I treat a lot of overdenture patients and, ultimately over time, start seeing a lot of the patients for recall appointments down the road. How do we take care of our long-term Zest Dental Solutions LOCATOR and other attachment system overdentures?
As a general rule, after delivery of the overdenture, I typically like to see the patient back 1-2 weeks later for a tissue check. At this appointment, I will verify that the patient is feeling comfortable and their retention level strength is appropriate. Typically I like starting the patient out on a bit of a lighter clip strength, such as the blue colored inserts on the LOCATOR R-Tx system.
I have found that when the overdenture housings are attached properly to the prosthesis, typically 80-90% of patients will be satisfied with the light retention level. In multiple implant cases and where the patient is younger, however, I will often mix and match retention level insert strength to help the patient feel more secure with their prosthesis.
During the first recall appointment, a patient may have a sore spot to get adjusted. As the tissues have settled and the patient is starting to test their prosthesis more and more with chewing and speaking, the prosthesis may impinge on tissues a bit more. Using disclosing media, such as Pressure Indicating Paste, will assist in making small adjustments to those tissue pressure spots.
After that first appointment, I have found that approximately 30-50% of overdenture patients don’t need a second or third appointment for adjustments. The other 50-70% of the patients require a second or third visit for a variety of reason. Typically they don’t have any major sore areas to adjust but their principle reason for returning is to dial in their retention levels for their prostheses. At every follow-up appointment I want to coach patients on how to properly clean their LOCATOR abutments and prostheses.
I like to see patients 12 months after delivery of their overdenture to ensure their retention level strengths are sufficient and the patient is adequately cleaning their abutments and prostheses. Additionally, checking tissue and implant health is paramount at this visit. I recommend changing their prosthetic inserts at the 12 month recall appointment and this appointment represents almost like a graduation ceremony for the patient.
It’s fairly common in academic circles that some feel that overdentures have an excessive amount of recall and adjustment requirements. The literature shows that we need to see our overdenture patients more often than fixed patients. This is often due to the fact that insert changes are the most common reason for patient recall requirements for overdentures. Now, I have found from experience that the above is true, however, changing inserts on a LOCATOR overdenture patient takes all of about 30-60 seconds per insert or 1-4 minutes total. Practically by the time the patient is settling into their chair in the treatment room, their inserts have been changed and the appointment is finished. Compare that to the 30-45 min appointments for changing out screws and/or removing a traditional screw-retained fixed prosthesis. I love the simplicity of overdentures and when done properly, long-term maintenance and recall is very simple and predictable.
Long-term maintenance of LOCATOR overdentures typically involves the patient seeing a hygienist every 6 months to a year. Most overdenture patients that have no remaining teeth typically don’t want nor feel the need to see a hygienist anymore. It is recommended to schedule at least yearly recalls for overdenture patients because catching insert wear and food impaction around abutments and dentures keeps emergency calls very low. The patients that don’t see hygienists and/or recommended recall strategies eventually need an emergency check/appointment typically say “something is wrong” with their prosthesis because “it just won’t stay in!!” It is recommended to really coach your receptionists to make sure they know and understand the basics of overdenture retention. During these phone calls, we make sure that patients understand that the likely reason for their overdenture not fitting well or retentive is the inserts are beginning or have worn out.
When the patent comes in either for hygiene or emergency recall appointments, it’s recommended to evaluate the denture and abutments together. Typically retention issues can be caused by worn out inserts or food impaction around the abutments. Properly cleaning and flushing out calculus and food particles out from abutment surfaces will enhance retention of the prosthesis even without changing inserts!
After attention has been paid to the abutment surfaces and recesses within the LOCATOR abutment, evaluating and changing out retentive inserts is often a necessary step. Most patients will have retentive inserts changed out every 1 to 3 years. I have seen and spoken with many clinicians who report some patients needing insert changes every few months and also other clinicians reporting insert changes lasting as long as 10+ years.
After changing the nylon inserts for the overdenture, the prosthesis is tried in and typically the patient gets excited and mentions comments like, “Wow, that’s much better!” It’s fairly predictable and yet still exciting each time it happens. On longer-term cases such as the case shown with the LOCATOR Overdenture Implant System case earlier, patients come in with a prosthesis that is somewhat retentive but comes out easily when the patient pushes with their tongue. I often coach patients on letting them know that the retention will be much greater and then will balance out in once it’s been inserts and removed a few times.
Whenever new LOCATOR or any overdenture inserts are replaced, it’s a very good idea to ensure the patient can safely and predictably insert and remove their prosthesis. Ensuring the patient can insert and remove the prosthesis without biting down or pushing with their tongue is most important at the delivery appointment and while less important, it’s never a bad idea to ensure the patient can demonstrate at any appointment inserts are changed out.
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