Prosthetic restoration patterns and patient satisfaction among partially dentate adults in Jordan: a cross-sectional correlational study

Abstract

Background

Tooth loss affects quality of life, requiring prosthetic restoration to restore function and aesthetics. Patient satisfaction varies by treatment type and sociodemographic factors, but data on prosthetic restoration patterns and satisfaction among partially dentate populations in Jordan remain limited. This study aimed to evaluate the pattern of and degree of satisfaction with prosthetic restoration among partially dentate patients in Jordan.

Methods

A cross-sectional correlational study was conducted across Jordan from September 2022 to June 2023. The data were collected from adult patients at institutions, including government, private, and teaching clinics. The questionnaire covered sociodemographics, behavioral habits, and clinical assessments of missing and restored teeth. Descriptive statistics, ANOVA, chi-square tests, and regression models were used to analyze restoration status and satisfaction (p < 0.05).

Results

Of the 463 participants, the mean age was 42.4 years (SD = 13.8), with 45.8% being male. A total of 55.9% of the participants had at least one tooth restored, with fixed partial dentures (FPDs) being the predominant type of restoration (65.9%), followed by implants (17.6%) and removable partial dentures (RPDs) (16.5%). Older age (adjusted odds ratio [aOR] = 1.05; 95% confidence interval [CI]: 1.03–1.07; p < 0.001), female sex (aOR = 1.58; 95% CI: 1.05–2.38; p = 0.03), and higher education (aOR = 1.85; 95% CI: 1.24–2.8; p = 0.003) were associated with a greater likelihood of tooth restoration. Satisfaction was significantly greater in females than in males (B = 0.51; 95% CI: 0.06–0.96; p = 0.03) and among those treated with FPDs (B = 0.97; 95% CI: 0.34–1.60; p = 0.003) and implants (B = 0.91; 95% CI: 0.12–1.7; p = 0.02) than in those treated with RPDs.

Conclusions

In this national clinic-based sample of partially dentate adults in Jordan, fixed partial dentures were the most frequently observed prosthetic restoration type, followed by implant-supported restorations and removable partial dentures. Satisfaction scores were higher for fixed partial dentures and implants than for removable partial dentures. In multivariable analyses, age, female sex, and higher education were associated with having at least one restored tooth, and female sex and restoration type were associated with satisfaction.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-026-08212-x.

Introduction

Tooth loss remains a significant public health concern with important effects on oral health-related quality of life (OHRQoL). Despite advances in preventive and restorative dentistry, partial edentulism continues to affect many adults worldwide, most commonly due to caries, periodontal disease, and trauma [1–5]. Beyond functional limitations such as impaired mastication and speech, tooth loss is associated with psychosocial consequences, including reduced self-confidence and social participation [6–8].

Prosthetic rehabilitation aims to restore oral function, esthetics, and overall well-being. Treatment options for partially dentate patients include removable partial dentures (RPDs), fixed partial dentures (FPDs), and implant-supported restorations [9, 10]. Treatment selection depends on clinical presentation, financial capacity, access to care, and patient preferences [11, 12]. Increasing attention has been directed toward patient-centered outcomes, particularly satisfaction, as a key indicator of treatment success [11, 13]. Evidence consistently demonstrates that fixed and implant-supported restorations are associated with higher satisfaction and improved OHRQoL compared with removable options, particularly in terms of comfort and esthetics [11, 12, 14].

International studies further indicate that prosthetic rehabilitation patterns are influenced by socioeconomic and contextual factors. Research from Europe, the United States, and East Asia has shown that education, income, and healthcare system structure affect both treatment uptake and patient-reported outcomes [15–18]. These findings suggest that prosthetic rehabilitation is shaped not only by clinical need but also by broader structural determinants.

In Jordan, national data describing prosthetic restoration patterns and associated satisfaction among partially dentate adults remain limited. Previous local studies have examined satisfaction with removable prostheses or preferences for single-tooth replacement, reporting higher satisfaction with implant-supported treatments [19]; however, these studies were based on relatively small or localized samples. Regionally, only a few investigations have explored prosthetic distribution patterns in partially edentulous populations [20, 21]. Because healthcare financing models, insurance coverage, and access to advanced prosthodontic care differ across countries, findings from other settings may not be directly generalizable to Jordan. Therefore, nationally representative data are required to characterize prosthetic rehabilitation patterns and satisfaction within the Jordanian context.

The present study aimed to evaluate prosthetic treatment patterns and satisfaction levels among partially dentate adults across different regions of Jordan. The primary objective was to determine the prevalence and types of prosthetic restorations. The secondary objective was to assess satisfaction with these restorations and to examine the association of sociodemographic and behavioral factors with restoration status and satisfaction. We hypothesized that restoration status and patient-reported satisfaction would be associated with sociodemographic characteristics and type of prosthetic treatment, with the null hypothesis being that no such associations would exist.

Materials and methods

Design, setting, and sample

This study was carried out in accordance with The Declaration of Helsinki (World Medical Association, 2013 revision) [22]. Ethical approval was obtained from the Institutional Review Board of Jordan University of Science and Technology (IRB No. 691/2021; approval date: 30 December 2021) prior to data collection. Moreover, no identifying information was collected, and informed consent and approval were received from all participants.

A cross-sectional epidemiological correlational study was conducted across Jordan.

Intern dentists and senior dental students randomly collected data from a variety of institutions located in both urban and rural areas, such as the Ministry of Health, Royal Medical Services, private clinics, and dental teaching clinics, from September 2022 until June 2023.

A sample size calculation was conducted for multiple regression analysis to predict satisfaction using four predictors. Assuming an alpha level of 0.05, statistical power of 0.80, and a medium effect size (f² = 0.15) [23], the analysis indicated a required minimum sample size of 85 participants.

Inclusion and exclusion criteria

The study included partially dentate patients aged 18 years or older who attended participating dental clinics for routine dental examination or treatment during the study period. Patients were consecutively invited to participate during their clinic visits. Individuals who were fully edentulous, younger than 18 years of age, or who declined participation were excluded.

Data collection and measures

The data collectors included five interns and senior (final-year) dental students who were systematically trained and calibrated by the primary investigator. Calibration was conducted through a pilot study involving 25 patients to ensure consistency in intraoral examinations, including the assessment of missing teeth and evaluation of restorations. Under supervision, the training emphasized standardized methods for completing questionnaire items and conducting clinical screenings. To minimize selection and measurement bias, all data collectors were calibrated prior to data collection, and face-to-face interviews were conducted to ensure clarity and accuracy of responses. The calibration and training processes resulted in an inter-examiner agreement level of 93%.

The study questionnaire was administered through face-to-face interviews and included a number of questions about participants’ sociodemographic characteristics, including age; sex (female or male); marital status (married, unmarried, widowed); education based on participants’ highest completed level of formal education into two groups: low (≤ high school) and high (> high school); income (low (≤ $800 USD), high (> $800 USD) based on the national average income, and prosthodontic dental insurance (yes or no); location of residence (north, south, or middle); and behavioral factors, such as smoking (current and the number of cigarettes per day) and oral health-related behaviors (brushing frequency / times per day). The participants were then clinically examined in the dental clinics of the participating institutions for the number and location of missing teeth in the upper and lower jaws, and the Kennedy classification for each jaw was recorded [24]. The cause of tooth loss was recorded based on patient self-report during the interview. The restored teeth were evaluated for the number and type of restorations (implants, fixed or removable partial dentures); fixed partial dentures were defined as tooth-supported fixed prostheses (conventional dental bridges) used to replace one or more missing teeth and permanently cemented to adjacent abutment teeth. In addition, the location of the restoration and the satisfaction level (visual analog scale [VAS], 0–10) for each restoration were recorded. The questionnaire is available in appendices.

Statistical analysis

Descriptive analyses were employed to summarize the study variables using means and standard deviations for continuous variables and frequencies and proportions for categorical variables. Analysis of variance (ANOVA) and chi-square tests were used to compare variables across the treatment groups for the continuous and categorical variables, respectively. A logistic regression model was developed to evaluate the predictors of tooth restoration status using age, sex, marital status, education, and tooth brushing. Another linear regression model was used to evaluate the predictors of satisfaction pertaining to tooth restoration. Statistical analyses were performed using R statistical software (version 4.2.2; R Foundation for Statistical Computing, Vienna, Austria). All analyses were two-tailed, and a p value < 0.05 was considered significant. There were no missing data for the main sociodemographic, clinical, or satisfaction variables analyzed in this study.

Results

Sample characteristics and dental history

A total of 647 patients were invited to participate in the study. Of these, 463 met the inclusion criteria, provided consent, and completed both the questionnaire and the clinical examination, resulting in a response rate of approximately 71.5%.

In this cohort of 463 participants, the average age was 42.4 years (SD = 13.8), with males constituting 45.8% of the sample. A significant majority (75.2%) were married. Over half (54.9%) had lower education levels, and the majority (60.2%) fell into the lowest income category.

Geographically, most participants resided in northern Jordan (73.2%). Smoking was reported by more than one-third (35.9%) of the participants, with an average consumption of 19.7 cigarettes daily. Almost two-thirds (60.5%) had prosthodontic dental insurance.

The Kennedy classification indicated that Class 3 was the most prevalent in both jaws—43.2% in the lower jaw and 51.6% in the upper jaw. Most participants (79.3%) brushed their teeth daily. The most common dental issue leading to tooth loss was caries (85.3%). Table 1 illustrates the sociodemographic, behavioral, and clinical characteristics of the study participants.

Table 1.

Sociodemographic, Behavioral, and Clinical Characteristics of the Study Participants (n = 463)

Variable	Overall (n (%) or mean (SD))
Sociodemographic
Age,	42.4 (13.8)
Sex, Male	212 (45.8)
Marital Status
Married	348 (75.2)
Single	97 (21.0)
widowed	18 (3.9)
Education, Low (≤ High school)	254 (54.9)
Income
Low (<$800 USD)	278 (60.2)
High (>$800 USD)	185 (39.8)
Dental Insurance, Yes	280 (60.5)
Residence Region
Middle	56 (12.1)
North	339 (73.2)
South	68 (14.7)
Smoker (current), Yes	166 (35.9)
Quantity of cigarettes	19.7 (12.8)
Smoking Duration, Years	15.6 (10.9)
Daily Tooth Brushing, Yes	367 (79.3)
Kennedy Classification (Lower Jaw)
Fully dentate	126 (27.2)
Class 1	51 (11.0)
Class 2	75 (16.2)
Class 3	200 (43.2)
Class 4	7 (1.5)
Fully edentulous	4 (0.9)
Kennedy Classification (Upper Jaw)
Fully dentate	109 (23.5)
Class 1	29 (6.3)
Class 2	58 (12.5)
Class 3	239 (51.6)
Class 4	13 (2.8)
Fully edentulous	15 (3.2)
Tooth Loss Cause
Caries	395 (85.3)
Iatrogenic	27 (5.8)
Periodontal Disease	63 (13.6)
Trauma	35 (7.6)
Others	27 (5.8)

Patterns of tooth loss and restoration

The mean number of missing teeth was 4.8 teeth ([SD] = 5.0). Among the samples, 76.2% were missing at least one tooth in the upper jaw (mean [SD] = 2.6 [3.1]), and 73.0% were missing at least one tooth in the lower jaw (mean [SD] = 2.2 [2.6]). Approximately 46.2% of the patients had more missing teeth in the upper jaw than in the lower jaw, 39.5% had more teeth missing in the lower jaw than in the upper jaw, and only 14.3% had an equal number of missing teeth in both jaws.

With respect to dental restorations, 259 (55.9%) patients had at least one tooth restored, with an average of 2.4 teeth per patient (SD = 4.3). Specifically, of the sample, 178 (38.4%) participants had only one treatment, 60 (13.0%) had two treatments, 12 (2.6%) had three treatments, and 9 (1.9%) had four treatments. The restorations included 1–3 teeth (36.7%), 4–6 teeth (8.6%), and more than 7 teeth (10.6%). The ratio of restored teeth to missing teeth varied by location and type: 60.5% for upper anterior teeth, 51.7% for upper posterior teeth, 68.3% for lower anterior teeth, and 40.6% for lower posterior teeth.

Prediction of tooth restoration

Age significantly increased the likelihood of tooth restoration, with an adjusted odds ratio (aOR) of 1.05 (95% CI: 1.03–1.07, p < 0.001). Compared with males, females were more likely to have restorations, with an aOR of 1.58 (95% CI: 1.05–2.38, p = 0.03). Higher education was associated with a greater likelihood of restoration (aOR = 1.85, 95% CI: 1.24–2.8, p = 0.003). Neither marital status nor tooth brushing significantly affected the likelihood of restoration.Table 2 shows the predictors of tooth restorations status.

Table 2.

Predictors of tooth restoration status (both jaws) (n = 463)

Variable	Upper Jaw
	aOR (95% CI)	p value
Age, years	1.05 (1.03, 1.07)	< 0.001
Sex
Male	Reference	0.03
Female	1.58 (1.05, 2.38)	-
Marital Status
Married	Reference	0.30
Unmarried	1.32 (0.78, 2.26)	-
Education
Low education (≤ High school)	Reference	0.003
High education (> High school)	1.85 (1.24, 2.8)	-
Number of Missing Teeth	1.04 (0.99, 1.1)	0.13
Tooth brushing
No (infrequent)	Reference	-
Yes (frequent)	1.02 (0.61, 1.71)	0.94

Types of restoration

The participants had a total of 370 treatments. The types of restorations performed were predominantly fixed partial dentures (65.9%), followed by implant-supported restorations (17.6%) and removable partial dentures (16.5%). Table 3 shows a comparison of the three types of restoration. The types of restoration differed significantly on the basis of age, income, education, self-reported problems, and satisfaction.

Table 3.

Comparison of the sociodemographic characteristics and self-reported outcomes across the three types of restoration (n = 370 treatments)

Variable	Removable (n = 61)	Fixed (n = 244)	Implants (n = 65)	p value
Socio-Demographic Characteristics
Age (mean (SD))	57.1 (13.9)a	46.3 (12.1)b	46.3 (14.7)b	< 0.001
Sex, Female (%)	28 (45.9)	145 (59.4)	31 (47.7)	0.068
Education, High (> High school) (%)	19 (31.1)a	116 (47.5)b	46 (70.8)c	< 0.001
Income, High (>$800 USD) (%)	16 (26.2)a	82 (33.6)a	45 (69.2)b	< 0.001
Dental insurance, Yes (%)	29 (47.5)	128 (52.5)	37 (56.9)	0.574
Self-reported Outcomes
Problems, Yes (%)	35 (57.4)a	80 (32.8)b	19 (29.2)b	0.001
Satisfaction (mean (SD))	7.0 (2.6)a	8.1 (2.0)b	8.0 (2.4)b	0.001

^{a, b, c} Means within rows with different superscripts differ significantly (p < 0.05)

Figure 1 shows the type of tooth restoration based on the tooth location. For upper teeth and lower posterior teeth, the predominant type of restoration was FPD, followed by RPD and then implantation. However, for the lower anterior teeth, the most common type of restoration was an RPD.

Fig. 1.

Type of restoration on the basis of tooth location

Satisfaction

The results from the linear regression model are presented in Table 4. When other variables were controlled for in the model, female patients had greater satisfaction than male patients did (B = 0.51, 0.06–0.96, p = 0.03). In addition, those who received treatment with fixed partial dentures (B = 0.97, 0.34–1.60, p = 0.003) or implants (B = 0.91, 0.12–1.7, p = 0.02) were more satisfied than those who were treated with removable partial dentures. Age and education level had no significant impact on satisfaction.

Table 4.

Predictors of satisfaction after tooth restoration (n = 370 treatments)

Variable	Coefficient (95% CI)	p value
Age	-0.01 (-0.03, 0.01)	0.37
Gender, Female	0.51 (0.06, 0.96)	0.03
Education, High (> High school)	0.14 (-0.31, 0.6)	0.54
Type of Restoration
Removable	Reference	Reference
Fixed	0.97 (0.34, 1.6)	0.003
Implants	0.91 (0.12, 1.7)	0.02

Discussion

This study evaluated prosthetic restoration patterns and patient-reported satisfaction among partially dentate adults in Jordan. It is one of the few studies to examine the distribution of different prosthodontic treatment types [20, 21, 25–27] and, to our knowledge, among the first to assess associated patient satisfaction in this population. Just over half of the patients had at least one tooth restored, most of whom had only one treatment. The most restored teeth were anterior teeth. Female sex, older age, and higher education were associated with a greater likelihood of tooth restoration. The predominant type of restoration was FPD, which was associated with greater satisfaction, along with implants, than RPDs were.

More than half of the patients in our study had at least one tooth restored, which might reflect the willingness of Jordanians to replace their missing teeth and the availability of dental treatments generally. These findings echo those of similar studies conducted in neighboring Saudi Arabia, which reported comparable trends in one of the large cities [21]. Zitzmann et al. also conducted a systematic review in 2007 and concluded that approximately half of the adult population in most European countries has undergone some type of prosthetic dental restoration [25]. This may reflect a willingness among patients to replace missing teeth. However, other studies in lower-income countries, such as India, revealed that the vast majority did not have any prosthodontic restoration to replace any of the missing teeth due to financial constraints and a lack of awareness, dental facilities, and dental hygiene [26, 27].

Our findings indicate that more than 60% of the missing upper and lower anterior teeth were successfully restored, representing the highest proportion of replaced teeth in our study. These teeth play a crucial role in esthetics; hence, this observation supports the popular claim that patients strongly prioritize esthetic considerations when opting for tooth restoration solutions [28–30].

Age was found to be a significant factor for tooth restoration, as older adults have more missing teeth due to the accumulation of dental problems, such as tooth decay and periodontal disease, over time, resulting in greater prosthetic needs to maintain oral function and esthetics [31–34]. In addition, elderly individuals are reported to have increased health consciousness and fewer financial duties [35–38]. Marital status was not significantly associated with restoration status, which is expected since it is not a direct determinant of oral disease or prosthetic treatment. Although tooth brushing is generally associated with better oral health, no significant relationship was observed in this study, possibly due to the cross-sectional design and the reliance on self-reported brushing behavior, which may not reflect long-term oral hygiene practices related to tooth loss.

Females were also more likely to restore their missing teeth than males were. This is true given that they have more aesthetic concerns and a lower labor force participation rate, which might lead to an abundance of time to seek treatment [39, 40]. Previous studies in Jordan have shown that females have greater aesthetic concerns and are more likely to seek dental treatments for cosmetic reasons [41, 42]. This finding is consistent with another regional study conducted in Hail, KSA, which also revealed that females had replaced missing teeth more frequently than males did [20].

Higher education levels were positively associated with more tooth restoration. Educated individuals are generally more aware of the importance of dental health and are capable of making informed decisions about restorative procedures [43]. They also typically have more financial resources and wider access to health insurance and affordable dental services [44]. Moreover, educated individuals are more encouraged to seek tooth restoration because of positive peer influence and social and cultural awareness of aesthetic and functional benefits [45]. A similar study conducted in Jordan confirmed the influence of education level on seeking treatments in patients with missing teeth [46].

The predominant type of dental restoration observed in our sample was fixed partial dentures (FPDs), which is consistent with findings in several other studies [20, 27, 39, 47, 48]. This result can be explained by the fact that most of our patients had only a few missing teeth, in which case it was favorably replaced with FPDs or had no replacement for both clinical and financial reasons [25, 48, 49]. Notably, in cases classified under class 3 of the Kennedy classification, the most prevalent class in our sample, FPD was the most common prosthodontic choice [21].

The observed types of restoration significantly differed in terms of age, education level, and income. In our study, removable prostheses tended to be the most prevalent type of restoration associated with increased age. The fact that young patients have fewer missing teeth reduces the likelihood of choosing removable prostheses, which are mostly used to restore multiple missing teeth [25]. This study was quite similar to a questionnaire study in the KSA where no removable prostheses were used in young patients [20].

Higher education levels are often associated with higher income, and as mentioned above, these patients have more access to financial and health resources combined with higher health literacy. Hence, these patients are more likely to have implants, as they are considered the first-line treatment owing to their durability, ability to preserve the jawbone, superior functionality and esthetics, and benefit to overall oral health by preserving the integrity of the remaining natural teeth [15, 50–52]. This is consistent with studies conducted in other countries, such as Japan, Malaysia, the U.S., and Sweden, where the richest and most educated individuals were more likely to spend money on implants [16–18, 53].

The type of prosthesis can vary on the basis of the location and extent of the missing area. Areas of high esthetic demand require more fixed treatments than removable treatments [29]. For example, a single crown in the anterior maxillary area places greater aesthetic demand on the patient than do fully edentulous patients in need of implant-supported overdentures [15]. Compared with other treatment modalities, replacing missing teeth with implants has superior stability and function and is more natural [15]. Furthermore, compared with implants, fixed partial dentures resulted in comparable improvements in patient oral health-related quality of life, whereas removable partial dentures resulted in the least improvement [14].

Satisfaction after the provided treatments was greater in females. This might be because males tend to have higher dental functional demands than females do [54]. In addition, females have greater initial discomfort, seek more information, and discuss treatment plans in more detail than males do; thus, females tend to be more satisfied when their expectations are met [55, 56]. Females also tend to have a more proactive approach and commitment to dental visits, which correlates with a more positive perception of dental outcomes [57]. Satisfaction was also greater in those with FPDs and implant treatments than in those with RPDs. In general, FPDs and implant treatments are reported to yield better functional outcomes, such as improved chewing ability and fewer food restrictions, as well as higher aesthetic satisfaction than RPDs do, leading to enhanced oral health-related quality of life [58]. FPDs also lead to greater comfort due to the elimination of issues such as denture movement and irritation, which are common with RPDs [59, 60].

This study included a relatively large sample size and included patients from all regions in Jordan (North, Middle, and South), which enhances the generalizability of the study. However, this study has several limitations. The cross-sectional design prevents causal inferences between predictors and outcomes, emphasizing the need for longitudinal research to assess changes in satisfaction and restoration outcomes over time. Selection bias may be present as the sample included only clinic attendees, potentially excluding those with limited access to care. Self-reported data on satisfaction and problems with restorations introduce the risk of recall and social desirability bias. Additionally, factors such as treatment costs, systemic health conditions, and cultural attitudes were not explored, which could influence restoration patterns and satisfaction. The study did not evaluate the clinical success or failure rates of restorations, limiting insights into their long-term effectiveness. Although the sample included participants from various regions in Jordan, differences in healthcare access and socioeconomic factors require further exploration. Future studies should address these gaps with stratified analyses and qualitative approaches to better understand patient motivations and preferences.

Conclusions

In this national clinic-based sample of partially dentate adults in Jordan, fixed partial dentures were the most frequently observed prosthetic restoration type, followed by implant-supported restorations and removable partial dentures. Satisfaction scores were higher for fixed partial dentures and implants than for removable partial dentures. In multivariable analyses, age, female sex, and higher education were associated with having at least one restored tooth, while female sex and type of restoration were associated with satisfaction. Future longitudinal and population-based studies are warranted to further examine temporal changes in prosthetic rehabilitation patterns and to explore additional determinants of patient-reported satisfaction.

Abbreviations

RPD

removable partial denture

FPD

fixed partial denture

USD

United States Dollar

Authors’ contributions

H.A. and M.A.: literature search, data analysis, drafting and revising the manuscript. A.A.: conception and design of the study, drafting and revising the manuscript. A.T.: data collection, drafting and revising the manuscript. R.A.: drafting and revising the manuscript.

Funding

This work was funded by Jordan University of Science and Technology [Grant #: 691/2021].

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

This study was carried out in accordance with The Declaration of Helsinki (World Medical Association, 2013 revision) [22]. Ethical approval was obtained from the Institutional Review Board of Jordan University of Science and Technology (IRB No. 691/2021; approval date: 30 December 2021) prior to data collection. Moreover, no identifying information was collected, and informed consent and approval were received from all participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Clinical Trial Number

Not applicable.