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What’s your protocol for patients with screw retained dentures- all on 4, all on 6?

What’s your protocol for patients with screw retained dentures- all on 4, all on 6? Currently recommend 3 month recare and removing dentures for cleaning at every other visit. Trying to decide when new screws are needed and the fee is $30 per screw. We have been billing code 6090 (implant main procedure for the prophy= $213 fee). The doctor states removal is only recommended once a year but so far hygiene is horrible in the few patients I’ve seen. Any suggestions on protocol and recommend home care? Most are using water pik but when those dentures are in place I feel like I can’t even clean them so how do they? I worry that these poor patients spending $50k for two arches are going to have failed implants!! Ugh



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2 Answers

Thank you, Kara for your response. I spoke with the Nobel rep for our area today and he said there are no clear cut recommendationd on hygiene protocol for all on 4 patients. We are going to develop a written policy for our office. Thank you so much for explaining all the different insurance codes! I would love input from other Hyg on their office protocol for these patients. Thanks again!

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I like your recommendation of a 3 month recall, especially if the patients are struggling with home care. Make sure you are explaining the importance of homecare in the simplest way a patient can understand – sometimes that’s what it takes to get it to click. I like to explain that even though implants aren’t “real teeth” they need to be cleaned as such (if not more) because they can become infected and fail. Sometimes making a reference about the money they spent to have the implants how it would be a shame to waste, or something along those lines. Every appointment, introduce a new interdental aid until the patient finds what works for them; implant floss, stimulator, waterpik (like you mentioned), interdental brushes, etc. Show them any plaque or infection with a mirror or intraoral camera. Here’s a great article regarding implant homecare and includes interdental aids that are recommended and found to be most beneficial with implants: http://www.rdhmag.com/articles/print/volume-33/issue-9/features/focus-on-implant-home-care.html
Remember, you can only lead a horse to water, but you cannot make them drink. It’s always disheartening when you can see a patient isn’t doing what they need to do, but all you can do is educate and give them the tools they need, they must take it from there.

As far as denture removal, that’s really up to the doctor. Maybe he/she should do the exam first to see if early removal would be most beneficial. Same goes for when new screws are needed; that’s in the doctor’s hands.

Implant insurance codes:

D6080 Implant maintenance procedures, including removal of prosthesis,
cleansing of prosthesis and abutments and reinsertion of prosthesis – This procedure includes a prophylaxis to provide active debriding of the implant and examination of all aspects of the implant system, including the occlusion and stability of the superstructure. The patient is also instructed in thorough daily cleansing of the implant.

D6090 Repair implant supported prosthesis, by report – This procedure involves the repair or replacement of any part of the implant supported prosthesis.

D6095 Repair implant abutment, by report – This procedure involves the repair or replacement of any part of the implant abutment.

D6100 Implant removal, by report – This procedure involves the surgical removal of an implant. Describe procedure.

D6199 Unspecified implant procedure, by report – Use for procedure that is not adequately described by a code. Describe procedure.

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