Evaluation of the effect of implant-supported fixed prostheses on patients’ quality of life and anxiety disorders

Abstract

Objectives

The study was aimed to assess anxiety levels and oral health-related quality of life in patients with indications for implant-supported fixed prostheses using pre- and post-treatment questionnaires and to show the impact of oral health on quality of life. In addition, this study tested the null hypothesis that implant-supported fixed prosthodontic treatment does not lead to significant changes in anxiety levels or oral health-related quality of life.

Materials and methods

This prospective study was conducted to evaluate changes in anxiety levels and oral health-related quality of life in patients who applied to the Department of Prosthodontics, Faculty of Dentistry, Tokat Gaziosmanpaşa University, before and after receiving implant-supported fixed prosthodontic treatment. Dental anxiety and oral health–related quality of life (OHRQoL) were assessed using the Oral Health Impact Profile-14 (OHIP-14), Modified Dental Anxiety Scale (MDAS), and State–Trait Anxiety Inventory (STAI-S/T). Participants were selected from patients over 18 years old, without intellectual disabilities, who had at least one missing posterior tooth, and were ready for intraoral prosthetic treatment. A total of 60 patients with implant-supported fixed prosthodontic indications who agreed to participate completed the questionnaires. Data were analyzed with IBM SPSS V23 (IBM Corp, Armonk, NY). The Shapiro-Wilk test assessed the data’s normality by gender and age groups. The Kolmogorov-Smirnov test was used for pre- and post-treatment comparisons. The significance level was set at p < 0.05. For each primary outcome, mean differences were calculated together with their 95% confidence intervals to enhance the clinical interpretability of the findings.

Results

The STAI-S score decreased from 32.58 pre-treatment to 28.98 post-treatment (mean difference − 3.60; 95% CI: −5.10 to − 2.12). The STAI-T score lowered from 45.42 pre-treatment to 43.35 post-treatment (mean difference − 2.07; 95% CI: −3.85 to − 0.92), and the MDAS score declined from 10.02 pre-treatment to 8.42 afterward (mean difference − 1.60; 95% CI: −2.35 to − 0.84). OHIP-14 scores were 25.3 pre-treatment and 21.35 post-treatment (mean difference − 3.95; 95% CI: −5.48 to − 2.41). Statistical analyses showed no significant association between age groups and changes in anxiety or oral health-related quality of life (p > 0.05), supporting the statement that age did not influence treatment outcomes.

Conclusions

After implant-supported fixed prosthetic treatment, patients’ anxiety levels decreased, and their quality of life improved. Women exhibited higher dental anxiety levels than men. Age did not appear to influence anxiety levels or quality of life.

Clinical relevance

Implant-supported fixed prosthodontic treatment not only restores oral function and esthetics but also helps reduce patient anxiety and enhances oral health-related quality of life. These findings emphasize the importance of considering patients’ psychological well-being when planning treatment. Understanding gender-related differences in dental anxiety allows clinicians to provide more personalized care, while the absence of age-related effects indicates that these benefits are applicable across a broad adult population.

Introduction

Oral health is a fundamental component of overall well-being, encompassing physical, psychological, and social domains. The World Health Organization emphasizes that health is not merely the absence of disease but a state of complete physical, mental, and social well-being, which includes oral health as an integral part of general health [1]. Oral health-related quality of life (OHRQoL) reflects the extent to which oral conditions affect daily functioning, emotional stability, and social interactions [2, 3]. Impairments in OHRQoL may lead to avoidance of dental care and negatively impact both systemic health and psychosocial well-being [4]. OHRQoL can be evaluated using a variety of different scales. Among these, the most commonly used is the Oral Health Impact Profile-14 (OHIP-14). Unlike previous research, which often combines mixed prosthetic designs or focuses primarily on removable implant-supported options, the present study uniquely isolates patients treated exclusively with implant-supported fixed prostheses and provides a concurrent, prospective evaluation of both dental anxiety (STAI, MDAS) and OHRQoL (OHIP-14).

One of the most significant psychological barriers to dental treatment is dental anxiety, which influences treatment compliance, increases avoidance behaviors, and deteriorates oral health outcomes [5]. Dental anxiety has been associated with delayed treatment seeking, leading to progressive functional and aesthetic problems [6]. Validated measurement tools such as the Spielberger State-Trait Anxiety Inventory (STAI) and the Modified Dental Anxiety Scale (MDAS) are frequently used to quantify anxiety levels in dental patients [7, 8]. However, previous studies show substantial variability in when these instruments are administered—some measure only preoperative anxiety, others only postoperative scores—resulting in inconsistent conclusions regarding the temporal effect of implant therapy on psychological outcomes.

Dental implant therapy, particularly implant-supported fixed prostheses, has become a widely accepted and effective treatment option for patients with tooth loss, as it restores function, improves aesthetics, and enhances self-confidence [9]. Recent studies have highlighted that implant therapy not only improves masticatory efficiency and aesthetics but also significantly reduces dental anxiety and improves OHRQoL scores [10–12]. Despite these positive findings, the literature remains heterogeneous in terms of prosthetic types, combining fixed, removable, and mixed implant-supported restorations, making it difficult to isolate the psychological effects of a single treatment modality. A multicenter prospective study reported that preoperative dental anxiety negatively influenced early postoperative OHRQoL, underlining the importance of psychological assessment before surgical procedures [13]. Similarly, systematic reviews published between 2018 and 2025 confirmed that implant rehabilitation leads to improvements in psychosocial outcomes, including reduced anxiety and enhanced patient satisfaction [14–16]. Moreover, most existing studies rely on a single anxiety or quality-of-life instrument, which limits comprehensive assessment and contributes to variability in reported outcomes. Differences in follow-up duration, patient age distribution, and clinical protocols further contribute to inconsistent findings across studies.

Recent field-specific studies have emphasized that psychological responses to implant therapy vary depending on prosthesis type, surgical complexity, and patient expectations. For example, recent analyses between 2020 and 2024 demonstrate that fixed implant-supported rehabilitations yield greater improvements in functional satisfaction and perceived stability than removable attachments, potentially influencing anxiety outcomes differently [16–18]. Furthermore, contemporary research also highlights that anxiety trajectories following implant surgery are modulated by postoperative discomfort, prosthetic adaptation period, and baseline psychological profiles, underscoring the need for modality-specific investigations [19, 20]. These recent findings support the importance of examining fixed implant-supported prostheses as a distinct category rather than relying on generalized assumptions about dental anxiety.

Despite these promising findings, to the best of our knowledge, prospective studies that simultaneously assess both anxiety (STAI, MDAS) and OHRQoL (OHIP-14) before and after implant-supported prosthetic rehabilitation—specifically in patients receiving implant-supported fixed prostheses and independent of removable or mixed prosthetic designs— remain limited, particularly among middle-aged and older adult populations. Although numerous studies have investigated anxiety and OHRQoL changes associated with implant therapy, the existing literature predominantly focuses on comparisons between implant-supported removable prostheses and conventional removable dentures, evaluations of different types of implant-supported removable attachments, assessments of conventional fixed prostheses, or combined analyses of removable and fixed implant-supported prosthetic options. This gap underscores the need for more targeted research that isolates the effects of fixed implant-supported prosthetic rehabilitation. Therefore, the present study aims to evaluate changes in anxiety and OHRQoL in patients undergoing implant-supported fixed prosthesis treatment, primarily involving single-tooth and short-span fixed restorations with the null hypothesis that implant therapy contributes not only to functional and aesthetic rehabilitation but also to psychological well-being and quality of life. Focusing exclusively on implant-supported fixed prostheses adds scientific value because fixed restorations differ from removable or mixed designs in biomechanical stability, functional performance, and psychological impact. Evaluating this group independently minimizes confounding from heterogeneous prosthetic types and provides a clearer assessment of how fixed implant rehabilitation specifically influences anxiety and OHRQoL. The null hypothesis of this study is that implant-supported fixed prosthesis treatment does not lead to statistically significant changes in patients’ anxiety levels or oral health-related quality of life. Based on current knowledge, this is the first prospective study to assess fixed implant-supported prostheses using STAI, MDAS, and OHIP-14 concurrently.

Materials and methods

Study design and ethical approval

This prospective study was conducted at Tokat Gaziosmanpaşa University, Faculty of Dentistry, Department of Prosthodontics. The aim was to evaluate the changes in anxiety levels and oral health-related quality of life (OHRQoL) before and after implant-supported fixed prosthetic treatments using the State-Trait Anxiety Inventory (STAI-S/T), the Modified Dental Anxiety Scale (MDAS), and the Oral Health Impact Profile-14 (OHIP-14). Ethical approval was obtained from the Tokat Gaziosmanpaşa University Clinical Research Ethics Committee (Klinik Araştırmalar Etik Kurulu, KAEK) (Approval No: 21-KAEK-082). All participants provided written informed consent prior to enrollment.

G power analysis

The sample size for the present study was calculated using G*Power version 3.1.9.2. The effect size (d = 0.377, r = 0.19) was derived from a pilot sample by dividing the mean pre–post difference in MDAS scores by the pooled standard deviation. A paired (dependent) t-test was selected as the primary analysis method because the study aimed to evaluate within-subject changes pre and post-treatment. With an expected medium effect size of 0.377, an α level of 0.05, and a desired statistical power of 0.80, G*Power estimated that a minimum of 58 participants would be required to detect a statistically significant pre–post difference.

Participants

A total of 60 patients who applied to the Faculty of Dentistry and were scheduled for implant-supported fixed prosthetic rehabilitation participated voluntarily. Inclusion criteria were: age ≥ 18 years, absence of mental disability, indication for implant-supported fixed prosthesis, at least one missing tooth in the posterior region, absence of acute dental pain or temporomandibular joint disorders, willingness to sign informed consent, and absence of diagnosed psychiatric disorder or ongoing psychiatric medication. Exclusion criteria were: age < 18 years, intellectual disability, refusal to provide informed consent, unsuitability for implant treatment or inadequate oral conditions for prosthetic treatment, and presence of a diagnosed psychiatric disorder or current use of psychiatric medication. Patients receiving antidepressant or anxiolytic medication, undergoing ongoing psychological or psychiatric treatment, or with any history of clinically documented psychiatric conditions were explicitly excluded. Implant-supported fixed prosthetic treatments in this study primarily consisted of single-tooth implant-supported crowns and short-span fixed partial prostheses (2–3 units) placed in the posterior region. Patients who received extensive full-arch or complete implant-supported rehabilitations were not included. All participants were undergoing implant-supported treatment for the first time and had no prior history of dental implant placement or implant-supported prostheses (fixed or removable).

Procedure

Each patient completed the questionnaires at two clearly defined clinical stages: [1] at the initiation of the definitive prosthetic rehabilitation phase (specifically during the Day 1 impression-taking appointment, which followed completion of all surgical procedures, osseointegration, second-stage surgery, and soft-tissue healing), and [2] on the 21st day after delivery of the definitive implant-supported fixed prosthesis [21]. The 21-day postoperative evaluation period was selected to assess early functional and psychological adaptation following delivery of the definitive implant-supported fixed prosthesis.

Instruments

• STAI-S/T: The State-Trait Anxiety Inventory is a 40-item Likert-type self-report scale developed to assess both temporary (state) and general (trait) anxiety levels. Scores range between 20 and 80, with higher scores indicating greater anxiety [22].

• MDAS: The Modified Dental Anxiety Scale is a 5-item questionnaire, each scored from 1 to 5, with total scores ≥ 19 considered to indicate high dental anxiety [23, 24].

• OHIP-14: The Oral Health Impact Profile-14 assesses oral health-related quality of life across seven domains, using a 5-point Likert scale (0–4). Higher scores reflect poorer quality of life [25].

Statistical analysis

Data were analyzed using IBM SPSS Statistics version 23. The normality of the data distribution by gender and age groups was assessed with the Shapiro–Wilk test, while pre- and post-treatment comparisons were evaluated using the Kolmogorov–Smirnov test. For gender-based comparisons, the independent samples t-test and the Mann–Whitney U test were applied, whereas one-way analysis of variance (ANOVA) and the Kruskal–Wallis H test were used for comparisons across age groups. Paired samples t-tests were employed to compare pre and post-treatment STAI-I, STAI-II, MDAS, OHIP total, and subscale scores. Results were presented as mean ± standard deviation and median (minimum–maximum). The significance level was set at p < 0.05.

Results

A total of 60 patients were included in the study. Overall, the pre-treatment scores of anxiety and oral health-related quality of life showed early improvements following implant-supported fixed prosthesis therapy. The normality of data distributions was examined using the Shapiro–Wilk test for gender and age groups, and the Kolmogorov–Smirnov test for pre-treatment and post-treatment changes. The parametric and nonparametric tests used in these analyses were justified as follows: Both pre-treatment and post-treatment values ​​and the difference (Δ) values ​​for the STAI-I and STAI-II total scores were normally distributed (Shapiro–Wilk p > 0.05) (Table 1). Therefore, an Independent Samples t-test was used for gender comparisons, a One-Way ANOVA for age group comparisons, and a Paired Samples t-test for pre-treatment and post-treatment comparisons. The distributions of pre-treatment and post-treatment differences for the OHIP subscales were normal (p > 0.05). Therefore, these subscales were analyzed using a paired t-test. Because the differences were normally distributed, parametric methods were used for all pre–treatment–post–treatment comparisons.

Table 1.

Comparison of OHIP subdomain scores pre- and post-treatment

OHIP Subdomain	Pre-Treatment	Post-Treatment	Difference	r**	p*
OHIP 1 (Functional limitation)	3.05 ± 1.29	2.67 ± 1.17	0.38 ± 1.25	0.491	0.021
OHIP 2 (Physical pain)	4.30 ± 1.82	3.40 ± 1.30	0.90 ± 1.56	0.542	< 0.001
OHIP 3 (Psychological discomfort)	5.40 ± 1.92	4.53 ± 1.78	0.87 ± 1.61	0.625	< 0.001
OHIP4 (Physical disability)	3.63 ± 1.93	3.07 ± 1.54	0.58 ± 1.97	0.373	0.030
OHIP 5 (Psychological disability)	3.17 ± 1.50	2.88 ± 1.72	0.28 ± 0.98	0.824	0.028
OHIP 6 (Social disability)	2.63 ± 1.06	2.50 ± 1.08	0.13 ± 0.81	0.712	0.209
OHIP 7 (Handicap)	2.85 ± 1.22	2.55 ± 1.03	0.30 ± 0.89	0.700	0.011

*Paired Two Sample t Test

**r: Correlation Coefficient; Mean ± S. Deviation

p* < 0.05 was considered statistically significant

When subsamples were examined for the MDAS total score by gender and age groups, the distributions deviated from normality. They were skewed to the right in most groups (Shapiro–Wilk p < 0.05). Therefore, the Mann–Whitney U test was used for gender comparisons, and the Kruskal–Wallis H test was used for age comparisons. As with the MDAS, the assumption of normal distribution was not met in many subgroups for the OHIP total score. Therefore, the Mann–Whitney U test was applied for gender, and the Kruskal–Wallis H test was applied for age groups. Presenting the results as medians (min–max) also supports the use of nonparametric analysis.

As shown in Table 1, implant-supported fixed prosthesis therapy resulted in early improvements across all OHIP-14 subdomains. The most pronounced reductions were observed in psychological discomfort, physical pain, and physical disability showing statistically significant decreases in post-treatment scores (p < 0.001).

Social disability did not show a significant change, indicating that certain social or environmental aspects of quality of life may be less influenced by oral rehabilitation.

After applying the Holm–Bonferroni correction, only the OHIP-2 and OHIP-3 subdomains remained statistically significant. Although several raw p-values indicated improvement, these did not retain significance following adjustment. This pattern suggests that implant rehabilitation exerts its strongest effects on physical pain and psychological discomfort domains, whereas changes in other subdimensions may be more limited.

Further analysis of OHIP subdomains revealed that most domains showed early improvement. However, OHIP 6 showed no statistically significant difference (p = 0.209) (Table 2). This indicates that while the majority of oral health-related quality of life domains benefit from treatment, some social impacts may persist despite prosthetic rehabilitation.

Table 2.

Holm–Bonferroni adjusted OHIP Sub-dimensional analysis

OHIP Subdomain	Raw p-value	Holm–Bonferroni p-value	Significance
OHIP-1	0.021	0.084	Non significant
OHIP-2	< 0.001	0.0035	Significant
OHIP-3	< 0.001	0.0030	Significant
OHIP-4	0.030	0.060	Non significant
OHIP-5	0.028	0.084	Non significant
OHIP-6	0.209	0.209	Non significant
OHIP-7	0.011	0.055	Non significant

*p < 0.05 was considered statistically significant

When results were stratified by gender, females initially presented with significantly higher pre-treatment STAI-S scores compared to males (p = 0.02) (Table 3). However, post-treatment, no significant differences remained (p = 0.34) (Table 3). STAI-T scores did not show significant differences by gender either before or after therapy.

Table 3.

Distribution of STAI scores by gender

Variables	n (%)	STAI-S pre-	STAI-S post-	STAI-T pre-	STAI-T post-
Female	30 (50)	35.27 ± 1.80	30.00 ± 1.60	46.20 ± 1.00	44.00 ± 1.00
Male	30 (50)	29.90 ± 1.35	28.00 ± 1.30	44.70 ± 1.20	42.70 ± 1.10
Test statistic		t = 2.385	t = 0.960	t = 0.973	t = 0.859
p*		0.020	0.341	0.334	0.394

*t: Independent samples t test statistic; Mean ± S. Deviation

*p < 0.05 was considered statistically significant

The mean pre-treatment STAI-S score was 32.58, and it decreased to 28.98 post-treatment. There is a statistically significant difference between pre and post-treatment STAI-S scores (p < 0.001) (Table 4). The mean pre-treatment STAI-T value was 45.42; it decreased to 43.35 post-treatment (Table 4). There is a statistically significant difference between pre and post-treatment STAI-T scores (p = 0.001). The mean pre-treatment MDAS value was 10.02, and it decreased to 8.42 post-treatment. There is a statistically significant difference between the pre-treatment and post-treatment MDAS values (p < 0.001) (Table 4). There is a statistically significant difference between pre and post-treatment OHIP total scores (p < 0.001) (Table 4).

Table 4.

Comparison of patients’ STAI-S, STAI-T, MDAS and OHIP values pre- and post-treatment

	Pre-treatment	Post-treatment	Difference	r**	Statistics	p*
STAI-S	32.58 ± 9.06	28.98 ± 7.93	3.60 ± 5.33	0.811	5.231	<0.001
STAI-T	45.42 ± 5.97	43.35 ± 5.85	2.07 ± 4.59	0.698	3.489	0.001
MDAS	10.02 ± 3.36	8.42 ± 2.80	1.60 ± 1.92	0.820	6.442	< 0.001
OHIP Toplam	25.30 ± 7.38	21.35 ± 5.97	3.95 ± 5.35	0.698	5.722	< 0.001

*Paired Two Sample t Test

**r: correlation coefficient; Mean ± S. Deviation

p* < 0.05 was considered statistically significant

According to the MDAS scale, the pre-treatment mean score was 11.37 for women and 8.67 for men, while the post-treatment median scores were 9 and 7, respectively (Table 5). Pre and post-treatment MDAS scores differed significantly by gender (p = 0.001 and p = 0.034). Post-treatment MDAS scores remained higher in female patients than in male patients; however, the extent of anxiety reduction following implant-assisted treatment was similar between genders. Across age groups, the median MDAS scores were 6 and 8 for individuals aged 18–24; 11 and 9 for those aged 25–34; 9.5 and 7.5 for those aged 35–45; 10.5 and 9.5 for those aged 46–60; and 9 and 7 for individuals over 60 (Table 5). However, these differences were not statistically significant (p = 0.134 and p = 0.503). For the OHIP scale, the pre-treatment mean score was 27.53 for women and 8.67 for men, while the post-treatment median score was 19.5 for both genders. Although pre-treatment OHIP scores differed significantly by gender, post-treatment scores did not (p = 0.018 and p = 0.500) (Table 5). Regarding age groups, the median OHIP scores were 21 and 18 for individuals aged 18–24; 27 and 20 for those aged 25–34; 21.5 and 19 for those aged 35–45; 27 and 21 for those aged 46–60; and 22 and 23 for individuals over 60. These changes were not statistically significant across age groups (p = 0.408 and p = 0.488) (Table 5). Because the age information of two patients is absent from the dataset, the aggregated count across only the age categories does not total 60.

Table 5.

Distribution of STAI-S, STAI-T MDAS, OHİP scores by age and gender (n = 60)

	n (%)	STAI-S		STAI-T
		Pre- treatment	Post- treatment	Pre- treatment	Post- treatment
Gender
Female	30 (50)	35.27 ± 1.80	30.00 ± 1.60	46.20 ± 1.00	44.00 ± 1.00
Male	30 (50)	29.90 ± 1.35	28.00 ± 1.30	44.70 ± 1.20	42.70 ± 1.10
Statistics		t = 2.385	t = 0.960	t = 0.973	t = 0.859
p		0.020	0.341	0.334	0.394
Age
18–24	3 (5)	28.33 ± 5.51	25.67 ± 7.37	43.67 ± 5.86	41.67 ± 5.03
25–34	6 (10)	34.17 ± 16.86	30.83 ± 13.26	46.17 ± 7.96	41.83 ± 7.03
35–45	18 (30)	33.06 ± 8.50	28.06 ± 8.50	43.67 ± 4.94	41.94 ± 3.47
46–60	22 (36.7)	33.14 ± 8.82	29.82 ± 7.40	46.09 ± 6.28	43.64 ± 7.28
60+	9 (15)	30.11 ± 4.31	28.67 ± 4.80	44.67 ± 3.04	44.67 ± 2.87
Statistics		F = 0.728	F = 0.318	F = 0.566	F = 1.098
p		0.591	0.865	0.688	0.407

	n (%)	MDAS		OHİP
		Pre- treatment	Post- treatment	Pre- treatment	Post- treatment
Gender
Female	30 (50)	11.37 ± 3.62	9 (5–19)	27.53 ± 7.32	19.5 (14–35)
Male	30 (50)	8.67 ± 2.47	7 (5–11)	8.67 ± 2.47	19.5 (14–40)
Statistics		t = 3.379	U = 308.000	t = 2.440	U = 404.500
p		0.001	0.034	0.018	0.500
Age
18–24	3 (5)	6 (6–9)	8 (6–9)	21 (14–26)	18 (14–21)
25–34	6 (10)	11 (6–15)	9 (6–10)	27 (16–30)	20 (15–27)
35–45	18 (31)	9.5 (6–14)	7.5 (5–11)	21.5 (16–43)	19 (14–40)
46–60	22 (38)	10.5 (5–20)	9.5 (5–19)	27 (15–48)	21 (14–31)
60+	9 (16)	9 (6–12)	7 (5–10)	22 (19–38)	23 (16–35)
Statistics		=7.031	=3.339	=3.989	=3.436
p		0.134	0.503	0.408	0.488

p < 0.05 was considered statistically significant

t: Independent samples t test statistic; U: Mann Whitney U test statistic; F: One-way analysis of variance (ANOVA)

χ2 Kruskal Wallis H test statistic; mean ± s.deviation; median (min. – max.)

Discussion

The findings of this study reflect changes in short-term anxiety levels and oral health-related quality of life following implant-supported fixed prosthesis rehabilitation. The present study demonstrated that implant-supported fixed prosthesis therapy was associated with early following significant reductions in dental anxiety and improvements in oral health-related quality of life. At baseline, patients exhibited relatively low anxiety levels and acceptable oral health–related quality-of-life scores, as reflected by mean pre-treatment values for STAI-S (32.58 ± 9.06), STAI-T (45.42 ± 5.97), MDAS (10.02 ± 3.36), and total OHIP-14 (25.30 ± 7.38). Accordingly, the null hypothesis of this study was rejected. These findings highlight the multifaceted benefits of implant rehabilitation, not only in functional and esthetic dimensions but also in psychological and social well-being. It should be noted that baseline anxiety levels and oral health–related quality-of-life scores in the present study were relatively low and within acceptable ranges. This finding may be explained by the characteristics of the study population, which consisted of patients with limited posterior tooth loss, absence of acute dental pain, and eligibility for elective implant-supported fixed prosthetic treatment rather than extensive or advanced edentulism. Consequently, the magnitude of observed postoperative changes should be interpreted in the context of these baseline conditions. Moreover, as the intervention predominantly involved single-unit and short-span fixed prostheses in patients without removable prostheses, a lower degree of baseline oral health–related impairment would be expected compared with patients presenting with more extensive tooth loss.

Gender differences in anxiety and quality of life

As an initial step in interpreting the study findings, gender-related differences were examined to determine whether anxiety levels and quality-of-life outcomes differed between male and female patients following implant-supported rehabilitation. The results showed that females presented with significantly higher pre-treatment STAI-S scores than males, consistent with previous studies reporting that women experience higher levels of situational anxiety prior to dental interventions [26, 27]. However, this difference disappeared post-treatment, suggesting that the therapeutic process fosters reassurance and psychological relief. MDAS scores also remained higher in females both pre- and post-treatment, supporting the notion that women may have a greater predisposition to dental anxiety [27]. Although female patients exhibited higher MDAS scores both pre- and post-treatment, the relative improvement in dental anxiety following implant-supported rehabilitation was similar across genders, suggesting that treatment-related anxiety reduction was not gender-dependent. In terms of quality of life, females reported lower OHIP-14 scores at baseline, yet the gap narrowed significantly post-treatment, reflecting the positive psychosocial impact of implant-supported prostheses [28]. A study in the field of periodontology reported that women had higher levels of dental anxiety among patients seeking treatment [29]. Previous research indicates that gender-related differences in dental anxiety are highly variable and may be influenced by several unmeasured confounding factors rather than inherent psychological traits. For instance, negative or traumatic dental experiences are among the strongest predictors of dental fear, and their distribution may differ between genders [5]. Pain sensitivity has also been shown to modulate anxiety responses during dental procedures, with studies reporting significant inter-individual variation in pain thresholds that may account for anxiety discrepancies [30]. Sociocultural expectations—including gender norms related to emotional expression, fear disclosure, and help-seeking behaviors—have further been implicated in shaping reported anxiety levels [31]. Additionally, coping styles such as avoidance, catastrophizing, or active coping strategies differ across populations and may influence anxiety severity independent of gender [32]. Taken together, these mixed findings in the literature emphasize that the gender differences observed in the present study should be interpreted with caution, as they may reflect a complex interplay of psychological, experiential, and sociocultural factors rather than biological predispositions.

Age-related variations

In addition to gender-related differences, age was evaluated as another key demographic factor that may influence psychological adaptation and perceived quality of life after treatment. No significant differences in STAI-S, STAI-T, MDAS, or OHIP-14 scores were observed across age groups. This suggests that dental anxiety and oral health-related quality of life are not strongly influenced by age. Previous studies have reported conflicting findings: while some observed higher anxiety in younger patients, others found no significant age-related associations [33, 34]. Some studies in the literature have observed a weak positive correlation between age and dental anxiety [35, 36]. This is consistent with our current study. However, some studies have reported that dental anxiety decreases with age [37]. These divergent results can be attributed to participant profiles and cultural differences. However, caution is warranted when interpreting the present findings, as the sample size within each age subgroup may not have been sufficiently powered to detect subtle or clinically relevant differences. Therefore, the results should not be taken to imply that the benefits of implant rehabilitation are entirely independent of age, but rather that no statistically detectable age effect was observed within the limitations of the current dataset.

Changes in anxiety levels (STAI-S, STAI-T, MDAS)

Following the assessment of demographic influences, changes in anxiety levels were analyzed using the STAI-S, STAI-T, and MDAS scales to provide a standardized evaluation of psychological responses to implant-supported treatment. Both STAI-S and STAI-T scores showed significant reductions following treatment, indicating that implant-supported prostheses contribute to alleviating general and situational anxiety. This is in line with reports associating dental interventions with increased feelings of calmness and confidence postoperatively [38, 39]. Similarly, MDAS scores decreased markedly post-treatment (p < 0.001), reinforcing the therapeutic role of dental care in reducing treatment-specific anxiety. In a study conducted in North Wales, patients who completed the MDAS and STAI-S scales before and after treatment showed a reduction in state anxiety post-treatment [40]. Similarly, another study involving pediatric patients reported lower scores on dental anxiety scales administered after treatment compared to pre-treatment levels [41]. These results are consistent with the findings of the present study. The consistently higher MDAS scores observed in women suggest that additional anxiety-reducing strategies, such as behavioral interventions or pre-treatment counseling, may be particularly beneficial in female patients.

Oral Health-Related quality of life (OHIP-14)

Beyond anxiety-related outcomes, the impact of treatment on oral health–related quality of life was assessed using the OHIP-14, allowing the functional and psychosocial implications of the observed psychological changes to be evaluated. After Holm–Bonferroni correction, statistically significant improvements were observed only in the physical pain (OHIP-2) and psychological discomfort (OHIP-3) subdomains, whereas changes in other OHIP-14 subdomains did not retain statistical significance. The selective significance of these domains suggests that early postoperative benefits were primarily related to reductions in physical discomfort and dental-related psychological distress, rather than broader social or functional aspects of oral health. Ali Bana et al. observed an improvement in patients’ OHIP-14 scores following complete denture treatment [42]. Similarly, Hernández et al. noted improvements in all subcategories of OHIP-14 scores compared to baseline in patients undergoing non-surgical periodontal therapy [43]. These studies suggest that dental treatments have positive effects on improving patients’ quality of life. These results support the idea that implant-supported prostheses improve oral health-related quality of life, both physically and psychologically [44]. Interestingly, the “social disability” subdomain did not show a statistically significant change, suggesting that social aspects of quality of life may be less responsive during the early postoperative period.

General implications

Taken together, the findings related to demographic factors, anxiety measures, and oral health–related quality of life offer important insights into the broader clinical and patient-centered implications of implant-supported prosthetic rehabilitation. Based on the observed early postoperative outcomes, the present findings highlight the potential value of incorporating psychological screening into routine implant treatment planning. Preoperative assessment tools such as the STAI or MDAS can assist clinicians in identifying patients with elevated levels of dental anxiety who may require additional support pre- treatment and during treatment. Integrating such screening measures may enhance communication, enable tailored behavioral strategies, and improve patient preparedness—factors known to reduce intraoperative stress and postoperative dissatisfaction. Moreover, psychological assessment can help clinicians anticipate possible anxiety-related delays, avoidance behaviors, or treatment interruptions. Given that psychological factors are integral to patient comfort, cooperation, and overall treatment success, incorporating structured psychological screening protocols may improve both clinical efficiency and patient-centered outcomes.

Although subgroup analyses were not conducted, existing evidence suggests that patients with higher baseline anxiety may experience more pronounced psychological improvement following implant rehabilitation. This pattern is supported by cognitive–behavioral models, which posit that reducing feared stimuli yields greater perceived benefit in individuals with heightened anticipatory fear. Thus, highly anxious patients may represent a subgroup that derives substantial psychological and quality-of-life gains, a hypothesis that warrants confirmation in future stratified studies.

Overall, this study highlights the early postoperative impact of implant-supported prosthetic treatments. Improvements were observed not only in clinical function but also in psychological well-being, reflecting the multidimensional nature of oral health. Gender-specific differences emphasize the importance of tailored approaches in managing dental anxiety, whereas the lack of age-related variation indicates that the benefits of implant rehabilitation are consistent across the lifespan.

If the implant indication and treatment planning stage had been included as a pre-treatment phase, higher levels of dental anxiety and psychological distress might reasonably have been expected. The preoperative period is often characterized by anticipatory anxiety related to surgical uncertainty, perceived pain, financial concerns, and outcome expectations. Accordingly, anxiety scores assessed during the planning phase may have been higher than those recorded at the prosthetic baseline, potentially resulting in a more pronounced overall reduction across the treatment trajectory. However, this remains speculative and should be explored in future studies with multiple preoperative assessment points.

Limitations and future directions

Despite its strengths, this study has several limitations that should be acknowledged. The relatively small sample size and short 21-day follow-up period limit the generalizability of the findings and preclude assessment of the long-term sustainability of improvements in anxiety and oral health–related quality of life (OHRQoL). Although the early postoperative interval was intentionally selected to capture initial functional and psychosocial adaptation, longer follow-up periods are required to evaluate the durability of these outcomes. In addition, the absence of control or comparator groups and the single-center design restrict causal inference and external validity. Finally, reliance on self-reported questionnaires may introduce response bias and does not account for potentially influential factors such as socioeconomic status, educational background, psychological profile, or prior dental experiences.

Future studies should therefore incorporate larger and more diverse samples, include adequately structured comparison groups, and adopt multi-center designs to enhance external validity. Extending follow-up durations is essential for evaluating long-term psychosocial adaptation. Finally, integrating objective clinical indicators alongside self-reported measures would strengthen methodological rigor and offer a more comprehensive understanding of the outcomes associated with implant-supported prosthetic rehabilitation.

An important limitation of the present study is that the implant-supported fixed prosthetic treatments predominantly involved single-tooth replacements and short-span fixed prostheses. Therefore, the findings may not be directly generalizable to patients undergoing extensive or full-arch implant-supported rehabilitations, which may exert different functional and psychological effects.

Another limitation of this study is that the duration of edentulism prior to treatment was not recorded. In addition, previous use of conventional tooth-supported fixed or removable prostheses was not assessed. As both factors may influence baseline anxiety and oral health–related quality-of-life scores, future studies should incorporate these variables to better control for potential confounding effects.

In addition, several potentially relevant confounding factors were not assessed in the present study, including socioeconomic status, educational level, prior dental trauma or experiences, oral hygiene practices, and specific reasons for tooth loss (e.g., caries, trauma, or periodontitis). These factors may influence baseline anxiety levels and oral health–related quality-of-life perceptions and should be considered in the design of future longitudinal studies.

Conclusion

This study suggests that implant-supported rehabilitation may contribute to early reductions in anxiety and improvements in oral health–related quality of life. Although women exhibited higher baseline anxiety levels, these differences were no longer evident post-treatment, and no age-related variations were observed. Given the limited sample size and short follow-up period, these findings should be interpreted cautiously and cannot be generalized to broader clinical populations. Further studies with larger, more diverse cohorts and extended longitudinal designs are needed to clarify the long-term psychological effects of implant therapy.

Authors’ contributions

A.İ.K, I.S. conceived the ideas. A.İ.K contributed to the study conception and design, data collection, data analysis, and drafting of the manuscript. I.S contributed to the study conception, supervision of the research process, critical revision of the manuscript for important intellectual content, and final approval of the version to be published.All authors read and approved the final manuscript.

Funding

This research received no specific grant from any funding agency in the pub- lic, commercial, or not-for-profit sectors.

Data availability

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

Ethical approval for this study was obtained from the Clinical Research Ethics Committee of Tokat Gaziosmanpasa University Faculty of Medicine (Klinik Araştırmalar Etik Kurulu, KAEK) (Decision No: 21-KAEK-082). All procedures involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the Declaration of Helsinki. Written informed consent to participate in the study was obtained from all participants prior to data collection.

Consent for publication

No individual participant has been identifed in the details within this manu- script. Each author has approved the final version of this paper.

Competing interests

The authors declare no competing interests.