Purpose: To evaluate the agreement of quantitative subjective evaluation of esthetic changes in implant dentistry and differences in perception among patients and practitioners. Materials and Methods: Four standardized clinical preoperative and postoperative pictures placed in random order were shown to 30 patients treated with dental implants, on two separate occasions, to subjectively evaluate the esthetic changes using both a graded scale and a visual analogue scale (VAS). The photographs included the front views of the overall smile and, when available, magnified pictures of the area treated including the two neighboring teeth. The same photographs were shown to 10 independent clinicians, who used the same scoring system. Agreement was assessed by evaluating intraobserver and interobserver agreement with a weighted Kappa statistic. Results: In general, agreement was moderate to substantial among patients but only fair among clinicians, with only one practitioner being consistently reproducible. Patients had better agreement than clinicians, but they only evaluated themselves, whereas the clinicians each had to evaluate 30 patients. The agreement of all patients together compared to each individual clinician was poor. The overall agreement between clinicians was also poor. Conclusions: This study of evaluations of pretreatment and posttreatment photographs by 30 patients and clinicians showed that: (1) patient responses were more in agreement, but patients evaluated only their own results; (2) practitioner responses were less in agreement than patient response, but clinicians evaluated all 30 patients; and (3) agreement between patients and clinicians was poor. Int J Oral Maxillofac Implants 2009;24:309–315