OBJECTIVES: The outcome of oral rehabilitation is usually monitored with clinical tests rather than by patient's perception of change. The aim of this study was to describe the objective measure and subjective perception of oral rehabilitation in patients with tooth agenesis. MATERIAL AND METHODS: The study included 129 patients with tooth agenesis rehabilitated with implant- or tooth-supported reconstructions, and a control group of 58 patients. Professional assessments included biological, technical and aesthetic variables. An aesthetic index score included mucosal discoloration, crown morphology, crown color match, occlusal harmony, and papilla level. The Oral Health Impact Profile (OHIP) questionnaire was used to evaluate the patient-based outcomes. Six OHIP questions were subtracted to evaluate the patient-based aesthetic outcomes. RESULTS: Severe root resorption was observed in 36% of the patients in whom orthodontic treatment had been performed. Twelve percent of patients had implants with 5-7 mm peri-implant bone defects. Mucosal discoloration was recorded in 57% of the patients. Twelve percent of the patients had metal visible on the buccal side. The median scores for all five aesthetic variables were acceptable in 92% of the implant reconstructions and for 83% of the tooth-supported fixed dental prostheses (FDPs). The total OHIP score was inferior in rehabilitated patients with tooth agenesis to that of the control group without tooth agenesis. The total OHIP score after rehabilitation was <50 for 95% of the patients with tooth agenesis. The six OHIP questions concerning aesthetics demonstrated patient-based aesthetic problems in 41% of patients treated with implant-supported reconstructions and 47% of patients treated with tooth-supported FDPs. Ninety-eight percent of the group treated with implant-supported reconstructions and 84% of the patients in the tooth-supported FDP group were very satisfied or satisfied with the treatment outcome. CONCLUSIONS: Patients with tooth agenesis had a high risk of severe root resorption after orthodontic treatment. A better aesthetic outcome was obtained with implant-supported reconstructions than with tooth-supported reconstructions. A positive but not significant correlation was observed between the professional and patient-based evaluations of aesthetic outcomes.