Patient-Reported and Clinician-Reported Esthetic Outcomes at Implant Sites Are Not Associated: A Systematic Review With Individual Participant Data Meta-Analysis

Abstract

Objectives This systematic review aimed to determine whether patient-reported outcomes (PROs) are associated with clinician-reported outcomes (ClinROs) in terms of esthetics in patients with single implant-supported crowns in the esthetic region.Methods A systematic electronic search was conducted following a pre-established protocol to identify randomized controlled trials (RCT) involving patients with single implant-supported crowns in the esthetic region. Studies had to assess both patient- and clinician-reported outcomes. A two-stage individual participant data (IPD) meta-analysis was conducted. First, each study was analyzed separately to obtain correlation coefficients. Second, these estimates were pooled using a random-effects restricted maximum likelihood (REML) model.Results A total of 29 RCTs evaluating 1414 implant-supported crowns were included, with IPD available for 14 trials evaluating 675 patients. At crown insertion, IPD meta-analysis from 171 patients across four RCTs showed no significant correlations (r = 0.11, 95% CI [-0.04; 0.27], p = 0.16) between pink esthetic score (PES) and patient satisfaction with esthetics assessed with visual analogue scale (VAS). At the 1-year follow-up, IPD from 502 patients in 11 studies showed a negligible positive correlation (r = 0.09, 95% CI [-0.00; 0.18], p = 0.06) between PES or modified PES and VAS esthetic satisfaction. At 10-year follow-up, data from 80 patients in two studies showed no correlation between modified PES and VAS patient satisfaction (r = -0.05, 95% CI [-0.37; 0.27], p = 0.75). Regarding white esthetic score (WES) and VAS satisfaction, data from 376 patients in seven studies showed no significant correlations at the 1-year follow-up (r = 0.03, 95% CI [-0.08; 0.13], p = 0.60).Conclusion Clinician-reported outcomes, using PES and WES, showed no correlation with patient-reported esthetic satisfaction, regardless of the follow-up duration.Trial Registration PROSPERO number CRD42023394920