What is the dental code for replacing the screw access holes on an all on 4 or other implant supported prosthesis?
There is no dental code for repairing or replacing the screw access holes on an All on 4 or other implant supported prosthesis. The ADA dental code that is the closest is D6090, but that is probably not the most appropriate. I feel D6199 might be better since D6090 is repair of the prosthesis and the screw hole access isn’t really a repair. D6199 is an unspecified dental implant procedure, by report. Thus with that code a note will need to be written by the dentist. While it can be a short note, it is kind of PIA. Furthermore it is definitely going to draw the attention of the insurance company for review.
Dental code for replacing screw access holes
D6199 or D6090. If you are taking it off then the replacement is part of dental code D6080 and you can learn more about that on our all on 4 maintenance post.
What are you filling the screw access hole with?
What material you fill with depends on your desire to remove the prosthesis in the future. Ideally if we make and design the prosthesis well, then you should not need to remove it again unless there is an issue. The ACP came out with this guideline in 2016, although many dentists are removing every year to clean them still. The other factor is what the material is that is surrounding the screw access.
If you are going to remove it, then use something you can remove easily like fermit, temp-it, or clip flow. I hate those materials for long use because most the cases I see with that half of them are already gone and it’s gross. I don’t have many that I can not make cleansable in my office so I rarely use any of these. However if I do have one that I want to remove then sometimes I will just use PVS. If you are going to fill the screw access hole for good then use some type of acrylic or composite.
No matter what you fill it with be sure that you place some PTFE tape or a sponge above the screw for protection. If using angled screws for an angulated screw channel ASC then use blue PTFE. There are many companies that make angulated screws now and all probably will. The blue PTFE will hopefully alert future doctors to the fact the it is an ASC and they will use the right driver.
What should the fee be for placing screw hole access material?
This will depend on what you are using and how you are doing it. Most answers I have seen from dentists fall into the $500 or less per arch range. I charge it like a 3 surface filling and charge around $300 for one arch and $500 for both. It’s very fast if just replacing screw hole access covers. The vast majority of the time I do this, is when I have an All on 4 patient from an office where they believe in removing every year.
Steps for replacing screw hole access filling
My steps if replacing old failing screw access materiel, assuming prosthesis is cleansable or has been made cleansable.
- Remove any temporary screw access material, although often several have come out.
- Remove food debris and PTFE tape.
- Clean out the access hole chamber with chlorhexidine.
- Chairside in the pink areas if acrylic or composite if not, following same steps as below. However, often the pink area is composite like Gradia gum so then just roughen bond and composite.
- Composite in the white areas with acrylic liquid for acrylic, Z prime and bond for zirconia or metal, and porcelain etch silane and bond for porcelain.
Sometimes I remove it and refine the borders to make it cleansable, which I have an All on 4 prosthesis adjustment fee for.
What if you have to take of the prosthesis as well as repair the screw access chambers?
I have an entire post of all on 4 maintenance that covers this topic.