Comparison of Clinical and Digital Assessments of Peri-Implant Soft Tissue Esthetics using the Pink Esthetic Score

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BACKGROUND AND AIM: The Pink Esthetic Score (PES) is a widely used index for evaluating the esthetics of peri-implant soft tissue in the anterior region. With the advent of digital technology, clinicians increasingly rely on digital tools to capture data and evaluate PES using standardized methods. This study aimed to compare the outcomes of clinical and digital assessments of peri-implant soft tissue esthetics using PES. MATERIALS AND METHODS: In this descriptive cross-sectional study, 24 patients with single implants in the anterior region were evaluated. The esthetic quality of the peri-implant soft tissue was assessed clinically and using scans obtained via an intraoral scanner, based on the PES. Scores were assigned for each parameter using a three-point scale: 0 (most differences), 1 (moderate differences), and 2 (least differences compared to the reference). Frequencies of PES scores were analyzed for each of the seven PES items, and total scores were calculated for both methods. Agreement between the two assessment methods was evaluated using weighted kappa statistics and the intraclass correlation coefficient (ICC). RESULTS: Out of 168 assessments, the clinical and digital modalities provided identical scores in 119 cases (70.8%). The weighted kappa for total scores was 0.64, indicating substantial agreement. Kappa values for individual parameters were as follows: 0.68 for mesial papilla, 0.69 for distal papilla, 0.54 for soft tissue margins, 0.66 for soft tissue contour, 0.68 for soft tissue color, 0.47 for soft tissue texture, and 0.62 for alveolar process deficiencies. CONCLUSIONS: Substantial agreement was observed between clinical and digital assessments of peri-implant soft tissue esthetics in the anterior region. Intraoral scanners offer a reliable and advantageous method for evaluating PES, providing consistency and convenience for clinicians.

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