Introduction

A patient's dental health is highly essential for social and psychological well-being, which is highly dependent on the presence of teeth in the oral cavity [1-3]. Edentulism, a complete loss of all dentition, can be linked to caries, periodontal disease, or an injury, which affects aesthetics and function and, therefore, has a considerable impact on social and psychological well-being. Therefore, an imminent urge to restore the natural has taken precedence, and hence several alternative treatment methods, such as complete dentures, removable partial dentures (RPD), fixed partial dentures (FPD), and dental implants, have emerged [4, 5].

The substitution and repair of missing dentition with fixed prosthetics reinstate the configuration purpose and appearance, and it provides excellent satisfaction to the patient as well as the dentist. It can change an unhealthy and unsightly dentition into a properly occluded, healthy bite and aesthetically pleasing dentition [4, 6].

FPDs are “dental prostheses that are luted, screwed, or mechanically attached or otherwise securely retained to natural teeth, tooth roots, and/or dental implant abutments." FPDs or bridges have been used for missing dentition restoration for many years. They are more suitable for the replacement of root canal-treated teeth, however, as they are highly economical in comparison to implants, which makes this treatment modality more acceptable to patients. The fixed partial prosthesis is sensitive to various frequent problems, which include periodontal and periapical infections, traumatic occlusion, loss of tooth vitality, breakage of the prosthesis, etc. Additionally, in the case of bridges, the neighboring structures need to be compromised to restore a single tooth, which is a significant drawback [7].

With the advent and widespread usage of osseointegrated implants, many edentulous cases are now being replaced through implants rather than FPDs. A dental implant is a screw that is surgically embedded into the bone, mimicking the root to restore a single or more teeth or making a complete prosthesis taking support of these. It has more advantages as compared to FPDs in terms of aesthetics and replacement of missing teeth without compromising the natural teeth. However, some patients still prefer FPDs over implants due to a lack of awareness in terms of its added advantages as compared to FPDs, coupled with its high cost and a misconception that during implants, a major surgical procedure is involved [8].

Several studies have been conducted in various countries to examine patients' awareness of dental implants from this standpoint. According to some studies, the level of awareness ranges from 23.24 percent to 79%. In contrast, others report that the high cost was the main reason preventing patients from choosing implants in 86.5% of cases, combined with fear of surgery and longer treatment time in 68.6 % and 71% of cases, respectively [9].

According to a study conducted by Salim et al. (2021), 34% of patients preferred implants [10]. In one study regarding awareness of dental prosthesis types, 60% had a piece of good knowledge about fixed prosthesis, compared to 47.5% about removable partial dentures and 57% about dental implants. Another study reported that due to the time length and the fact that the implant is a surgical treatment, about 48% of patients believe that FPD is less time demanding than the implant [11].

Benefits of the study

The findings of this study may help determine the treatment plan for patients with their input and reasons.

Scope of the study

This study is going to focus mainly on Saudi patients visiting REU clinics.

Study hypotheses

Patients showed a positive attitude towards FPDs as compared to Implants.

Aims of the study

• To determine the knowledge and attitude of Saudi dental patients towards their choice of fixed prosthesis.
• To compare the responses based on gender, educational level, and socioeconomic status.

Materials and Methods

Study design

This is a cross-sectional study conducted among Saudi patients using an online survey.

Study sample

398 patients visiting various campuses of REU were utilized in this study.

Study instrument

The online questionnaire consisted of questions related to demographic data followed by questions including knowledge and attitude towards the choice of various fixed prostheses and reasons associated with them.

Instrument validity and reliability

A pilot study was conducted by sending the survey to 20 participants. The data was inserted in SPSS version 22 to determine the reliability using Chronbach’s coefficient alpha (value: 0.725). The validity of the questionnaire was tested by sending it to experienced researchers in REU, but no changes were made.

Statistical analysis

Collected data were analyzed using SPSS version 22, where descriptive and inferential statistics were conducted. Comparisons between groups will be made with the value of significance kept under 0.05 using the Chi-square test.

Results and Discussion

In the present study, based on the knowledge and attitude of patients regarding the choice of selection of FPDs and dental implants, the frequency table revealed that the majority of participants were female, comprising 62.6% of the total sample (Table 1). 85.7% of participants were from the middle class, and the age group of 36-40 was 37.4%, followed by 40 above participants. 78.9% of participants were married, and the majority were graduates. Information level about implants and crowns was poor, while the majority chose fixed partial dentures over implants. The reason for choosing implants was longevity, and the high cost was not to choose them. The source of information was friends and family. 67.6% were not sure about any complications related to it, while those who agreed thought broken or loose implants were the most common complication. When it comes to crowns/bridges, minute differences exist between choosing it due to cost and would not choose it. The reason for not choosing it was also its high cost for the majority, and the source of information was friends and family, same as implants. The majority thought no complications were associated with crowns, while those who agreed thought bad odor was the most common complication. The majority agreed they needed more information about implants and crowns/bridges. In Table 2, we explored the non-significant gender differences, and the findings revealed that the majority of both groups were from the middle class, married, and graduated. Females were from the 36-40 years age group while the males were more from the 40-above group. Both groups have poor information about implants and crowns/bridges and choose FPDs over implants. Longevity was the reason for choosing and the high cost for not choosing implants for both groups. Friends and family were a source of information for males while social media was for females. Both groups were unsure of any complications, while the remaining thought broken implants were the most common ones. In crowns/bridges, the majority did not choose crowns, and the reason was its cost. Information source was friends and family for males while dentists for females. Most of them were not sure about any complications, while those who agreed thought bad odor was the most common. Both groups think they need more information about implants and bridges.

Table 1. Frequency Percentages of the variables

Table 2. Differences across gender

In Table 3, we explored the differences across socioeconomic status and fining reported non-significant differences. The majority of lower SES were from the age group of 31-35, the middle class was 36-40, and the higher were from 36 to 40 above age group. The majority of all three groups were married and graduated. The level of information was poor for all groups for implants and crowns and chose FPDs over implants. The reason for choosing implants was longevity for the 2nd and 3rd groups while the cost for the 1^st group. The reason for not choosing it was the high cost for the first 2 groups while longevity and need surgery for the later group. The source of information was social media for the first, friends for 2^nd and dentists for 3^rd group.  Higher SES think complications are associated with implants, and the most common one is gingival bleeding, while for other two are bad odor and broken implant, respectively. The reason for choosing bridges was the cost for lower and middle SES, while the higher class would not choose it. The source of information was friends for the lower and middle class while other sources were for the higher class. The complication associated with bridges is a bad odor, according to all groups. All groups think they need more information about implants and bridges.

Table 3. The difference across Socioeconomic status

In Table 4, we explored differences across education levels and found reported non-significant differences. The high school was majority from the 31-35 age group while the graduates were 36-40 and postgraduates were from 36-40 above age category. The majority of all three groups were married and marked their information about implants and bridges as poor. Preferred FPDs over implants. The reason to choose them was longevity for postgraduate and graduate groups while the cost for high school. The reason not to choose was the cost for all groups. The source of information was social media for the first group, while the latter two were dentists. All three groups were unsure about complications, while those who agreed thought broken implants as the most common complication. Postgraduates did not choose bridges, while others chose them due to their cost. The reason behind not choosing it was its cost and long treatment for groups, respectively. The source of information was friends and family for all. They were not sure about any complications while bad odor was most common, according to them. All groups think they need more information about implants and bridges.

Table 4. The difference across education level