The purpose of this retrospective cohort study was to investigate patient satisfaction factors that affect the usage of removable partial dentures (RPDs) using a multivariate analysis. Sixty-seven patients, who had RPDs inserted at the Tohoku University Hospital between 1996 and 2001, participated in this study. Data were collected from patients' clinical records and a questionnaire. Of the 15 factors examined, significant associations were found between RPD usage and pain, color of the artificial teeth, and arrangement of the artificial teeth. These findings suggest that RPD usage is related to patient satisfaction with esthetics and an absence of pain.