Today, dental esthetics are becoming increasingly important among patients and clinicians, as current social media, personality, rituals, and the culture have a strong influence on the perception of dental appearance (Josefsson et al. 2010). In essence, dental appearance and especially anterior teeth can play an important role in creating positive first impressions among individuals. In addition, the orofacial esthetics can be subjectively associated with the level of intellect, social competence, psychosocial adjustment, and relational ability (Duvernay et al. 2014, Kershaw et al. 2008, Montero et al. 2014). Considering the importance of dental appearance, tooth loss has a definitive impact on patients' satisfaction with their dentition and it has been reported that the higher the number of missing teeth, the lower the levels of satisfaction with the dentition and daily life (Al-Omiri et al. 2009).

In the last two decades, dental implants have become a predictable and safe restorative treatment option (Chrcanovic et al. 2018) and, in cases of single tooth loss, preferable to conventional fixed dental prostheses from an economic point of view (Brägger et al. 2005). Implant restorations in the esthetic zone are one of the most challenging restorative procedures in dental medicine, as in many cases bone and soft tissue augmentation procedures and the consequent provisional phase are required (Belser et al. 2004, Furze et al. 2019). Regarding the individual characteristics of patients, in the last decade both in research and in the clinical practice of implantology, treatments have tended to be based on the concept of patient-centered dental medicine.

This concept aims to place the person and their social well-being at the center of clinical decision-making in order to understand the personal factors that play a role outside the clinical setting, including individual behavior, social context and lifestyle in order to offer the best treatment (Lee et al. 2018).

In line with this concept and in order to assess the final outcome of clinicians and patient’s expectations, several methods have been proposed to evaluate the treatment outcomes in dental medicine (Wittneben et al. 2018). In implant dentistry, patient´s esthetic demands have increased, making an objective evaluation of the esthetic parameters to be achieved in treatment with dental implants necessary (Cosyn et al. 2017).

For clinicians’ evaluation, objective parameters have been proposed such as the presence or absence of papilla, the level of mucosal margin, the two- and three-dimensional peri-implant tissue changes and how well the restoration matches with the contralateral natural teeth in terms of shape, color and texture (Cosyn et al. 2017).

Although several studies claim the homogenization of esthetic evaluation parameters (Benic et al. 2012), in recent years, specific assessment tools such as pink esthetic score, white esthetic score and crown implant esthetic score have been gaining importance in clinical studies. Consequently, the quality of research has improved remarkably as the use of these parameters in a universal way allows both clinicians and researchers to ensure the replicability and validity of the assessed clinical research (Fürhauser et al. 2005, Belser et al 2009. Tettamanti et al 2016). However, although these scores are widely used they have certain limitations since they are indicated for the evaluation of single restorations with the presence of contralateral teeth. Therefore, for multiple restorations or extended edentulous spaces cases, more precise tools are needed for a better assessment of these situations.

The aim of the present review is to provide a general overview and recommendations for use reflecting current status of the assessment of the esthetic outcome of dental implant restorations.