Maintenance routine for a screw retained complete lower denture?
I fabricated a complete lower hybrid denture [fixed-detachable] that is retained by 5 implants. The patient generates large amounts of calculus and I have instructed the patient to utilize a water pic from both the buccal and lingual as well as running floss under the hybrid denture from the distal of the denture up to the most distal implant on each side. When would you recall the patient past the first post insertion visit and would you routinely remove the denture for hygiene? Also, would you reuse the screws which were torqued to 30 NCm? The lab that fabricated the case also provides a soft mouth guard for the patient. Would you have the patient sleep with the mouthguard?
6 Comments on Maintenance routine for a screw retained complete lower denture?
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Baker Vinci
9/17/2013
If this patient is accumulating plaque this early in the process, GOOD LUCK! This patient needs a stern OH discussion. Maybe he will change his ways and I hope he does. I am going to suggest a Q 3 month recall, until he proves he has changed. This is one of those cases I may have deferred until I was certain the patient was ready to take ownership in their care.
mwjohnson dds, ms
9/17/2013
I recall the patient at six months and clean the hybrid. I rarely remove the prosthesis to clean unless there's a reason. Use titanium or plastic/composite scalers to remove the calculus. You will probably find that the calculus is only supragingival so there's no need to try and get below the tissue. I routinely have them back every six months forever, just like real teeth. If they show they can keep the hybrid clean, then we see them annually. If you remove the prosthesis you can always reuse the abutment screws. In regards to the mouthguard, what does the hybrid oppose? if it's a complete denture then no, the mouthguard is not needed, just have them take the denture out at night. If they oppose natural teeth then a guard may be needed but certainly not manditory if not a parafunctioner.
Dr L
9/18/2013
Early perio/hygiene issues doesnt bode well with long term prognosis. Try as hard as you can to change his ways, but if youre not getting anywhere, perhaps convert it to a overdenture-locator system. It will make the hygiene alot easier and give him some motivation perhaps to get his act together.
GG
1/9/2018
Oh my gosh I think I'm going crazy. I am actually wondering if I should have gotten an over implant denture. I believe I have an excellent dentist. But things are a little touchy around his office for ever reason. He works with a lot of other dentist and assistance, yeah he's the only one with dental reconstruction skills.
When I finally got my hybrid denture I left the chair but thought now wait no one's told me how to clean this thing? So I asked and assistant. She showed me some floss that had like a stick and a brush on it and it's very tiny. That was it. I walked out of the office and I was a little dazed. I went straight to the store to get this floss and then I thought wait well I was looking for this denture I heard the thing about the Waterpik I better pick up a waterpik too. So grateful that I picked one up that very first night.
I'm not a really big food person but the first thing I ate was a protein shake and one of these cookies that are marketed it as health cookies but they have tons of sugar.
Immediately I felt like it went underneath my denture and I got completely freaked out.
I use the Waterpik and eventually got coordinated with it but that took about 20 minutes. I had the new floss but it seem like I had to really hurt my gums to be able to use it.
I've been back to the office and they just kind of ignore the fact that I feel like there's food underneath my denture. I simply want to cry I sometimes almost go crazy trying to get a piece of nut or something else out of my teeth.
Now I want to thank you for reminding me that while I was looking for the solution dentist had told me about this thick floss that I could purchase. I didn't go with him because he was in Mexico but he was a very fine dentist.
My dentist is top of the line but something is lacking in the aftercare. Hopefully your floss that you described above will work for me and I've got to get one today.
Little particles keep getting caught like rice, peanuts from chunky peanut butter. Simple things like snap peas Etc. It got to the point to where I wondered if I was a fool to even get a hybrid bridge and it would have been much cheaper for me to get the other. Well let's see if I can make something work with the floss that you're speaking of cuz I have not used it yet and will have to maybe order it or find it somewhere. Seems my doctor's office doesn't know about it and I've been there twice regarding this issue but I don't want them to be mad at me.
In the big picture it's their loss but I still believe my dentist is a good dentist. I just don't understand why these basic things weren't discussed me it makes me want to cry. Obviously it cost me a fortune to get this hybrid and it's only on my bottom Arch my top Arch is my natural teeth plus caps over it from the damage that my bottom teeth cause by becoming misaligned and hitting the top teeth. Frankly I can't imagine anyone not wanting to keep their Dentures clean it drives me crazy to have one piece of snap pea in them. Okay blah blah I'm very sorry if I gave too much detail.
Baker Vinci
9/21/2013
Good suggestion, Dr. L.. Bv
Dr. Omar Olalde
9/25/2013
Usually I unscrew the prostheses each 4 months.
The only reason I wouldn't unscrew it, is because the design of the prosthesis is such that the patient has an excellent access to clean below with a simple tooth brush, but most of the cases an hybrid denture covers more tissue than needed.
So if I know I have to unsrew it, I torque it at 20 N/cm2. Using the same screws.
Patient use a Hard mouthguard at nights, if the prosthesis is hybrid (acrylic-metal) and the antagonist are natural teeth. After years the acrylic anterior teeth are going to be broken.
In some cases after years of use I have decided to change to locators because of hygiene, as Dr. L indicate above.
