ZEST is considered the "Leader in the overdenture world" with several key competitive advantages:

Universal Compatibility:
ZEST has a locator abutment for any implant system that exists, allowing you to have a mix or match of implants in one arch with one unified overdenture system. Other overdenture systems are very proprietary to their specific abutment and implant only.

Practice Efficiency:
Offices only need to deal with one overdenture system instead of figuring out which system was used, what inserts to use, or what housing is needed. This streamlines operations and makes things very efficient.

Proper Terminology:
The "Locator" is ZEST's specific branded abutment system. Many offices say they're "placing locators" when they're using someone else's overdenture system - it's like buying adhesive bandages and calling them "band-aids."

Technical Advantages:
The Locator abutment is one of the lowest profile abutments available with self-leveling property - the insert floats inside the denture cap, allowing for self-leveling of the overdenture.

ZEST offers multiple abutment options based on implant angulation and clinical needs:

Gold Locator (Standard Legacy):

• Angulation range: 0 to 20 degrees divergence
• Profile: Low profile abutment
• Use: Standard removable overdenture cases within normal angulation parameters
• Advantage: Allows potential conversion to Locator Fixed later

Pink RTX Abutment:

• Angulation range: Outside of 20 degrees divergence
• Profile: Taller abutment (not low profile) with two lips
• Movement capability: Pivoting inserts allow for full 30-degree movement over the abutment
• Use: Removable overdentures when implant angulation exceeds 20 degrees

Angled Locator (New):

• Function: Corrects 15 degrees of angulation
• Advantage: Allows RTX cases to be converted to gold abutment (within 20 degrees)
• Availability: Currently available for Nobel, Straumann, ZimVie, and Neodent
• Benefit: Keeps patients in a low-profile system and enables future fixed conversion

Selection Strategy: Prefer angled locators when possible, to keep patients in the gold system for lower profile and potential Locator Fixed conversion.

ZEST offers a complete spectrum of prosthetic solutions:

Traditional Overdentures (Removable):

• Patient removable prosthetics
• Implant-retained, soft tissue supported
• Cannot fix an ill-fitting denture (denture must fit properly first)
• Uses nylon inserts designed for daily in/out use

Locator Fixed (Introduced 2 years ago):

• Purpose: Fills the gap between overdentures and all-on-X cases
• Conversion advantage: Takes overdenture patients with existing gold locators into a fixed prosthesis without changing the abutment
• Patient preference: Addresses the reality that every patient wants a fixed, not removable
• Budget solution: Provides a fixed option for patients who want all-on-X but have overdenture budgets

Key Insight: Locator Fixed bridges the huge gap that previously existed between basic overdentures and expensive all-on-X cases, capturing patients who might otherwise walk out the door to competitors.

Cuff height is critical for proper Locator placement and requires precise measurement:

Measurement Process:

1. Remove the healing abutment
2. Take a probe and place it on the platform of the implant
3. Measure around the entire circumference of that site
4. Take the tallest measurement from all sides (mesial, distal, buccal, lingual)
5. Order the cuff height based on the largest measurement

Example: If mesial is 2mm, distal is 3mm, buccal is 2mm, and lingual is 2mm, order a 3mm cuff height.

Specifications by Manufacturer:

• Range: Most platforms start at 0mm or 1mm and go up to 6mm maximum
• Maximum limit: 6mm is the tallest available (above 6mm requires gingivectomy)
• Whole numbers: Some platforms use whole numbers (0,1,2,3,4,5,6mm)
• Fractional measurements: ZimVie uses 0.75, 2.5, 3.5, 4.5, 5.5mm on some platforms
• Implant stickers: Implant stickers and/or surgery reports are a huge help with implant ID for accurate Locator ordering.
• Torque Specifics: Zest offers Locator drivers to torque the Locator into the implant adequately. A variety of drivers are available depending on the office’s torque wrench system.

ZEST Auto-Calculations:

• ZEST automatically adds a 1.5mm "lip" above the ordered cuff height
• Final result: Locator should be exactly 1.5mm above the highest gum tissue
• The lip engages with the insert in the denture cap

Critical Timing:

• DO: Measure when ready to restore and healing is completed
• DON'T: Measure from x-rays, surgical letters, or healing abutments during healing
• Reason: Tissue heals, shrinks, and changes from surgery until the restorative time

Accurate ordering requires four critical pieces of information with manufacturer-specific considerations:

Four Required Elements:

1. Manufacturer (e.g., ZimVie, Straumann, Bio Horizon, Nobel, Dentsply)
2. Type of implant
3. Platform (specific platform designation)
4. Cuff height (measured as described above)

Manufacturer-Specific Requirements:

• BioHorizons: Requires the diameter platform measurement, not just the platform designation
• ZimVie: Uses fractional measurements (0.75, 2.5, 3.5, etc.) on some platforms
• All manufacturers: Each has different platform specifications requiring reference

Reference System:

• Approximately four different reference sheets are needed for different implant systems
• Each manufacturer has slightly different specifications and requirements
• Must match exact platform specifications to ensure proper fit

Torque Specifications:

• Range: 25-35 Newton centimeters (average 30)
• Critical: Always defer to the implant manufacturer's specifications
• Torque values depend on the specific implant system being used

Workflows are essentially the same whether analog or digital, but differ significantly based on processing location:

Universal Principle: The key workflow decision is WHO processes the denture cap - the lab or the office.

Lab Processing Workflow:

• Analog: Place impression coping ("wine glass") over locator → take wash impression → send to lab
• Digital: Scan arch, existing dentures, occlusion → send digital files
• Result: Lab processes denture cap inside denture and delivers it immediately
• Doctor involvement: Minimal - no processing required

Office Processing Workflow:

• Analog: Use white spacer around locator → take impression → overdenture returned with sites welded out
• Digital: Use tan scan bodies over locators → scan → process in the office
• Result: The Office handles denture cap pickup and processing
• Doctor involvement: Significant - full processing procedure

Component Differences:

• Impression copings: "Wine glass" shaped for analog lab processing
• Spacers: White blockout spacers for analog office processing
• Scan bodies: Tan, flat, autoclavable for digital office processing
• Passive fit: All spacers are designed to provide passive fit with adequate clearance

Quality Considerations:

• Lab processing: Great results, but potential impression/distortion issues require office reprocessing
• Office processing: Better predictability but requires a comfort level of the physician and staff
• Recommendation: Decision often based on doctor/staff comfort rather than technical superiority

Both digital and analog workflows have specific requirements for optimal results:

Digital Scanning Requirements:

• Standard scans: Arch, existing dentures (upper/lower), occlusion, current dentures
• Scan bodies: Tan, flat, autoclavable components that fit over locators
• Stocking recommendation: Offices doing frequent scanning should keep scan bodies on hand
• Lab coordination: Contact the lab to confirm specific scan requirements for each case

Analog Impression Requirements:

• Lab processing: Use impression copings ("wine glasses") over locators
• Office processing: Use white spacers around locators for blockout
• Wash impression: Standard technique with appropriate impression material
• Passive fit: All components are designed for a passive relationship with locators

Pickup Impressions: When copying existing dentures, the approach depends on the processing location:

• Office processing: Spacers block out locator sites
• Lab processing: Impression copings capture the exact locator position

Critical Insight: This workflow distinction is often the most confusing aspect of removables - offices must understand the workflow based on their preferred processing method.

Locator Fixed has specific technical requirements that must be met for successful outcomes:

Minimum Requirements:

• Implants: 4 implants minimum required
• Angulation: Each implant must be within 20 degrees (only works with gold legacy abutment)
• VDO: 9-11mm per lab manual, 10-12mm preferred, 9mm workable but challenging
• Removability: Clinician removable, NOT patient removable

Contraindications:

1. Insufficient implant sites: Less than 4 implants
2. Inadequate VDO: Cases below 9mm are contraindicated
3. Excessive angulation: Implants outside 20-degree range (requires gold abutment)

VDO Management for Challenging Cases:

• Limited VDO (9-10mm): May need to "steal" space from opposing arch if possible
• Natural dentition: Cannot steal space from the upper arch with natural teeth
• Patient expectations: Critical to set realistic expectations with limited VDO
• Case-by-case: Each overdenture conversion is unique, requiring individual assessment

System Differences from All-on-X:

• VDO requirement: 10-12mm vs 15mm+ for all-on-X
• AP spread: Less than all-on-X cases
• Cantilever ratios: 1:1 for non-bruxer, 1:0.5 for bruxer
• Patient acceptance: Removable patients typically don't care about cantilever limitations

Locator Fixed pricing is affected by a number of variables: 

Cost Variables:

• Number of implants: 4-implant vs 5-6 implant cases
• Surgeon type: GP surgery vs oral surgeon
• Prosthetic material: Acrylic to zirconia range
• Geographic area: Regional pricing variations
• Available VDO: Influences material and design complexity

Material Options (lowest to highest cost):

1. Reinforced acrylic: Basic option
2. PMMA: Lab standard material
3. Ivoclar (Ivo): Highly recommended, excellent quality/price ratio
4. Zirconia: Premium option

Material Selection Criteria:

• Patient budget: Higher-end materials cost more
• Opposing arch: Must match or complement the opposing restoration
• Aesthetic expectations: Patient satisfaction with appearance
• Available VDO: Space limitations may influence choice

Example: Upper zirconia arch requires lower zirconia Locator Fixed to ensure arches match and meet patient expectations.

ZEST Material Preference: Ivoclar is highly recommended for optimal results and competitive pricing.

Locator Fixed requires specific maintenance protocols and specialized equipment:

Maintenance Schedule:

• First year: Every 6 months (twice per year)
• After the first year: Once per year minimum
• Bare minimum: GP visits twice yearly for oral cancer screening, OHI, prosthesis evaluation, and implant assessment

System Technology Differences: Removable System:

• Insert material: Nylon (squishy, soft)
• Function: Daily in/out use, multiple wear cycles
• Movement: Pivoting and slight movement allowed

Locator Fixed System:

• Insert material: PEAK (rigid material)
• Manufacturing: Housing and insert made on the same machine for a precise fit
• Movement: No pivoting, minimal movement
• Critical limitation: PEAK inserts distort when removed and never regain the same retention - must replace every removal

 Required Tooling:

• Seating/removal tool: Handle with seat and removal ends (similar to crown and bridge removers)
• Function: The Removal end goes underneath the cantilever
• Sound/vibration: Makes noise, but isn't as aggressive as it seems
• New core tool: Required for PEAK inserts (old core tools are too thin, insufficient stability)
• Ownership: Clinician purchases and owns (needed for ongoing maintenance)

Component Availability:

• Current status: Lab doesn't carry Locator Fixed inserts, housings, tooling
• Sourcing: All components must come directly from ZEST
• Coordination: Contact ZEST representative for component delivery
• Future: Direct partnership being developed between ZEST and lab
• Removable components: Currently available through Preat (third-party vendor). With this said, Fixed components and angled locators are not offered through some distributors.

Workflow Options:

• Lab processing: Available with ZEST component coordination
• Office processing: Available using the pickup method
• Cement selection: Must match prosthetic material (contact lab for guidance)

Locator Fixed addresses major case acceptance challenges through strategic treatment planning:

Patient Reality Check:

• Universal desire: Every patient wants a fixed prosthesis, not removable dentures
• Budget constraints: Patients often want all-on-X but only have overdenture budgets
• Market pressure: Media and large DSO practices drive full arch expectations

Phased Treatment Strategy:

1. Phase 1: Start with a 2-implant overdenture (meets current budget)
2. Phase 2: Add 2 more implants the following year (spread the cost over time)
3. Phase 3: Keep the patient in a removable while fabricating the final fixed prosthesis
4. Final Phase: Convert to Locator Fixed system (achieve the desired fixed outcome)

Business Advantages:

• Patient retention: Captures patients who want fixed but can't afford all-on-X immediately
• Revenue spreading: Allows treatment over multiple budget cycles
• Conversion opportunity: Existing gold locators convert to fixed without abutment changes
• Competitive positioning: Fills the gap between basic overdentures and expensive all-on-X

Case Acceptance Psychology: Patients appreciate having a pathway to their desired fixed outcome rather than being told "you can't afford what you want."

Locator Fixed provides significant operational advantages over traditional all-on-X maintenance:

Time Efficiency:

• Locator Fixed: 5-minute process for removal, insertion, change, and replacement
• All-on-X: 30-40 minute restorative appointments are typically required
• Appointment type: Can be managed in hygiene appointments vs separate restorative time

Task Delegation:

• Removal: Hygienists, assistants, and any trained staff
• Insert changes: Hygienists and assistants
• Replacement: Only doctor needed (because it's a fixed prosthesis)

Patient Compliance Benefits:

• Pleasant experience: Quick, efficient maintenance process
• Easy appointments: 5-minute vs lengthy restorative appointments
• Regular care: Encourages 6-month return compliance
• Competitive advantage: Addresses maintenance gaps in corporate/large practices that do all-on-X but don't maintain properly

Locator Fixed provides an effective salvage solution for compromised all-on-X cases:

Failure Scenarios:

• Implant failure: One or two implants failed in an existing all-on-X case
• Financial constraints: Patients can't afford complete all-on-X replacement
• Process fatigue: Patients can't go through the entire all-on-X process again

Conversion Process:

1. Remove the failed prosthesis
2. Assess remaining implants: Determine viability and positioning
3. Address angulation: Use MUAs (Multi-Unit Abutments) or angled locators to correct angles
4. Anatomical considerations: Particularly important in maxillary cases with sinus anatomy
5. Convert to Locator Fixed: Provides an affordable alternative to complete replacement

Clinical Advantages:

• Cost-effective: Significantly less expensive than complete all-on-X replacement
• Predictable: Uses existing viable implants
• Faster treatment: Shorter timeline than a complete restart
• Patient satisfaction: Achieves fixed outcome without full reconstruction

Maxillary Considerations:

• Angle correction: May need angled locators or MUAs for implant angulation
• Anatomical challenges: Upper jaw anatomy requires specific planning
• Case-specific solutions: Each conversion requires individual assessment

This solution transforms failed cases into successful outcomes while providing affordable alternatives for patients facing implant complications.

ZEST employs comprehensive quality control through proper training and support:

Common Failure Causes:

• Inappropriate planning: Cases not properly planned from start
• Variable control issues: Missing critical steps or components
• Inadequate training: Teams attempting cases without proper onboarding
• Lack of ZEST involvement: Cases done without manufacturer support

Prevention Strategies:

• ZEST involvement: Include ZEST in case planning and execution
• Complete onboarding: Ensure full training before attempting cases
• Protocol adherence: Follow all recommended procedures and use correct components
• Team education: All members educated on proper protocols
• Variable control: Systematically address all critical case factors

Quality Assurance System:

• Territory management: ZEST representatives work to control case quality regionally
• Proactive alerts: System flags when inserts are ordered without tooling (incomplete setup)
• Case involvement: Direct participation in complex or initial cases
• Ongoing support: Continuous availability for troubleshooting and guidance

Reputation Management:

• Critical impact: One or two improperly executed cases can ruin the system for the entire office
• Negative spread: One bad experience reaches 25 people, one good experience reaches 5
• Patient confidence: Poor outcomes affect patient trust in the treatment option
• Team confidence: Failed cases discourage staff from recommending the system

ZEST's Quality Control Philosophy: Cannot control every case in the territory, but provides comprehensive support to ensure proper execution and prevent failures that damage the system's reputation.