Validation of the dental esthetic screening index in relation to patient-reported psychosocial outcomes and social perception ratings: A cross-sectional multicenter study.

内容摘要

Objective dental esthetic indices have been commonly used in prosthodontic outcome assessment; however, their integrated validation against patient-reported psychosocial outcomes and social-perception ratings remain limited. The purpose of this cross-sectional multicenter study was to externally validate the Dental Esthetic Screening Index (DESI) and investigate the mediating role of social perception in the relationship between objective esthetics and patient satisfaction. The study included 150 adults who received anterior maxillary esthetic prosthodontic treatment. Standardized smile photographs were evaluated using DESI by calibrated prosthodontists. Participants completed the Psychosocial Impact of Dental esthetics Questionnaire and the Patient Global Impression of Satisfaction scale. Lay observers independently rated smile attractiveness and social attributes. Reliability was assessed using intraclass correlation coefficients and the Cronbach alpha. Associations were evaluated using correlation and regression analyses. Diagnostic performance was assessed using receiver operating characteristic analysis. Mediation analysis evaluated indirect effects of social perception (&#x3b1;=0.05). DESI demonstrated excellent interexaminer reliability (ICC=0.88). Higher DESI scores were strongly associated with greater psychosocial impact (r=0.89; P<.001) and lower patient satisfaction (r=-0.84; P<.001). Poorer objective esthetic scores were significantly associated with reduced social-perception ratings (P<.001). DESI showed excellent discrimination for identifying high psychosocial burden (AUC=0.947) and good accuracy for identifying low satisfaction (AUC=0.908). Social perception partially mediated the DESI-satisfaction relationship, accounting for approximately one-third of the total effect. DESI demonstrated strong external validity across objective, patient-reported, and social-perception outcome domains and may support comprehensive esthetic outcome assessment in prosthodontic practice.