Validation of maintenance requirements and patient satisfaction of classical implant locators versus customized attachments in mandibular implant-retained overdentures

Objectives: This study was performed to compare implant locators versus customized mandibular implant-retained overdentures
considering patient satisfaction and prosthesis maintenance.
Materials and Methods: 12 completely edentulous patients from the prosthodontic department-Cairo university outpatient
clinic were selected according to specific inclusion criteria. The patients were then allocated randomly into two groups using
closed envelopes For both groups, each patient received dental implants in the planned position. The patients were left for 3
months for implant healing. For group (A) the patients received two locator attachments. The attachment collar height was
selected based on the soft tissue thickness keeping the retentive part 1 mm above the soft tissue level. The denture was relieved
opposite the locator housing and the attachment was picked up using cold-cured resin.
For group B, the implants were exposed, and healing collars were placed. After 2 weeks, the implants were scanned using an
intraoral scanner. The denture was readapted using a light body closed mouth impression. The relined denture was scanned from
both the fitting and the occlusal side. The scanned fitting surface was used to create an inverted virtual model and proceeded
till creating custom locator attachments. The generated custom attachment abutment was milled from grade V titanium blanks
using a 5-axis milling machine. The abutments were anodized into gold color using an electric anodizer. The attachments were
then sterilized and placed in the patient mouth as set before in the design. The pick-up of the housing was done in the same
manner as group A. For both groups, the patients were given instructions for using and maintaining the overdenture. Initial
denture corrections were made in the first 2 weeks if any complaint existed. The patients were recalled periodically at 3 months,
6 months, 9 months & 12 months respectively.
Results: Likert scale out of 5 was followed for patient denture satisfaction along 3, 6, 9, and 12 months for groups A & B.
Applying an Independent t-test for significance evaluation between group A and group B, precluded the higher significance of
group B than group A for all follow up as P-value < 0.05. For prosthetic maintenance along twelve months follow-up, group
B revealed a lower insignificant different incidence of prosthetic complications than group A using the Chi-square test for
significance testing between proportions as P-value > 0.05.
Conclusions: Customized locator attachments are highly recommended to retain mandibular overdentures, as they exhibited
better maintenance values and more wear resistance with minimal loss of retention. Moreover, can be utilized by any presented
implant system in the market, in addition, Patients were completely satisfied with their customized locators retaining their
implant-supported overdentures.