Objective: To assess the reproducibility and reliability of the pink (PES) and white esthetic scores (WES) using digital images and the intra- and inter-examiner agreement among different clinical backgrounds and assessment methods.
Material And Methods: Standardized intraoral images were obtained from adult subjects with an implant-supported single-tooth fixed dental prosthesis located in the maxillary esthetic zone using a digital camera and a true-color intraoral scanner. According to the PES and WES criteria, the images were evaluated by 20 calibrated evaluators, 5 prosthodontists, 5 periodontists, 5 undergraduates, and 5 oral surgeons.
Results: The total number of individual PES and WES was 12600 and 9000, respectively. Similar PES and WES values were obtained with the intraoral scanner compared to the digital camera. Intra- and inter-rater variations were observed between and within evaluators' clinical backgrounds, with periodontists showing consistently lower mean PES and WES. The intraclass correlation coefficient ranges between 0.41 to 0.61 for the PES and 0.42 to 0.69 for the WES, resulting in fair to good agreement in both digital methods.
Conclusion: The digital assessment of the peri-implant tissues and implant-supported prostheses utilizing images provided by an intraoral scanner offers a reproducible and reliable digital method comparable with the digital camera.
Clinical Significance: This study highlights the reliability and reproducibility of using intraoral scanners for evaluating peri-implant tissues and implant-supported prostheses. The findings suggest that intraoral scanners are a viable digital alternative to traditional digital imaging for these assessments. However, the observed intra- and inter-rater variations in pink and white esthetic scores, according to the clinical background of evaluators, emphasize the need for caution when interpreting these values in clinical decision-making and research.
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