Patient Satisfaction and Acceptance with Dental Esthetics after Endodontic and Prosthodontic Treatment of Dental Dyschromia

Abstract

Background:

Dental dyschromia, commonly resulting from trauma, infection, or endodontic treatment, significantly affects patients’ self-esteem and satisfaction with dental esthetics. Effective treatment often combines endodontic therapy and prosthodontic restoration, but patient perception of esthetic outcomes remains underexplored.

Materials and Methods:

A prospective observational study was conducted on 84 patients (aged 20–55) presenting with anterior tooth discoloration. Participants underwent endodontic therapy followed by either composite veneers, ceramic crowns, or full-coverage zirconia restorations. A structured questionnaire assessed satisfaction using a 5-point Likert scale. Color match, smile esthetics, and self-confidence were measured pre- and post-treatment using the visual analog scale (VAS). Statistical analyses included paired t-tests and ANOVA.

Results:

Post-treatment satisfaction scores significantly increased (mean VAS: pre-treatment 4.3 ± 1.6 vs. post-treatment 8.7 ± 1.2, P < 0.001). Patients treated with zirconia crowns reported the highest esthetic satisfaction (9.1 ± 0.9), followed by ceramic crowns (8.6 ± 1.1) and composite veneers (7.8 ± 1.4) (P = 0.004). 92.8% of participants reported improved self-confidence, and 87.5% indicated willingness to recommend the treatment. No significant difference was observed in satisfaction based on age or gender (P > 0.05).

Conclusion:

Combined endodontic and prosthodontic treatment significantly enhances dental esthetics and patient satisfaction in cases of dental dyschromia. Zirconia crowns yielded the highest esthetic acceptance, suggesting their favorable role in restoring anterior esthetics.

INTRODUCTION

Dental dyschromia, or intrinsic discoloration of teeth, is a common aesthetic concern among patients, particularly involving anterior teeth. It may arise from pulp necrosis, prior endodontic treatment, trauma, or developmental disturbances.[1] Such discoloration, even if functionally asymptomatic, can profoundly affect a patient’s social confidence and willingness to smile.[2]

Endodontic treatment often resolves the underlying pathology, but the esthetic issue remains, necessitating further prosthodontic management. Recent advances in restorative dentistry, such as the use of zirconia crowns, lithium disilicate ceramics, and composite veneers, have enabled more predictable esthetic outcomes.[3,4]

Studies have explored the optical properties and structural performance of these materials,[5] but fewer investigations have focused on patient-reported outcomes (PROs), such as satisfaction with esthetics and psychosocial impact post-treatment. Patient perception plays a critical role in treatment acceptance and success, especially in visible areas like the anterior zone.[6]

Moreover, existing literature on esthetic satisfaction is often limited to either restorative or endodontic interventions independently. There is a notable gap in assessing the cumulative impact of combined endodontic and prosthodontic treatments on patient satisfaction regarding esthetic outcomes.[7]

Therefore, this study aimed to evaluate patient satisfaction and esthetic acceptance following endodontic and subsequent prosthodontic management of dental dyschromia. The study also sought to compare satisfaction levels among different prosthetic materials used for anterior restorations.

MATERIALS AND METHODS

Inclusion Criteria

• Age between 20 and 55 years

• Presence of single or multiple anterior teeth with discoloration due to trauma, caries, or previous root canal treatment

• Completed endodontic therapy before prosthodontic restoration

• Consent to participate and attend follow-up visits

Exclusion Criteria

• Presence of untreated periodontal disease

• History of psychiatric disorders affecting self-perception

• Patients requiring orthodontic treatment for esthetic alignment

• Non-restorable teeth

Treatment protocol

All patients underwent standardized root canal treatment using rotary NiTi files and resin-based sealer. Following a 2-week observation period, patients received prosthodontic treatment based on clinical need and personal preference:

• Group A: Composite veneers (n = 26)

• Group B: Ceramic crowns (n = 28)

• Group C: Monolithic zirconia crowns (n = 30)

Assessment tools

Patient satisfaction was measured using a structured questionnaire containing:

• Visual analog scale (0–10) for color match, smile esthetics, and confidence

• Likert-scale responses for satisfaction and treatment acceptance

• Assessments were done pre-treatment and at a 1-month follow-up.

Statistical analysis

Data were analyzed using SPSS version 26. Paired t-tests evaluated changes in satisfaction scores. One-way ANOVA compared outcomes between groups. A P-value <0.05 was considered statistically significant.

RESULTS

Demographic characteristics

The study included 84 participants (48 females, 36 males), with a mean age of 34.7 ± 9.2 years. Distribution among treatment groups was statistically balanced (P > 0.05).

Improvement in esthetic satisfaction

Overall esthetic satisfaction significantly increased post-treatment (pre-treatment VAS: 4.3 ± 1.6; post-treatment: 8.7 ± 1.2; P < 0.001). Across all subdomains (color match, smile esthetics, confidence), post-treatment scores were significantly higher [Table 1].

Table 1.

Mean±SD VAS scores pre- and post-treatment (all patients)

Parameter		Pre-treatment		Post-treatment		P
Color match		4.1±1.7		8.9±1.1		<0.001
Smile esthetics		4.5±1.5		8.6±1.3		<0.001
Self-confidence		4.3±1.6		8.5±1.2		<0.001

Comparison between prosthetic groups

Post-treatment esthetic satisfaction was highest in the zirconia crown group (9.1 ± 0.9), followed by ceramic crowns (8.6 ± 1.1) and composite veneers (7.8 ± 1.4), with a statistically significant difference (P = 0.004) [Table 2].

Table 2.

Post-treatment satisfaction by prosthetic material

Group		Mean±SD score		P
Composite veneers		7.8±1.4
Ceramic crowns		8.6±1.1
Zirconia crowns		9.1±0.9		0.004

Patient acceptance and psychosocial impact

Overall, 92.8% of patients reported improved self-confidence. 87.5% would recommend the treatment. Gender and age did not significantly influence satisfaction (P > 0.05).

DISCUSSION

This study demonstrates that a combined endodontic and prosthodontic approach substantially improves patient satisfaction with dental esthetics in cases of anterior dental dyschromia. Patients reported a significant increase in self-perceived esthetic appeal and psychological comfort post-treatment.

The higher satisfaction scores among zirconia crown recipients align with previous findings indicating superior optical and mechanical properties of monolithic zirconia, especially in anterior restorations.[8] Zirconia’s ability to mimic natural translucency contributes to its favorable esthetic outcomes.[9]

Ceramic crowns also performed well, consistent with findings from de Sousa et al., where lithium disilicate ceramics showed high patient satisfaction and long-term success.[10] Composite veneers, though cost-effective and minimally invasive, demonstrated relatively lower satisfaction scores, which may be attributed to color stability issues and surface wear over time.[11]

Interestingly, patient demographics such as gender and age did not significantly impact satisfaction, suggesting that esthetic perception is primarily influenced by treatment outcomes rather than intrinsic patient characteristics.[12]

CONCLUSION

This study confirms that endodontic treatment followed by prosthodontic rehabilitation markedly improves esthetic satisfaction in patients with dental dyschromia. Among restorative options, zirconia crowns yield the highest satisfaction and acceptance. Incorporating patient feedback in treatment planning is essential to enhance esthetic and psychosocial outcomes in clinical dentistry.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.