FIX On SIX® – A Mini Dental Implant Alternative to the All-on-4®
Less Invasive, Less Time, Less Costly, and Less Discomfort

Todd Ellis Shatkin, D.D.S. – Private dental practice Buffalo, NY, Owner Shatkin F.I.R.S.T., LLC

Alysa Brooke Sadkin – Dental student, University of Pittsburg Dental School

Aesthetic dentistry has evolved throughout the past few decades, specifically in the field of Implantology. Patients are preferring endosseous procedures over dentures and other removable prosthetics in order to increase stability, increase comfort and decrease pain. Conventional implants require several procedures, multiple appointments and upwards of a year until completion, although some newer techniques promote a faster completion time. The All-on-4® technique is an immediate conventional implant procedure, in which four large diameter implants, two in the anterior and two in the posterior, are inserted at a forty five degree angle in order
to take advantage of the available bone and reducing the need for bone augmentation and/or sinus lift.2 According to the Nobel Biocare All-on-4® treatment concept manual,
a minimum of 5 mm in bone width and 8 mm in bone height is necessary to begin the procedure.3 Though the All-on-4® technique claims to eliminate the need for bone
augmentations and sinus lifts, these procedures cannot always be eliminated if the bone quantity does not meet the requirements due to the large diameter of a conventional implant.1-2,4 While the All-on-4® technique offers acceptable support with four implants, the endosseous procedure is still invasive and time consuming compared to the immediate and early loading procedures used with mini dental implants. The All-on-4® often requires a minimum of four to six months before the final restoration is fully
completed.4 In addition, if one of the 4 implants fails to integrate or fails following placement of the restoration, the entire restorative procedure must be restarted, additional
surgery performed and the restoration remade. Considering
the average fee for All-on-4® is in the range of $30,000 –
$40,000 per dental arch, this technique is not affordable to
the vast majority of dental patients.
Immediate and early loading endosseous procedures with
mini dental implants are more desirable to patients in
many instances because of the speed of completion, the
affordable fee, the less invasive procedure and the reduced
post-operative discomfort.4 The small size of the mini
dental implants (available in several lengths and diameters)
eliminates the need for bone augmentation and/or sinus
lifts. This is due to the fact that the mini dental implant
can be angled into available bone rather than augmenting
the bone.4 The Shatkin F.I.R.S.T®Technique (Fabricated
Implant Restoration and Surgical Technique) (Patent USPTO
#7,108,511 B; September 2006), developed by Dr. Todd E.
Shatkin DDS, provides for the mini dental implant(s) to be
placed and the restoration(s) cemented in one patient visit.8
Dr. Shatkin’s most recent innovation, FIX On SIX®, offers
a combination of the Shatkin F.I.R.S.T.® Technique using 6
– 8 or 10 mini dental implants with a 12 unit fixed detachable
zirconia full arch restoration with O-ring implant housings.
The restoration is only removed at recall cleanings as the
dentist is able to snap off the FIX On SIX® restoration.
The hygienist will then completely clean the implants, the
restoration and the surrounding tissue and easily reinsert the
restoration without patient discomfort. This FIX On SIX®
procedure is completed in a fraction of the patient’s and
the dentist’s time as required by the All-on-4® technique.
The success rates of the immediate loading mini dental
implant endosseous procedures are competitive with the
All-on-4® technique. If one of the mini dental implants
were to fail with a FIX On SIX® restoration, the failed mini
implant can be easily replaced with a new mini implant and
O-ring housing, placed in the same or different location. In
addition, the FIX On SIX® restorations are considerably
more affordable than the All-on-4®, costing approximately
a third to half of the cost. Consequently the FIX On SIX®
restorations are more desirable to the patient due to their
affordability, greater comfort, reduced treatment time and
the less invasive nature of the procedure.
Fixed partial dentures are commonly supported by mini
dental implants to provide a natural, aesthetic appearance
for the patient. In recent years, Zirconium Dioxide
(zirconia) frameworks have been used in dentistry for fixed
The introduction of zirconia has allowed
for the production of metal free prosthetics, by means of
(CAD/CAM) technology. The result is improved aesthetics
with increased success and reliability.6
There is also
evidence that zirconia attracts less plaque accumulation
preventing gingival problems.7
The architecture of these
zirconia-based prosthetics enable superior strength and
chewing resistance on the posterior teeth relative to other
ceramics.8-9 Due to its favorable chemical composition