Dental Implant Esthetic Risk Assessment Form
Evaluate key esthetic risk factors before dental implant treatment to support optimal planning and outcomes.
Smile Line Classification
*
High (full display of teeth and gingiva)
Medium (display of teeth and some gingiva)
Low (minimal display of teeth and gingiva)
Gingival Biotype
*
Thin
Thick
Shape of Adjacent Teeth
*
Triangular
Oval
Square
Bone Quality at Implant Site
*
Excellent (no defect)
Moderate (minor defect)
Poor (major defect)
Soft Tissue Volume at Implant Site
*
Adequate
Moderate
Inadequate
Papilla Height Adjacent to Implant Site
*
Complete papilla present
Partial papilla loss
Papilla absent
Midfacial Mucosa Level Compared to Adjacent Teeth
*
Same level
Slightly lower
Significantly lower
Esthetic Risk Factors Table
*
Rows
Low Risk
Medium Risk
High Risk
Thin scalloped biotype
1
2
3
High smile line
4
5
6
Adjacent tooth with restoration
7
8
9
Horizontal bone defect
10
11
12
Patient Esthetic Expectations
*
1
2
3
4
5
Overall Esthetic Risk (Clinician's Assessment)
*
Low
1
2
3
4
High
5
1 is Low, 5 is High
Submit Assessment
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