Purpose: Determining the esthetic success of single-tooth implant restorations (STIR) requires an

objective tool such as one devised by Belser et al., 2009 - pink esthetic scores and white esthetic

scores (PES/WES). This study aimed to utilized PES/WES to establish threshold scores based on

(1) detectability and (2) acceptability of a STIR by lay person perception, (3) to study the

difference in the ability of laypeople and dentists in detecting the presence of STIR, and (4) to

study the pink and white deficiencies in relation to the detectability of the presence of STIR.

Materials and Methods: A total of 38 calibrated photographs of STIR in the anterior region were

scored with PES/WES by 3 prosthodontists. Next, 100 laypeople and 60 dentists were instructed

to identify the STIR among the anterior teeth and provide reasoning behind the identification

(based on pink and white esthetic criteria). The acceptance of the STIR was recorded. Receiver

Operating Characteristics (ROC) analysis was utilized to determine the threshold scores. Results:

At the PES/WES score of 17, 71% of laypeople could not correctly identify the STIR, and at the 

PES/WES score of 12, 80% of laypeople accepted the implant. Out of 3,800 occasions, laypeople

correctly identified the STIR 1,770 (46.58%) of those occasions. Among the correctly identified

STIR, 751 (42.43%) of those occasions were identified with pink deficiencies and 1019

(57.57%) of those occasions were with white deficiencies. Out of 2,280 occasions, dentists

correctly identified STIR 1869 (81.98%) of those occasions. Conclusions: The PES/WES score

of 12 indicates the clinically acceptable threshold, while the score of 17 indicates the detectable

threshold for an exceptional esthetic outcome. Laypeople tend to accept the implant despite its

detectability. For both laypeople and dentists, root convexity/soft tissue color and texture are the

most focused criteria of PES/WES, followed by overall white deficiencies that remain

influential. Compared to laypeople, dentists tend to have a higher ability to detect STIR.