Rehabilitation of missing teeth in the anterior maxilla with an implant-supported fixed prosthesis is a widely accepted treatment modality [1]. Dental implants have high rates of predictability in terms of osseointegration, particularly due to improvements in treatment techniques and surface topography [2]. However, rehabilitation with dental implants is not yet considered a perfect treatment modality as several problems may be encountered during and after implant placement [3]. The success of an implant-supported prosthesis is dependent on several factors and classically defined according to criteria, which mainly focus on osseointegration and the amount of radiographic bone loss [4, 5]. Although these factors are indispensable elements of implant success, they often fail to objectively evaluate all aspects of treatment outcomes, particularly of the implants placed in esthetically demanding areas. In our day, dental implants are commonly used not just to provide patients with function but also form and esthetics. Therefore, an accurate assessment of success inevitably involves objective and patient-reported esthetic evaluation of the treatment outcomes.

An early attempt to evaluate the esthetic aspects of dental implants was made in 1997 by Torsten Jemt who proposed a papilla index, which assessed the size of the interproximal papilla [6]. Since then, successively described evaluation methods of esthetic outcomes have been subject to several studies aiming to test the accuracy and effectiveness of these methods. Today, several factors in addition to the size of the interproximal papilla including the color, form, and the level of peri-implant soft tissues have been included in evaluation of the esthetic outcomes [7, 8].

Recently, more objective approaches to evaluating esthetics of single implant restorations have been described. The pink esthetic score (PES), which evaluates soft tissue esthetics around an implant, was introduced by Furhauser et al. [9]. This effort was followed by Belser et al. who introduced the White Esthetic Score (WES) that reflects the esthetic outcome with regard to the quality of the implant crown [8]. These evaluation methods have since been used by researchers who aim to more objectively evaluate and report esthetic outcomes of implant restorations particularly in the anterior maxilla [10].