri-implant soft tissues
with an objective score would help to
evaluate the esthetics of implant-supported
single tooth restorations and optimal surgi-
cal and prosthodontic treatment strategies.
Conclusions
The PES is a tool for reproducibly evaluat-
ing the esthetic appearance of the soft
tissue around single-tooth implant crowns.
Very good and very poor outcomes were
associated with low standard deviations,
suggesting better reproducibility. Restoring
the papilla, which ranks prominently in
the literature, fared best in the assess-
ments, while the level of the soft-tissue
margin and the color of the peri-implant
soft-tissue fared worst. The latter two vari-
ables should, therefore, be given more at-
tention. Unbiased by an awareness of the
problems encountered in achieving nat-
ural-looking implant-supported restora-
tions, orthodontists were the most critical
observers.
Resume
Dans cette etude la reproduction dun nouveau
Score dEsthetique Rose (PES) pour levaluation
des tissus mous autour des couronnes dimplants
uniques a ete evaluee. Leffet de la specialisation de
lobservateur etait un autre point dinteret. Vingt
observateurs (cinq specialistes en prothese, cinq
chirurgiens, cinq orthodontistes et cinq etudiants
en medecine dentaire) ont recu des photographies
de 30 couronnes sur implant unique. Sept variables
ont ete evaluees vs une dent de reference naturelle :
papille mesiale, papille distale, niveau du tissu mou,
couleur du tissu mou, perte du processus alveolaire,
couleur du tissu mou et texture. En utilisant un
systeme 012, zero etant le plus bas et deux etant la
plus haute valeur, le score maximum PES etait donc
de 14. Chaque observateur a recu comme instruc-
tion de realiser deux evaluations a un intervalle de
quatre semaines. A la seconde evaluation les photo-
graphies ont ete evaluees dans un ordre inverse. Les
PES moyens des evaluations de la premiere fois
(n 600) etaient de 9,46
3,81 et 9,24
3,80 la
seconde fois. La difference entre ces deux moyennes
netait pas significative (P 0,6379). Le PS moyen
en relation pour les implants sur dent unique variait
de 2,28 a 13,8 avec des deviations standards de 0,46
a 3,51. Les restaurations de moindre qualite et les
excellentes affichaient les plus petites deviations
Furhauser et al . Esthetic score
standards. Le PES total moyen etait de 10,6 pour
les specialistes en prothese, 9,2 pour les chirurgiens,
9,9 pour les etudiants et 7,6 pour les orthodontistes.
Le PES evalue donc les tissus mous paramplantaires
autour des implants uniques. Un aboutissement
objectif de differents protocoles chirurgicaux ou
prothetiques peut donc etre estime. Les orthodon-
tistes etaient clairement plus critiques que les autres
observateurs.
Zusammenfassung
Ziel: In dieser Arbeit wird die Reproduzierbarkeit
eines neu entwickelten Pink Esthetic Index (PES)
zur Evaluation vom Weichgewebe um Kronen auf
Einzelzahnimplantaten untersucht. Zusatzlich in-
teressierte der Einfluss des Spezialisierungsgrades
eines Untersuchers.
Material und Methoden: Man gab zwanzig Unter-
suchern (5 Prothetiker, 5 Oralchirurgen, 5 Orthodon-
ten und 5 Zahnmedizinstudenten) Fotoaufnahmen
von 30 Kronen auf Einzelzahnimplantaten. Sie hat-
ten 7 Variabeln gegenuber einem naturlichen Refer-
enzzahn zu beurteilen: mesiale Papille, distale
Papille, Niveau der Weichgewebe, Form der Weich-
gewebe, Defizit an Alveolarkamm, Farbe und
Struktur der Weichgewebe. Man definierte eine Be-
wertungsskala 0-1-2, wobei 0 fur den schlechtesten
und 2 fur den besten Wert stehen, so dass man einen
maximalen PES von 14 erreichen konnte. Jeder
Untersucher war angehalten, im Abstand von 4
Wochen zwei Beurteilungen durchzufuhren. Anlas-
slich des zweiten Untersuchungstermins wurden die
Fotoaufnahmen in ungekehrter Reihenfolge beurteilt.
Resultate: Der mittlere PES bei den Untersuchun-
gen im ersten Umgang (n 600) betrug 9.46
(
3.81 SD) und 9.24 (
3.8 SD) im zweiten
Umgang. Der Unterschied zwischen diesen zwei
Mittelwerten war statistisch nicht signifikant
(P 0.6379). Der mittlere implantatspezifische
PES fur die Einzelzahnimplantate variierte zwischen
2.28 und 13.8 mit Standardabweichungen zwischen
0.46 und 3.51. Sehr schlechte und sehr schone
Rekonstruktionen zeigten die kleinesten Standar-
dabweichungen. Der mittlere Gesamt-PES war bei
den Prothetikern 10.6, bei den Oralchirurgen 9.2,
bei den Zahnmedizinstudenten 9.9 und bei den
Orthodonten 7.6.
Zusammenfassung: Der Pink Esthetic Index
untersucht die periimplantaren Weichgewebe um
Einzelzahnimplantate und wird auf seine Re-
produzierbarkeit uberpruft. Damit kann man die
Ergebnisse von verschiedenen chirurgischen und
prothetischen Protokollen objektivieren. Die Ortho-
donten waren deutlich kritischer bei ihrer Beurtei-
lung als die anderen Behandler.
Resumen
Intencion: En este estudio se valoro la reproductibi-
lidad de una nueva Valor de Rosado Estetico (PES)
para evaluar el tejido blando alrededor de coronas de
implantes unitarios. El efecto de la especializacion
del observador fue otro punto de interes.
643 | Clin. Oral Impl. Res. 16, 2005 / 639644
Furhauser et al . Esthetic score
Material y metodos: Se entrego a veinte observa-
dores (5 prostodoncistas, 5 cirujanos orales, 5 orto-
doncistas y 5 estudiantes dentales) fotografas de 30
coronas de implantes unitarios. Se evaluaron 7 vari-
ables frente a dientes naturales de referencia: papila
mesial, papila distal, nivel de tejido blando, contorno
de tejido blando, deficiencia del proceso alveolar,
color y textura del tejido blando. Usando un sistema
de puntuacion de 0-1-2, siendo 0 el valor mas bajo, 2
el valor mas alto, el PES mas alto alcanzable era de
14. Se solicito a cada observador que llevara a cabo
dos valoraciones en un intervalo de 4 semanas. En la
segunda valoracion las fotografas se valoraron en
orden inverso.
Resultados: El PES medio de evaluaciones a la
primera valoracion (n 600) fue 9.46 (
3.81 SD)
y 9.24 (
3.8 SD) en la segunda. La diferencia entre
estas dos medias no fue estadsticamente significa-
tivo (P 0.6379). El PES medio relacionado al im-
plante para implantes unitarios vario desde 2.28 a
13.8 con desviaciones estandar entre 0.46 y 3.51.
Las restauraciones mas pobres y mas esteticas mos-
traron las desviaciones estandar mas bajas. El PES
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