Assessing Esthetic and Functional Benefits of Three Types of Maxillary Partial Denture Designs over Five Years

<b>Background/Objectives:</b> The design of removable partial dentures (RPDs) influences long-term clinical success and patient satisfaction. Maxillary Kennedy Class I partial edentulism can be treated with clasp-retained (C-RPD), attachment-retained (A-RPD), or implant-retained (I-RPD) removable partial dentures. Evidence on their long-term effects on esthetics, oral health-related quality of life (OHRQoL), and masticatory function is limited. This study compared patient-reported outcomes of these three RPD types over five years. <b>Methods:</b> Eighty-eight patients received C-RPD, semi-precision attachment A-RPD, or mini-implant I-RPD. Outcomes: Esthetic satisfaction (OES), OHRQoL (OHIP-14), and chewing function (CFQ) were assessed pre-treatment, post-treatment, and at 1- and 5-year follow-ups. Treatment effect sizes were analyzed using ANCOVA adjusting for baseline scores, age, gender, and education, while long-term trends were assessed by repeated-measures ANCOVA. <b>Results:</b> Treatment group significantly influenced outcomes. C-RPD users reported lower esthetic satisfaction, OHRQoL, and chewing function than A-RPD or I-RPD users (<i>p</i> < 0.001). Baseline scores predicted post-treatment outcomes (lower pre-treatment = lower post-treatment scores). Over five years, OES worsened in all groups (<i>p</i> = 0.004) with C-RPDs, consistently showing the worst scores. OHIP-14 scores increased most in C-RPD wearers (17.6 → 28.4; <i>p</i> < 0.001) indicting worst OHRQoL, while A-RPD and I-RPD scores remained significantly lower (10.8 → 17.4 and 10.9 → 13.1, respectively). CFQ scores followed similar trend: C-RPD: 20.43; A-RPD: 13.59; I-RPD: 12.40 (<i>p</i> < 0.001). Age, gender, and education had minimal or no significant impact. <b>Conclusions</b>: C-RPDs are associated with lower esthetic satisfaction, poorer OHRQoL and reduced chewing function, with a marked decline over five years. In contrast A-RPDs and I-RPDs showed higher treatment effect sizes and more stable patient-reported outcomes over 5 years. Due to study limitations, results should be interpreted cautiously, as they may reflect treatment self-selection rather than prosthesis design alone.