Caroliene Meijndert

150 Chapter 8 the tissues around implants change continuously, albeit only a little, it would be useful to re-evaluate the previous statement when more long-term studies are available. Aesthetic outcome and patient satisfaction The professionals in the different studies used various indices to rate the aesthetics: the Implant Crown Aesthetic Index (ICAI) developed by Meijer et al. (2005) and the Pink Esthetic Score/ White Esthetic Score (PES/WES) developed by Fürhauser et al. (2005) and Belser et al. (2009). It is still under debate whether there is an ideal index that reflects the patients’ judgment. A systematic review assessing the value of aesthetic indices concluded that clinicians are more critical of aesthetic outcomes than patients. Moreover, it was noted that there is a need for a comprehensive and practical index to assess the aesthetic outcomes for single-tooth implant restorations in the aesthetic zone (Arunyanak et al., 2017). In the studies described in this thesis, independent of what index was used, it appeared that the professionals rarely gave a 100% satisfaction score. This means that, despite the surgical and prosthetic procedures applied, the implants used, and whether the procedures were carried out by experienced professionals, it is still difficult to achieve a perfect result, one that is completely in harmony with the surrounding pink and white tissues. A favorable outcome of the 5- and 10-year studies is that the aesthetic results appeared to be stable throughout the years. This could mean that the satisfying aesthetics results achieved in the short-follow-up studies ( Chapters 4-6 ) have good prospects for future aesthetic stability. In line with the conclusion stated in the Arunyanak et al. (2017) systematic review, it can be concluded from the studies described in this thesis that patients are much more satisfied than the professionals. In fact, the patients rated the aesthetics very highly, not only at the 1-year evaluation time points, but also after 5 years and 10 years. It could be that the professional scoring indices are too strict for evaluating small deviations from the ideal situation, deviations that are of minor importance for patients, or are not noticed at all. In fact, while the professionals only rate the end product, the patients also take the initial situation into account when assessing how satisfied they are with the end result. As long as there are no better aesthetic indices, it is not justified to leave out either the professional or the patient judgment in evaluating the aesthetic outcome.