All-on-X Maintenance Template (AOX Recall)

The template

Pick your PMS to format the placeholders, then copy.

PMS format

[Prompt:"name"]

All-on-X maintenance visit.

RMH: Medical history reviewed/updates

Implant prosthesis support: Extraction/implant placement dates, implant system, abutment/component records
Support/retention type: Implant-supported vs abutment-supported; screw/cement retention
Maintenance findings: Peri-implant tissue, bone level/radiographs, occlusion, hygiene access
Torque/component details: Torque values, screw access, O-rings/gaskets/attachments if applicable

Arch: Arch
Time since surgery: Time since surgery

Evaluation:
Prosthesis removed.
Implants examined.
Probing depths: Probing depths
Tissue health: Tissue health
Radiograph: Radiographs taken/reviewed and findings

Cleaning: Cleaning
Prosthesis cleaned.
Abutments cleaned.
Tissue cleaned.
Irrigation performed.

Prosthesis reattached.
Screws torqued.
Occlusion verified.

Home care reviewed.
Water flosser use.
Brush under prosthesis.

NV: Next visit

Field glossary

What each placeholder represents.

Medical history reviewed/updates
Note that medical history was reviewed and any changes since last visit — meds, conditions, allergies, smoking status, diabetes A1C trend, anti-resorptive therapy. Smoking and uncontrolled diabetes are the highest-yield items.
Extraction/implant placement dates, implant system, abutment/component records
Dates of arch extraction and implant placement, the implant manufacturer and product line (Nobel, Straumann, Zimvie, Neodent, etc.), implant sizes and positions, multi-unit abutment torque spec, and prosthesis screw torque spec. Manufacturer-specific values matter for retorque.
Implant-supported vs abutment-supported; screw/cement retention
Whether the prosthesis loads directly on implants or on multi-unit abutments, and whether retention is screw or cement. Drives the workflow (screw access caps, torque sequence, reseating).
Peri-implant tissue, bone level/radiographs, occlusion, hygiene access
Today's findings — peri-implant tissue health (color, edema, BOP), radiographic crestal bone levels compared to baseline, occlusion balance, and patient's hygiene access under and around the prosthesis.
Torque values, screw access, O-rings/gaskets/attachments if applicable
Specific Ncm value used for retorque, what was used to reseal screw access channels (Teflon + composite, PVS + composite), and any wear-component replacements (O-rings, locator caps, gaskets, attachments).
Arch
Maxillary, mandibular, or both. AOX patients may have a hybrid in one arch and natural dentition or another prosthesis type in the other.
Time since surgery
Years and months since implant placement, plus time since prosthesis delivery if different. Recall expectations differ in years 1-2 vs. years 3+.
Probing depths
Per-implant probing depths at 4 or 6 sites where access permits, measured with a plastic probe at light pressure. Compare to the post-delivery baseline; increases >2 mm at any site are a peri-implantitis red flag.
Tissue health
Per-implant peri-implant mucosal findings — color, contour, edema, BOP, suppuration, recession, keratinized mucosa width. Patient-specific, not default WNL.
Radiographs taken/reviewed and findings
Bone-level PAs taken or prior films reviewed, diagnostic quality, and a one-line interpretation of crestal bone levels vs. baseline. Films are billed separately under D0220 / D0230.
Cleaning
What was used (titanium curettes, plastic instruments, glycine air-polish, ultrasonic with implant-safe tip) and what was cleaned (intaglio of prosthesis, multi-unit abutments, implant collars, soft tissue). Avoid stainless-steel curettes and standard ultrasonics on implant surfaces.
Next visit
Recall interval (3, 4, 6, or 12 months) with rationale tied to risk factors, plus any prerequisites (PAs, problem-visit, surgical referral if peri-implantitis is suspected).

Documentation requirements

The defensible AOX maintenance note proves three things: (1) the patient has a full-arch implant-supported prosthesis that justifies the prosthesis-off workflow, (2) today's peri-implant tissues and prosthesis components were assessed objectively, and (3) the prosthesis was reattached to manufacturer spec.

Medical history review and update — meds, conditions, allergies, smoking status, diabetes (A1C trend if available), bisphosphonate or anti-resorptive therapy, and any new systemic risk factors. Smoking and uncontrolled diabetes are the two highest-yield items because they predict peri-implantitis risk and may justify a shorter recall interval.
Implant prosthesis support data — extraction date, implant placement date, surgical/restorative provider, implant system and manufacturer (Nobel, Straumann, Zimvie, Neodent, Hiossen, etc.), implant diameters/lengths/positions, multi-unit abutment torque spec, and prosthesis screw torque spec. Manufacturer-specific torque values matter — Nobel multi-unit abutments are commonly 15 Ncm for prosthesis screws and 35 Ncm for the abutments themselves; Straumann and others differ. Document the actual values used.
Support and retention type — implant-supported vs. abutment-supported (multi-unit), screw-retained vs. cement-retained, fixed vs. fixed-detachable, hybrid acrylic vs. monolithic zirconia vs. PFZ. The retention type drives the workflow (screw access caps, torque sequence, reseating).
Time since surgery and time since prosthesis delivery — recall scheduling and bone-remodeling expectations differ in the first year vs. years 2+.
Prosthesis removal documentation — screw access located (note any composite plug removal), screws backed out, prosthesis removed atraumatically, condition of intaglio surface (calculus, biofilm, food debris, fractures, wear of acrylic teeth).
Peri-implant probing — 4 or 6 sites per implant where access permits; record absolute depths and compare to baseline (the post-delivery probing chart is the reference). Probing implants is technique-sensitive — use a plastic probe, light pressure (~0.15 N), and document sites that were inaccessible. Increases of >2 mm from baseline at any site are a peri-implantitis red flag.
Bleeding on probing / suppuration — record presence and distribution. BOP at >1 site per implant is the AAP/EFP threshold for peri-implant mucositis; suppuration is a peri-implantitis sign.
Peri-implant tissue health — color, consistency, edema, keratinized mucosa width, fistula, recession of the soft-tissue collar around each abutment. Document objectively, not as a default "WNL."
Radiographs reviewed — bone-level periapicals are the standard; compare to the post-delivery baseline. Crestal bone loss >2 mm beyond initial remodeling (or any progressive loss after year 1) is a peri-implantitis indicator and should trigger escalation, not a routine maintenance note. Films are billed under their own codes (D0220 / D0230) — not bundled into the maintenance.
Cleaning performed — instruments used (titanium curettes, plastic instruments, glycine air-polishing, ultrasonic with implant-safe tip), what was removed (calculus, biofilm), and on what surfaces (intaglio of prosthesis, multi-unit abutments, implant collars, soft tissue). Avoid stainless-steel curettes and standard ultrasonics on implant surfaces — document the implant-safe instrumentation.
Occlusion check — anterior guidance, posterior contacts in MIP, lateral excursions, parafunction signs, wear of the acrylic teeth, fractured teeth or framework. Hybrid prostheses load the implants axially when occlusion is balanced; cantilever overload and lateral interferences are the two leading causes of screw loosening and prosthesis fracture.
Screw retorque to manufacturer spec — explicit Ncm value, calibrated torque driver used, screw access channels resealed (Teflon tape / cotton + composite plug, or PVS + composite). Document the torque value and the manufacturer it matches. "Screws torqued" without a value is a documentation weakness.
Wear-component replacement (overdenture variants) — O-rings, locator caps, retentive nylons, gaskets, attachment housings replaced as indicated, with part numbers if available. Bill D6081 or appropriate repair code separately if applicable.
Home care reinforcement — patient-specific demonstration: water flosser settings (typically low to medium for hybrid undersides), interproximal brush size, super-floss threading under cantilevers, brushing technique on the prosthesis exterior. Note compliance trend if known.
Findings discussed with patient — peri-implant status, any escalations recommended (shorter recall, problem visit, referral to surgical specialist for peri-implantitis workup), and the next recall interval with rationale.
Complications — explicit. "None" if true. Loose screw, fractured tooth, suppuration, bone loss, soft-tissue overgrowth — each requires a follow-up plan, not silence.
Provider and assistant signatures, including who removed and reseated the prosthesis and who performed the torque step.

The "amnesia test" applies. A reviewer reading this note in 2 years should be able to reconstruct: which arch, which implant system, which abutments, what depths, what torque, and whether the patient was stable.

Common denial reasons

Common reasons AOX maintenance claims are denied, downgraded, or audited:

Frequency violation on D6080 — patient already had D6080 within the carrier's lookback window (often 6 months, sometimes 12). The most common denial; resolve by verifying eligibility and prior claim history before the visit.
D6080 billed per implant when carrier caps per arch — billing 4-6 units of D6080 on an AOX arch when the carrier's policy is 1 unit per arch produces a partial denial of the extra units.
D6080 + D1110 same-day denial — many carriers bundle the implant maintenance with prophylaxis when both are billed for the same patient on the same DOS, especially when the patient is fully edentulous.
D4910 billed for the implant arch — D4910's descriptor requires periodontitis history; carriers routinely deny D4910 on edentulous arches and on patients without a documented prior SRP / perio surgery.
Missing periodontitis history for D4910 contralateral billing — when D4910 is billed for a remaining natural-dentition arch alongside D6080 for the implant arch, carriers want documented prior SRP within their lookback window for the D4910 portion.
Insufficient documentation of prosthesis removal and retorque — note reads like a routine prophy ("scaled and polished") with no mention of prosthesis off, screw access, torque value, occlusion, or peri-implant probing. Reviewers downgrade or recoup.
No peri-implant probing documented — periodontal/peri-implant probing is the load-bearing finding for an implant maintenance visit. "Tissue WNL" without numbers is treated as missing required content.
Missing implant-system and torque-spec documentation — without the manufacturer and the Ncm value, a reviewer cannot verify the retorque step was performed correctly. Increasingly cited in audits of high-volume implant practices.
Default-normal templating — every AOX patient with identical "tissue healthy, occlusion stable, screws torqued" notes flags as boilerplate. Patient-specific findings (probing depths, BOP sites, wear, plaque distribution) are required.
Same-DOS conflict with D6090 / D6091 / D6092 / D6093 — when a screw needed re-tightening or a component needed replacement, the encounter became problem-focused and D6080 may not be billable in addition. Bill the repair code or D6080, not both, unless the carrier policy allows it.
D6081 billed without documented peri-implant mucositis — billing D6081 as a default "deeper cleaning" without inflammation findings is a known audit pattern.
Radiograph denials — bitewings (D0270 / D0274) are commonly denied for fully edentulous arches; use periapicals (D0220 / D0230) for AOX bone-level imaging.