Esthetic failures in dental implant rehabilitation

Abstract

Introduction: Dental implant rehabilitation aims not only for function but also for esthetic excellence. However, esthetic failures constitute a relevant clinical concern that can affect patient satisfaction and the perception of treatment success. Objective: To identify the factors contributing to esthetic failures in dental implant rehabilitation and to propose recommendations for improving esthetic outcomes. Method: A descriptive cross-sectional study conducted on 96 patients rehabilitated with 270 dental implants at the René Otazo Casimajou clinic, Havana. Esthetic failures were evaluated through the combined application of the PES and WES indices, grouping parameters into four domains: color-texture-translucency; crown morphology; arch architecture and integration; and gingival morphology. The following variables were analyzed: prosthetic treatment type, loading protocol, and connection type. Results: Thirty-six esthetic failures were identified. The most affected domain was arch architecture and integration, followed by color, texture, and translucency deficiencies. Gingival and crown morphology showed lower frequencies. Cement-retained rehabilitations, delayed loading, and internal connections predominated. Conclusions: The main esthetic failure factors are poor prosthesis integration into smile architecture and optical mimicry alterations. It is recommended to prioritize macro-esthetic design from planning, exercise extreme chromatic and textural control, and individualize therapeutic decisions to optimize esthetic results.