Age-Related Aesthetic Outcomes of Anterior Direct Composite Restorations: Color Match, Patient–Clinician Concordance, and Oral Health-Related Quality of Life

Background/Objectives: Anterior direct composite restorations are evaluated through instrumental color matching, clinician appraisal, and patient perception, but these endpoints may diverge by age. This cross-sectional study compared adolescents/young adults (AYA, 15–25 years) with adults/elderly (AE, 50–75 years) for spectrophotometric color difference (ΔE*ab), patient and clinician aesthetic ratings, patient–clinician agreement, and oral-health-related quality of life (OHRQoL). Methods: Consecutive recall patients with at least one anterior direct composite restoration placed ≥6 months earlier were screened; 128 were enrolled, and 126 completed all assessments (AYA n = 64; AE n = 62). Participants completed the OHIP-14 and aesthetic visual analogue scale (VAS) before receiving any USPHS, clinician VAS, or spectrophotometric feedback. A separate clinician, masked to patient scores and spectrophotometric outputs but not to patient age, recorded clinician VAS and modified USPHS criteria. Results: AE restorations showed higher ΔE*ab than AYA restorations (4.8 ± 1.6 vs. 3.2 ± 1.1; p < 0.001), whereas AYA reported lower patient VAS (72.4 ± 12.3 vs. 81.6 ± 10.8; p < 0.001) and higher OHIP-14 psychosocial burden (7.2 ± 2.8 vs. 4.0 ± 2.3; p < 0.001). Clinician VAS was higher in AYA (85.2 ± 7.3 vs. 79.4 ± 8.9; p < 0.001). Patient VAS correlated modestly with ΔE*ab (ρ = −0.38 in AYA; ρ = −0.31 in AE) and more strongly with psychosocial OHIP-14 scores (ρ = −0.54 and −0.47, respectively). Patient-clinician agreement was poor in AYA (ICC = 0.26) and moderate in AE (ICC = 0.58), with larger negative patient-minus-clinician discrepancies in AYA. Exploratory mediation statistically decomposed the age-related patient-satisfaction difference more through patient–clinician discrepancy than through ΔE*ab; causality cannot be inferred. Conclusions: Younger patients may experience dissatisfaction and psychosocial burden despite better instrumental color match. Assessment of anterior composites should combine objective shade measurement with patient-centered expectation clarification, and longitudinal studies should test temporal mechanisms and communication interventions.