John Jameson - November 01, 2005
Featuring New York implant doctor Todd Shatkin
Implant placement and restorative needs might be one of the top requested categories that laboratories receive today. With the evolution of implantology during the last 25 to 30 years, Dr. Todd Shatkin has become a leader of these conservative techniques, not only in regard to placement but the overall process.
Dr. Jameson: First, let’s talk about the mini-implant. What is its most significant advantage as compared to the osseointegrated implants that have been on the market for the last 15 years?
Dr. Shatkin: Since I’ve been in practice for 16 years, I have seen most of the major companies manufacturing conventional-style implants and have used many of these systems. All of these have great research and great statistical studies to show their wonderful success. The problem is trying to get patients to accept these treatment modalities can be difficult. As we know, a single conventional implant typically takes seven office visits to complete, and usually five to seven months of treatment. Usually, it involves cutting the tissue, reflecting a flap, drilling holes, and then second-stage surgery. Many of the companies now are releasing single-stage products, which have helped the situation. But still, they require multiple-office visits and extensive treatment time frames. In addition, the cost is fairly expensive since it requires one to three specialists to be involved in the treatment.
About six years ago, I became affiliated with Imtec. I had been using some of their conventional implants a few years earlier, but then started using these mini dental implants for lower-denture stabilization. Following this, I used them for upper dentures when we removed the hard, plastic palate and made a horseshoe-type palate with these mini-implants and O-ring keepers. These were extremely successful. I would say the greatest advantage is that mini-implants can be done in a nonsurgical manner by making a tiny pinhole in the gum, and threading the implants into the bone. They are self-tapping and self-threading so they engage the bone immediately. Dr. Victor Sendax developed this technique more than 20 years ago, and has patents on the protocol of this denture-stabilization procedure. What’s nice is that a patient can have the procedure performed in about an hour, go home to eat dinner, and awaken the next morning with virtually no discomfort. The cost is significantly less as well.
Dr. Jameson: What specific indicators need to be in place for a doctor to find a good candidate for this type of implant?
Dr. Shatkin: You can use mini-implants in almost any location. They come in various lengths and sizes. They also can be angled easily to find bone. So, when you look at an X-ray, sometimes it looks like a sinus may be low and you may not have sufficient room. But often there is palatal bone through the sinus since you’re looking at a two-dimensional view. If you go in one way and don’t find bone, you can angle them another way and find bone. So, even if it appears on an X-ray that a patient may not be a candidate, often these implants can be used because of their small diameter. A good candidate would have to have some bone. He or she needs to be a healthy individual who’s not on a tremendous amount of medication (although you could still treat patients with steroids and blood thinners to circumvent medication issues). Bone should be of average or better density. A low-bone density doesn’t work well with these immediate-load type implants. Fortunately, though, only about one to two percent of the population has low-bone density.
Dr. Jameson: In your experience with mini-implants, you have developed a technique for working with minimal patient appointments. You have coined this technique the F.I.R.S.T. procedure. Please explain this acronym, and how you use it in your practice.
Dr. Shatkin: After having tremendous success with mini-implants in stabilizing both upper and lower dentures, I started using them for abutments in fixed crown and bridge cases. For about two years, we did this before I developed the F.I.R.S.T. procedure. What we were doing was attaching natural teeth to these implants, or doing them free-standing for abutments. If patients didn’t want to have a partial denture, we could eliminate the partial by placing mini-implants and then putting on crowns and bridges. I found that we were loading mini-implants with temporary crowns and bridges, and then a couple weeks later, placing final crowns and bridges. We had 97 to 98 percent success with the mini-implants during a period of two to three years. After these results surfaced, I decided there should be a way to fabricate a custom final crown or bridge restoration and put it on these mini-implants the day of placement. This would be the ideal. A patient could have several missing teeth replaced in 30 minutes to one hour while having the crowns and implants placed in the same visit.
This is when I developed F.I.R.S.T. It stands for Fabricated Implant Restoration and Surgical Technique. This is similar in concept to the Invisalign approach in which a doctor would take polyvinyl or rubber-based impressions of the arches, a putty-bite registration, photographs and X-rays before sending them to Dr. Samuel Shatkin and me. We then review the models, X-rays, and records to determine with the referring doctor whether the case is acceptable or not for this type of treatment. If it is acceptable, we proceed to the laboratory where we do a mock surgery on the models, place mock analog implants in the models, and have the lab fabricate a surgical stent with titanium sleeves over the implants. Once this is completed, the actual crowns and bridges are fabricated on the models as if the implants are already in place in the patient’s mouth. Next, we return the case to the doctor so he or she can place the implants and cement the crown(s) or bridge(s) on the same visit. This is my patented procedure. We also utilize an instrument, the F.I.R.S.T. Pilot Drill Guide, which helps direct the pilot drill into the middle of the cylindrical titanium sleeve so that it locates the implant in the middle of the sleeve. The dentist places the implant in the mouth via the titanium sleeve in the stent, which stays in the mouth during placement. The stent then is removed and the crowns are cemented.
Dr. Jameson: That is an amazing development. What do you think is the next phase in the future of implant development?
Dr. Shatkin: I think you are seeing already the beginning stages of what will grow in popularity. I started promoting this procedure about two years ago. Other companies now are trying to do similar things. Time will tell whether they have unique ideas, or are just copying the technique I have described. As I see it, this is the future of dental implantology. A patient will be able to come for a consultation, and have impressions taken the same day. The next time you see them, they can have implants and crowns placed. I can’t imagine anything better. In fact, I have done this procedure on my father. Since I feel so strongly about it, my family members are having the procedure done in order to replace individual teeth.
Dr. Todd Shatkin lectures internationally on the subject of mini dental implants. He developed the F.I.R.S.T. technique (patent pending), and has placed thousands of these implants for use with dentures, crowns, and bridges. He has a private practice for cosmetic and implant dentistry in Amherst, N.Y. He can be contacted at the Aesthetic Associates Center for Plastic Surgery and Dentistry at (716) 839-1700, or at
Samuel Shatkin FIRST, LLC Laboratories at (716) 839-2959.
Dr. John Jameson is chairman of the board of Jameson Management, Inc., an international dental consulting firm. Representing JMI, he writes for numerous dental publications and provides research for manufacturers and marketing companies. He also lectures worldwide on the leadership and integration of technology into the dental practice. Dr. Jameson manages the technology phase of the consulting program carried out by JMI consultants in the United States, Canada, and Europe. He may be reached at (877) 369-5558, or by visiting www.jamesonmanagement.com.