Should I replace these Locator R-TX attachments?

As long as the acrylic is thick enough it should not be a problem to leave them. While I prefer a shorter attachment I have heard others make valid arguments supporting the use of a taller attachment such as these on an atrophic mandible. I would leave them alone and just make a new denture.

The longer locator attachment can create a longer lever arm and transmit lateral forces to the implant. Ideally a shorter locator is a better choice, but since the case has been functioning without any problems, there might be little to no advantage to the patient to replace the attachments with a shorter version. You can always discuss it with the patient and express your opinion. Thanks for sharing and good luck!

It looks like your over denture is a bit thin at the housing locations. Shorter is better for the afore mentioned reasons. Also, the retentive areas of the locators may be worn out, so while you are at it why not do an overhaul.

Thanks for the comments. Including some more information here. Images show that the upper is an existing Cusil type denture that I am remaking and the image of the lower model for fabricating custom trays. Patient not interested in additional implants. Based on your comments I might as well swap out the attachments since I will be placing the female components directly.

shorter is better. very valid point by Dr. Boudet with regard to the lever arm. That being said, either way should work but if making a new denture, switch out the attachments for shorter ones.

All excellent comments...obviously, shorter attachments would reduce the effects of the lever arms, and allow the attachments to be buried deeper in the acrylic denture.

While I agree a shorter abutment may be better theoretically, I have not found any problems clinically if the locator abutment is a little longer than recommended – provided there is enough OVD to allow plenty of acrylic bulk and strength around the denture retainers. However if the locator abutments are too short (even sometimes the recommended height above the gingival crest) I have found that often it is harder for the patient to click the denture into place due to soft tissue resistance. Indeed more than once, getting the denture to click into position has been a problem. Therefore I would recommend that you have the locator abutment length about 1 or 2 mm longer than recommended (again as long as there is enough vertical space). This will help avoid problems for the patient. In regards to your particular case, it appears that the existing locators may have a little wear, but there seems to be plenty of retention still available. So if it was me – I would leave them as they are. “If it is not broken, don’t fix it.”

In my practice I have noticed a pattern of wear on the gold portion of the abutment when left long. Probably due to making the denture a mostly implant retained and supported prosthesis vs soft tissue support shared with implant support as they are designed to function.

If there is room for the longer one in the denture you can leave it. If however, it looks worn or if replacing the caps doesn't improve the retention ( assuming the denture is loose ), then replace it.

I practice in a rural area and have done many of these cases. If the retention ring of the abutment is in good shape, no silver showing, the radiographs of the implants look good and the patient has had no fracture problems. I would think keeping the abutment acceptable. New females on worn abutments help for only a short period of time. The patient will be back soon complaining. If the abutments are worn,I would explain to the patient the value of new shorter abutments. Let them then decide and make a note of the conversation. I always have to pick up the attachments in the mouth with LIGHT pressure on the denture to get good retentive results. Good luck thanks for posting!

These aren't terribly long. In my office I wouldn't have even considered replacing them. Longer abutments sometimes makes it easier for patients with limited dexterity to insert a denture. For me, the biggest reason to leave the existing abutments is so that the old denture can be used as a backup. That eliminates the urgency associated with a lost denture, denture sore or a future repair. I spent Christmas eve in my office one year because a patient dropped a denture in the sink and broke the base (I am a sucker for people in crisis). It would have been great to have been able to instruct the patient to put in their old denture and schedule an appointment the next week. Also - Metal framework! I have had too many all acrylic implant retained dentures break, and grandmas don't bake pie for the office for broken denture appointments. And why didn't you pick up your housing when you took the impression? Having lab analogs in the model would have helped you later in the process.

I agree shorter height. Also, check out DESS USA for their locator type attachment.

All valid points . Apparently no right or wrong here. Inlike Dr TK’s thoughts on being able to have old as a spare and metal frame. Excellent ideas.

I have used Locator OD attachments for years and have a case with 4 implants each arch where the Locator male nylon components wear out very quickly and the female abutments have been replaced twice as well. I have reviewed every aspect of OD care with the patient and he wants something different. I am considering the new Sterngold SNAP OD attachments. I liked the Sterngold ERA attachments long ago and can't remember why I switched to Zest Locators. Has anyone used these Stern SNAP attachments and have advice?

Thanks for all the input!

This is almost exclusively what I do in my practice. While I tend to agree with the concept of "if-it-aint-broke-don't fix-it", this is not one of those times. A two locator implant lower denture works much better with these recommended changes. Remove those locator abutments, They are way too tall. It takes 2 minutes to back them out and replace correct height abutments. Explain to the patient a third implant, one placed at the midline provides a much more stable lower denture owing to the properties of a 3 point plane we all learned about in geometry. Now that you have the patient's attention, explain that you are going to see if the patient is ready to upgrade to a fixed prosthesis. Here you would place 2 more implants in the molar region ( if you have room) . If not just place one more at the midline. The photo is not great, it looks like one mine! The patient really needs a new lower denture.

Interesting case