Assessing the Psychological and Emotional Impact of Prosthodontic Rehabilitation: A Comprehensive Quantitative and Qualitative Investigation in Adults

Introduction

Edentulism, the complete loss of natural teeth, poses significant challenges to individuals' oral health and quality of life.^1,2 Prosthodontic rehabilitation, encompassing various interventions ranging from fixed and removable prostheses to implant-supported restorations, plays a pivotal role in restoring oral function, aesthetics, and psychological well-being.^3,4 Understanding the impact of these interventions on patients' psychological and emotional well-being is crucial for optimizing prosthodontic care and improving patient outcomes.

While prosthodontic interventions aim to address functional and aesthetic aspects, their influence on patients' self-esteem and overall quality of life remains an evolving area of research.⁵ The psychological and emotional dimensions of prosthodontic rehabilitation involve intricate interactions between the physical aspects of treatment and the individual's subjective experience.⁶ Factors such as the type of prosthesis, adaptation to oral changes, and social perceptions can significantly influence patients' perceptions of self-esteem and quality of life.⁶

To date, empirical research investigating the psychological impact of different prosthodontic interventions is limited and often lacks a comprehensive approach that combines both quantitative and qualitative assessments. This study seeks to bridge this gap by employing a cross-sectional observational design, incorporating robust psychological assessments, quality of life measurements, and in-depth structured interviews. This study aimed to address this gap by employing a comprehensive approach that combines quantitative and qualitative assessments. The primary objectives include a quantitative evaluation of the impact on self-esteem, an assessment of quality of life and a documentation of prosthodontic outcomes through clinical examinations and patient-reported measures.

Materials and Methods

Participants

For this cross-sectional observational study, a sample of 226 adult patients aged 18 years and above undergoing prosthodontic rehabilitation was recruited. A stratified purposive sampling approach was employed to ensure representation across different prosthodontic interventions. Participants were stratified based on the type of prosthetic treatment received, including fixed or removable prostheses. The inclusion criteria encompassed both genders and various types of prosthodontic interventions, including fixed or removable prostheses. Exclusion criteria ensured the exclusion of patients with severe cognitive impairments, significant psychiatric disorders, or those unwilling to participate.

Sample size determination

The sample size for this study was determined based on several considerations to ensure the statistical power and reliability of our findings. The following factors were taken into account during the sample size determination process:

1. Effect size: Prior research and clinical experience provided estimates of the expected effect size for the differences in psychological and emotional outcomes between patients receiving fixed and removable prostheses. Effect sizes were calculated based on relevant literature and pilot studies conducted in similar patient populations.
2. Statistical power: We aimed to achieve a statistical power of 80% or higher, with a significance level (α) set at 0.05. This level of power is generally considered adequate to detect meaningful differences between groups while minimizing the risk of type II errors. 
3. Precision of estimates: We sought to obtain precise estimates of key parameters, including mean selfesteem scores, quality of life indicators, prosthesis success rates, and patient satisfaction levels. Precision was determined based on the desired width of confidence intervals around these estimates, which was set at a clinically meaningful level.
4. Stratification: Given the potential variability in outcomes based on the type of prosthodontic intervention (fixed vs. removable prostheses), we employed a stratified sampling approach. Stratification ensured that both groups were adequately represented in the sample, allowing for comparisons between them while controlling for potential confounding variables.
5. Feasibility: Practical considerations such as time, resources, and accessibility to potential participants were taken into account when determining the final sample size. We aimed to balance the need for a sufficiently large sample with the constraints imposed by available resources and logistical considerations.

Based on these considerations and utilizing established principles for sample size determination in observational studies, a sample size of 226 participants was deemed appropriate for this study. This sample size allowed for robust statistical analyses while ensuring the representativeness and generalizability of the findings to the target population of adult patients undergoing prosthodontic rehabilitation.

Recruitment

Participants meeting the eligibility criteria were identified through prosthodontic clinic records. Informed consent was obtained from each participant, outlining the study's purpose, procedures, and the voluntary nature of participation.

Data collection

To comprehensively capture the psychological and emotional impact of prosthodontic rehabilitation, a meticulous data collection process was implemented.

Psychological assessment

Participants' self-esteem was evaluated using the well established Rosenberg Self-Esteem Scale (RSES). This validated measure provides a quantitative assessment of individuals' self-worth and confidence, allowing for a nuanced understanding of the psychological effects of prosthodontic interventions on participants.⁷

Developed by Morris Rosenberg in 1965, the RSES is a widely used instrument for assessing an individual's self-esteem, encompassing feelings of self-worth, self respect, and self-confidence (Rosenberg, 1965). The scale consists of ten items, each scored on a Likert scale ranging from strongly agree to strongly disagree.

In our study, participants were asked to respond to statements such as "I feel that I have a number of good qualities" and "I feel that I am a person of worth, at least on an equal plane with others." Responses were recorded, and scores were calculated to determine participants' levels of self-esteem. Higher scores indicated higher levels of self-esteem, while lower scores indicated lower levels of self-esteem.⁷

Quality of Life assessment

The evaluation of participants' quality of life was a multifaceted approach involving the administration of Oral Health Impact Profile (OHIP). The Oral Health Impact Profile-14, a widely recognized tool, was employed to gauge the specific impact of oral health on participants' daily functioning, well-being, and overall quality of life.⁸ Additionally, the SF-36 questionnaire, a comprehensive instrument covering various aspects of health-related quality of life, was utilized to capture a broader spectrum of dimensions, including physical functioning, mental health, and social well-being.⁹

The Oral Health Impact Profile (OHIP) was utilized in this study to assess the specific impact of prosthodontic rehabilitation on participants' oral health-related quality of life. The OHIP is a validated instrument designed to measure the impact of oral conditions on individuals' quality of life across various dimensions.⁸ It comprises 14 items representing seven subscales, including functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap.

Participants were asked to respond to statements such as, "Have you felt uncomfortable eating any foods because of problems with your teeth, mouth, or dentures?" and "Have you been self-conscious because of your teeth, mouth, or dentures?" Responses were recorded, and scores were calculated for both the total OHIP score and subscale scores.^8,9

Prosthesis success rate

Prosthesis success was defined based on clinical criteria, including stability, retention, and absence of complications.

A trained prosthodontist conducted detailed clinical examinations, assessing the condition of the prostheses and recording any observed issues.

The prosthesis success rate was calculated as the percentage of participants in each group with prostheses meeting the defined criteria for success.

Patient satisfaction

Patient satisfaction with prosthodontic interventions was assessed using a structured questionnaire administered after the completion of the prosthetic treatment. The questionnaire utilized a numerical rating scale, where participants were asked to rate their satisfaction on a scale from 1 to 10, with 1 indicating extremely dissatisfied and 10 indicating extremely satisfied.

Questionnaire design

The patient satisfaction questionnaire was designed to capture various aspects of the prosthodontic experience, including comfort, aesthetics, functionality, and overall satisfaction. The questions were developed based on a comprehensive review of literature, expert input from prosthodontic practitioners, and pilot testing to ensure clarity and relevance.

Scoring system

Each participant provided a single numeric rating corresponding to their overall satisfaction with the prosthodontic treatment received. The scores were recorded and averaged to calculate the mean satisfaction score for each group.

Interviews

Structured interviews were a pivotal component of our data collection strategy, aiming to delve deeply into participants' emotional experiences associated with prosthodontic rehabilitation. The interviews were meticulously designed to provide a comprehensive understanding of the psychological and emotional dimensions influenced by various prosthodontic interventions. The structured format ensured consistency across interviews while allowing flexibility for participants to articulate their unique perspectives.

Prior to conducting the interviews, a set of open-ended questions was developed, encompassing a range of topics related to the participants' prosthodontic journey. These questions were carefully crafted to encourage participants to share their subjective experiences, emotions, and reflections on the impact of prosthodontic interventions on their daily lives. By employing open ended questions, we sought to capture nuanced and detailed responses that would offer rich qualitative data for analysis.

During the interviews, participants were encouraged to express their feelings openly and reflect on their overall well-being before and after prosthodontic rehabilitation. We probed specific aspects, such as changes in self esteem, social interactions, and daily activities, allowing participants to provide narrative accounts of their experiences. This approach facilitated the exploration of both positive and challenging aspects, ensuring a comprehensive understanding of the multifaceted impact of prosthodontic care.

To enhance the reliability and validity of the qualitative data, interviewers underwent training to maintain consistency in their approach and to create a supportive environment for participants to share their perspectives. Additionally, the interviews were audio-recorded and transcribed verbatim, ensuring the accurate capture of participants' narratives. The thoroughness of our interview methodology aimed to uncover subtle nuances in participants' emotional responses, contributing to a nuanced and in-depth analysis of the psychological and emotional impact of prosthodontic rehabilitation on their lives.

Data analysis

Quantitative analysis employed t tests and ANOVA to explore relationships between prosthodontic outcomes and self-esteem/quality of life scores. Qualitative analysis involved thematic analysis of interview data to identify recurring themes and patterns related to emotional experiences.

Results

Participant characteristics (Table 1)

The participant characteristics table demonstrates a wellbalanced distribution between the fixed and removable prosthesis groups, with a total of 226 participants. The mean age was slightly higher in the fixed prosthesis group (52.3±6.8) than in the removable prosthesis group (49.8±7.2). The gender distribution was also fairly equal in both groups.

Psychological assessment (Table 2)

The results of the psychological assessment using the Rosenberg Self-Esteem Scale revealed a statistically significant difference between the two groups (P <0.05). Participants with fixed prostheses exhibited a higher mean self-esteem score (28.5 ± 3.2) than those with removable prostheses (26.8 ± 4.1). This suggests that individuals with fixed prostheses may experience a more positive impact on self-esteem following prosthodontic rehabilitation.

Quality of Life assessment

The OHIP results reveal a substantial and statistically significant difference in oral health-related quality of life between the fixed and removable prosthesis groups. Participants with fixed prostheses exhibited a notably lower overall oral health impact, as indicated by the significantly lower OHIP total score (15.2±5.6) compared to those with removable prostheses (18.7±6.3) (P <0.01). Further analysis of OHIP subscale scores underscores the superiority of fixed prostheses, with participants reporting significantly lower scores across dimensions such as functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, and social disability (P <0.01 or P <0.001) (Table 3).

The SF-36 results indicate that participants with fixed prostheses, compared to those with removable prostheses, report superior health-related quality of life. The fixed prosthesis group demonstrated significantly higher scores across multiple domains, including physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health (all P <0.05) (Table 4).

Prosthodontic assessment and patient satisfaction (Table 5)

The prosthodontic assessment revealed notable differences between the fixed and removable prosthesis groups. The prosthesis success rate was significantly higher in the fixed prosthesis group (92.0%) than in the removable prosthesis group (85.0%) (P <0.05). Patient satisfaction scores also favored the fixed prosthesis group, with a mean score of 8.9±1.2, compared to 7.5±1.8 in the removable prosthesis group (P <0.01). These findings suggest that fixed prostheses are associated with higher success rates and greater patient satisfaction.

Qualitative themes from interviews

The thematic analysis of the interviews revealed several key themes. Participants in the fixed prosthesis group frequently reported positive changes in self-perception and confidence, emphasizing improved self-esteem. Improved social interactions were a common theme in both groups, but those with fixed prostheses highlighted a more significant impact on their social life. Removable prosthesis users commonly reported challenges in adapting to the prosthetic device, which affected their emotional well-being.

Combined impact

The combined impact analysis, integrating quantitative and qualitative data, emphasizes the overall superiority of fixed prostheses. Participants with fixed prostheses exhibited more positive outcomes in terms of self esteem, quality of life, prosthesis success, and patient satisfaction than those with removable prostheses. This comprehensive view supports the notion that fixed prostheses may offer a more favorable psychological and emotional impact following prosthodontic rehabilitation.

Discussion

The impact of prosthodontic rehabilitation on patients' psychological and emotional well-being is a multifaceted aspect that has gained increasing attention within the dental research community.^10,11 This cross-sectional observational study aimed to comprehensively explore the psychological and emotional effects of prosthodontic interventions, particularly focusing on self-esteem and quality of life. The findings, derived from a sample of 226 adult patients undergoing prosthodontic rehabilitation, offer valuable insights into the nuanced relationship between different types of prostheses and patients' psychosocial outcomes.

Psychological assessment

The results of the psychological assessment, utilizing the Rosenberg Self-Esteem Scale, indicated a statistically significant difference between participants with fixed and removable prostheses. Individuals with fixed prostheses demonstrated a higher mean self-esteem score than those with removable prostheses. Dental aesthetics, closely linked to prosthodontic rehabilitation, plays a pivotal role in shaping an individual's self-perception and confidence.^12,13 The positive correlation between fixed prostheses and higher self-esteem underscores the psychological benefits associated with comprehensive prosthodontic treatments.

These findings resonate with studies emphasizing the psychological impact of dental aesthetics, suggesting that improved oral appearance contributes to enhanced self-esteem and overall well-being.^14,15 Such psychological benefits are particularly relevant in the context of prosthodontic rehabilitation, where restoring both form and function becomes integral to a patient's sense of self.

Quality of Life assessment

The quality of life assessment, encompassing the Oral Health Impact Profile (OHIP-14) and the SF36 questionnaire,^8,9 provided a comprehensive understanding of the broader implications of prosthodontic rehabilitation on participants' well-being

The OHIP total score was significantly lower in the fixed prosthesis group, indicating a reduced oral health impact compared to the removable prosthesis group. Moreover, the SF-36 questionnaire revealed higher physical and mental component scores in participants with fixed prostheses.

The OHIP findings are consistent with studies demonstrating a direct relationship between oral health and quality of life, where prosthodontic interventions contribute significantly to improving patients' daily functioning and overall well-being.¹⁶ The SF-36 results further highlight the holistic benefits of fixed prostheses, positively influencing both physical and mental dimensions of health-related quality of life.

These outcomes align with the biopsychosocial model of oral health, emphasizing the interconnectedness of oral health with broader aspects of physical and mental well-being.¹⁷ The comprehensive nature of the quality of life assessment in this study underscores the importance of prosthodontic interventions, not only in restoring oral function but also in fostering an improved overall quality of life.

Prosthodontic assessment

The prosthodontic assessment, including prosthesis success rate and patient satisfaction, provided objective and subjective measures of treatment outcomes. The significantly higher prosthesis success rate in the fixed prosthesis group implies a greater functional efficacy of fixed prostheses compared to removable alternatives. This finding aligns with the biomechanical advantages of fixed prostheses in providing stability and improved masticatory function.¹⁸

Patient satisfaction scores reinforced the preference for fixed prostheses, with participants expressing higher levels of satisfaction compared to those with removable prostheses. Patient satisfaction is a crucial metric in evaluating the success of prosthodontic interventions, as it reflects the overall patient experience and perceived benefits of the treatment. The higher satisfaction reported by participants with fixed prostheses is indicative of the positive impact of these interventions on patients' daily lives.

These outcomes are in concordance with studies emphasizing the importance of patient-centered care in prosthodontics, highlighting the significance of not only achieving functional success but also ensuring patient satisfaction and subjective well-being.^19,20 The amalgamation of objective clinical assessments and subjective patient-reported outcomes in this study provides a comprehensive evaluation of the effectiveness and impact of prosthodontic rehabilitation.

Qualitative themes from interviews

The qualitative analysis of structured interviews offered a nuanced understanding of participants' emotional experiences associated with prosthodontic rehabilitation. Themes emerged, including positive self perception, improved social interactions, and challenges in adaptation. Participants with fixed prostheses frequently reported positive changes in self-perception and confidence, aligning with the quantitative findings of higher self-esteem scores in this group. Improved social interactions were a common theme in both groups, suggesting a positive impact of prosthodontic interventions on individuals' social well-being.

Challenges in adaptation were more commonly reported by removable prosthesis users, emphasizing the importance of considering patients' psychosocial experiences alongside clinical outcomes. This qualitative dimension adds depth to the study's findings, offering a rich understanding of the lived experiences of individuals undergoing prosthodontic rehabilitation.

Combined impact and clinical implications

The combined impact analysis, integrating quantitative and qualitative data, provides a comprehensive picture of the psychological and emotional effects of prosthodontic rehabilitation. Fixed prostheses emerged as having a more favorable overall impact on participants' self esteem, quality of life, prosthesis success, and patient satisfaction compared to removable prostheses.

These findings have significant clinical implications for prosthodontic practice. Dentists and prosthodontists should recognize the importance of not only achieving functional success in prosthodontic interventions but also considering the broader psychological and emotional well-being of patients.²⁰ The study supports the notion that fixed prostheses, through their positive impact on self-esteem, oral health impact, and overall quality of life, may be preferred by patients.

Strengths of the study

This study's strengths include its comprehensive exploration of the psychological impact of prosthodontic rehabilitation. The use of validated scales, such as the Rosenberg Self-Esteem Scale, and comprehensive quality of life assessments ensures a nuanced quantitative analysis. Structured interviews add qualitative depth, while the inclusion of objective clinical assessments, such as the prosthesis success rate, strengthens validity. Meticulous data collection and a combined analysis of quantitative and qualitative data contribute to a holistic understanding of the psychological impact of prosthodontic rehabilitation on patients.

Study limitations and future directions

Despite the valuable insights gained, this study is not without limitations. The cross-sectional design limits our ability to establish causal relationships, and the reliance on self-reported outcomes introduces potential bias. Future research could employ longitudinal designs to explore the long-term impact of prosthodontic interventions on psychosocial well-being. Additionally, investigating cultural and socioeconomic influences on patients' perspectives could enhance the generalizability of findings.

Conclusion

This study offers a comprehensive exploration of the psychological and emotional impact of prosthodontic rehabilitation on patients' self-esteem and quality of life. The findings underscore the positive association between fixed prostheses and improved psychosocial outcomes. The integration of qualitative insights enriches the understanding of patients' lived experiences, emphasizing the need for a patient-centered approach in prosthodontic practice. These findings contribute to the evolving landscape of prosthodontic research, emphasizing the holistic nature of dental interventions and their profound impact on patients' overall well being.

Declaration

Upon request, the questionnaires used in this study, including the Rosenberg Self-Esteem Scale, Oral Health Impact Profile (OHIP), and the informed consent form, are available from the corresponding author. Researchers interested in accessing these materials for replication or further investigation may contact corresponding author.

Conflict of interest

None