Aesthetics and Patient-Reported Outcomes in Periodontology and Implant Dentistry: Consensus Report

Maurizio Tonetti¹, Mariano Sanz², Francesco Cairo³, Jose Nart⁴, Iain Chapple^{5

6

7}, Mario Aimetti⁸, Sofia Aroca⁹, Gustavo Avila-Ortiz¹⁰, Juan Blanco¹¹, Antonio Bujaldón¹², Raffaele Cavalcanti¹³, Pierpaolo Cortellini¹⁴, Jan Cosyn¹⁵, Monique Danser¹⁶, Massimo de Sanctis⁹, Jan Derks¹⁷, Henrik Dommisch¹⁸, Elena Figuero², Rodolfo Gianserra¹⁹, Filippo Graziani²⁰, Søren Jepsen²¹, Moritz Kebschull^{5

6

7

22}, France Lambert²³, Eduardo Montero², Nadja Naenni²⁴, Ian Needleman²⁵, Andrea Pilloni¹⁹, Ausra Ramanauskaite²⁶, Mario Roccuzzo²⁷, Ignacio Sanz-Martín²⁸, Ignacio Sanz-Sánchez², Frank Schwarz²⁶, Anton Sculean²⁹, Martina Stefanini³⁰, Daniel Thoma³¹, Leonardo Trombelli³², Cristina Valles⁴, Nicola West³³, Giovanni Zucchelli³⁰, Otto Zuhr³⁴, David Herrera²

Affiliations

¹ Shanghai PerioImplant Innovation Center, Institute for Oral, Craniofacial and Sensory Research, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre for Oral Diseases, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain.
³ Research Unit in Periodontology and Periodontal Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.
⁴ Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.
⁵ Birmingham NIHR Biomedical Research Centre in Inflammation, University of Birmingham, Birmingham, UK.
⁶ Periodontal Research Group, Dentistry, School of Health Sciences, College of Medicine & Health, University of Birmingham, Birmingham, UK.
⁷ Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK.
⁸ Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy.
⁹ 26K Center for Clinical Research, Paris, France.
¹⁰ Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, USA.
¹¹ Surgery and Medical-Surgical Specialties, Facultad de Medicina y Odontología, Santiago de Compostela University, Santiago de Compostela, Spain.
¹² Private Practice, Almería, Spain.
¹³ Campus Bio-Medico, University of Rome, Rome, Italy.
¹⁴ European Research Group on Periodontology (ERGOPERIO), Bern, Switzerland.
¹⁵ Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.
¹⁶ Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
¹⁷ Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
¹⁸ Department of Periodontology, Oral Medicine and Oral Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany.
¹⁹ Section of Periodontology, School of Dentistry, Sapienza University of Rome, Rome, Italy.
²⁰ Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, School of Dentistry, University of Pisa, Pisa, Italy.
²¹ Department of Periodontology, Operative and Preventive Dentistry, University Hospital Bonn, Bonn, Germany.
²² Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, New York, USA.
²³ Department of Periodontology, Oro-Dental and Implant Surgery, CHU of Liège, Liège University, Liège, Belgium.
²⁴ Clinic of Reconstructive Dentistry, Center of Dentistry, University of Zurich, Zurich, Switzerland.
²⁵ Department of Periodontology, Eastman Dental Institute, UCL, London, UK.
²⁶ Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany.
²⁷ Private Practice, Torino, Italy.
²⁸ Private Practice, Lausanne, Switzerland.
²⁹ Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
³⁰ Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
³¹ Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland.
³² Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.
³³ Periodontology, Bristol Dental School, University of Bristol, Bristol, UK.
³⁴ Department of Periodontology, Center of Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.

PMID: 40495112
PMCID: PMC12377961
DOI: 10.1111/jcpe.14182

Aesthetics and Patient-Reported Outcomes in Periodontology and Implant Dentistry: Consensus Report

Maurizio Tonetti et al. J Clin Periodontol. 2025 Sep.

. 2025 Sep;52(9):1222-1244.

doi: 10.1111/jcpe.14182. Epub 2025 Jun 10.

Authors

Affiliations

¹ Shanghai PerioImplant Innovation Center, Institute for Oral, Craniofacial and Sensory Research, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre for Oral Diseases, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain.
³ Research Unit in Periodontology and Periodontal Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.
⁴ Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.
⁵ Birmingham NIHR Biomedical Research Centre in Inflammation, University of Birmingham, Birmingham, UK.
⁶ Periodontal Research Group, Dentistry, School of Health Sciences, College of Medicine & Health, University of Birmingham, Birmingham, UK.
⁷ Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK.
⁸ Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy.
⁹ 26K Center for Clinical Research, Paris, France.
¹⁰ Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, USA.
¹¹ Surgery and Medical-Surgical Specialties, Facultad de Medicina y Odontología, Santiago de Compostela University, Santiago de Compostela, Spain.
¹² Private Practice, Almería, Spain.
¹³ Campus Bio-Medico, University of Rome, Rome, Italy.
¹⁴ European Research Group on Periodontology (ERGOPERIO), Bern, Switzerland.
¹⁵ Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.
¹⁶ Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
¹⁷ Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
¹⁸ Department of Periodontology, Oral Medicine and Oral Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany.
¹⁹ Section of Periodontology, School of Dentistry, Sapienza University of Rome, Rome, Italy.
²⁰ Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, School of Dentistry, University of Pisa, Pisa, Italy.
²¹ Department of Periodontology, Operative and Preventive Dentistry, University Hospital Bonn, Bonn, Germany.
²² Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, New York, USA.
²³ Department of Periodontology, Oro-Dental and Implant Surgery, CHU of Liège, Liège University, Liège, Belgium.
²⁴ Clinic of Reconstructive Dentistry, Center of Dentistry, University of Zurich, Zurich, Switzerland.
²⁵ Department of Periodontology, Eastman Dental Institute, UCL, London, UK.
²⁶ Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany.
²⁷ Private Practice, Torino, Italy.
²⁸ Private Practice, Lausanne, Switzerland.
²⁹ Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
³⁰ Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
³¹ Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland.
³² Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.
³³ Periodontology, Bristol Dental School, University of Bristol, Bristol, UK.
³⁴ Department of Periodontology, Center of Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.

PMID: 40495112
PMCID: PMC12377961
DOI: 10.1111/jcpe.14182

Abstract

Background: Aesthetics and patient-reported experiences (PREs) and outcomes (PROs) influence treatment choices, but have been largely overlooked in periodontology and implant dentistry. This consensus conference evaluated these factors by focusing on gingival recession defects (GRDs), immediate or early/delayed implant placement and peri-implant buccal soft-tissue dehiscences.

Methods: The workshop discussions were informed by five specifically commissioned systematic reviews covering PREs, PROs and clinician-reported outcomes (CROs), including effectiveness, aesthetics and other concerns.

Results: Following treatments such as coronally advanced flaps (CAFs) with a connective tissue graft (CTG) for root coverage (RC), a positive correlation was noted between clinician-reported aesthetic scores and RC measures for GRDs. However, a corresponding correlation for patient-reported aesthetic perceptions was not evident. In dental implant procedures, the addition of a CTG immediately after implant placement significantly mitigated the apical shift in the mid-facial mucosal level. However, clinician- and patient-reported aesthetic scores were not reflective of these changes. Neither set of scores captured the impact of grafting on improving peri-implant soft-tissue volume. In the treatment of peri-implant dehiscences, soft-tissue augmentation (STA), using CTG beneath CAF, resulted in favourable outcomes in clinician- and patient-perceived aesthetics.

Conclusions: Clinician and patient views provide complementary perspectives for evidence-based clinical decision making. They need to be integrated into select interventions. Specific trials are needed encompassing PREs, PROs and CROs and reporting benefits and harms.

Keywords: aesthetic scores; connective tissue grafts; gingival recession; patient‐reported; patient‐reported outcome measures; peri‐implant soft‐tissue dehiscence; soft‐tissue substitutes.

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Conflict of interest statement

Individual potential conflicts of interest forms were completed by all participants and are available on file at the European Federation of Periodontology.

Figures

**FIGURE 1**
Diagram of the decision‐making process leading to patient‐reported outcomes and clinician‐reported outcomes. The diagram illustrates the interplay between patient and clinician perspectives on managing gingival recessions defects. Symptoms and perceptions are central to the considerations that patients take into account when making treatment decisions. Clinical presentation and scientific evidence are the main factors that inform a professional assessment of addressing the patient's problem. The two perspectives inform each other during the evaluation and are integrated throughout the decision‐making process. While the different perspectives are separated for illustrative purposes, they are closely integrated in real life. The diagram specifically describes the decision‐making process that leads to the identification and consideration of patient‐reported outcomes (PROs) and clinician‐reported outcomes (CROs). Patient‐reported outcome measures (PROMs) pertain to the ‘minimally important difference’ (e.g., improved oral hygiene performance, root coverage, reduction of dentine hypersensitivity, no progression of tooth wear, and tooth retention) that justify an intervention. PROs are influenced by the considerations of the dental professional team and/or the patient regarding clinical problems or treatment needs, such as periodontal health, aesthetics, dentin hypersensitivity, tooth wear and root caries. Fear of tooth loss and health economics also play a role in patient considerations. These factors and the information provided by the specialist influence the patient's objectives and, eventually, decisions. The clinical situation is characterised by the diagnosis and professional assessment, which considers tissue phenotype, the depth and width of the recession, interproximal attachment, tooth position and non‐carious cervical lesions, including the detection of the cemento‐enamel junction, in cases of single or multiple gingival recession defects. The available scientific evidence determines the diagnosis and potential solutions, and the decision‐making process is influenced by the clinician's level of expertise, including their education, training and experience. The specialist informs the patient about treatment options, cost effectiveness and the ability to manage aetiological factors. With the patient's consent, the clinical feasibility can contribute to CROs. CROs, clinician‐reported outcomes; NCCLs, non‐carious cervical lesions; OT, orthodontic treatment; PROMs, patient‐reported outcome measures; PROs, patient‐reported outcomes; PT, prosthodontic treatment; REC, gingival recession. Colour code: blue boxes, clinically/clinician‐related factors; yellow boxes, patient‐related factors.

**PHOTOGRAPH 1**
Photograph of Workshop participants.

See this image and copyright information in PMC

References

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Aesthetics and Patient-Reported Outcomes in Periodontology and Implant Dentistry: Consensus Report

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Aesthetics and Patient-Reported Outcomes in Periodontology and Implant Dentistry: Consensus Report

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