Ball vs. Locator Attachments in Mandibular Overdentures: A Narrative Review of Clinical Performance and Patient Outcomes

Background: The long-term success of implant-supported mandibular overdentures depends largely on the type of attachment system used. This review compares the clinical performance, complication rates, maintenance requirements, and patient satisfaction between ball and Locator attachments. Methods: A literature search was conducted across PubMed, Scopus, and Web of Science. Studies evaluating clinical outcomes, prosthetic complications, patient-reported satisfaction, and frequency of maintenance in ball and Locator attachments were included. Results: Locator attachments showed higher patient satisfaction scores (mean VAS 8.1–9.0) compared to ball attachments (VAS 6.7–7.9). Complication rates, including matrix wear and attachment loosening, were lower in Locator systems (14–20%) than in ball systems (24–35%). Maintenance needs were more frequent in ball attachments, particularly for the replacement of retentive components (1.8 interventions/year vs. 0.9 in Locator). Peri-implant bone loss was comparable in both systems (<1.5 mm/year), with no statistically significant difference in survival rates over 3–5 years. Conclusions: Locator attachments demonstrate superior clinical performance in terms of patient satisfaction and lower complication rates, with reduced maintenance interventions compared to ball attachments. However, both systems remain viable options depending on anatomical and financial considerations.