Fixed on 2.-All on 4 gone mad?

Fixed on 2.-All on 4 gone mad?

When does something experimental become acceptable to the scientific community?

When does one persons exceptional skill and determination become a technique?

What’s the process by which one mans inspiration and passion which is outside the accepted norm become something that we all accept?

How much data is enough?


I had the privilege to watch Dr Canizarro working in a way that breaks all the rules and he appears to be getting away with it.

At the #FGDPItaly course Dr Canizarro showed us his fixed on 2 technique. Fixed on 2 involves placing 2 implants flapless and loading them with fixed full arch 10-12 unit bridge on the same day.

I remember seeing the controversy that started and in some circles still exits about all on 4, and I can’t imagine what people will make of this new variation.

Dr Canizarro reminds me of a southern baptist preacher when lecturing. The lectures are delivered with passion, with fire and amusing anecdotes, with references to football (he supports AC Milan) art and a personal philosophy that calls for us to think and question the scientific rationale that we believe.

Frequent calls that will stick with me are

Why do you do that ? Why ?

Think! Think you have to think!

In addition to breaking all the biomechanical rules about implant prosthesis he is breaking the all the surgical rules- carrying out his surgery flapless , using a “one drill one implant” protocol, with short implants that have a smooth surface.

He is also using the implant motor in ways that the manufacturers of both the motor and the implant have not dreamed could be done, implants are placed at 900rpm and with 80 Ncm of torque.

One the unconventional (and incredibly fast) surgery is complete, the 2 implants are loaded on the same day !

It has to be seen to be believed. If you blink you miss the surgery.

Dr Canizarro was training to be an eye surgeon and, as is common in Italy, was carrying out some dentistry in the evenings to help pay his bills. His father died during his training and his family needed the money, so he never completed his eye surgery and so began his working life as an a Implantologist.

The lighting speed with which the surgery is performed is sharply contrasted by the slow methodical, attentive, deliberate and artistic technical team headed by Marco, his technician.

In the middle of this grand 4 floor , 10 surgery practice, the last person you would expect to be here is a man of science, of studies of controls, but right next to this implant maverick with a volcanic personality (his description of Dr Canizarro) is Marco Esposito (for those of you who have not met him, pronounce ex-posssss-ito)

Marco is slowing him down and at the same time looking at how one dentists technique can be turned into something that we may all one day use. The is data coming out of the studies, some of the early data is positive, but more time, data and studies are needed.

The MAY be a technique for the future, but not one I would use now.


Why is he doing this? Why is he putting his patients through this?

The reason is people, patients in his practice may not have the money for more complex and expensive techniques and chose this option because of price.More traditional and expensive techniques are out of their price range, and for many this is the only price point at which the can afford implants. They may not know that they are part of an experiment, but will be happy to have the fixed teeth for as long as they last. He is not short of patients, and the size and quality of the facility tends to suggest that he is doing well.

As part of his personal philosophy he wants all dentists to sometimes look at how lucky we are to be dentists and to be happy that we can provide a living for us and our families.

Remember when all on 4 was first discussed? Palo Malo was thought of in the same way, and now his technique has become part of the accepted landscape in implant dentistry. Pretty much all the implant companies have an all on 4 protocol, and the components for dentists to use this technique.

I saw him recently at BAAD ( showing his twenty year results with all on 4.

He is at the forefront of experimentation and has the patients, prosthetic and scientific team around him to test if fixed on 2 will work as a technique. He also has an implant company, Sweden and Martina, who will make components as he designs and needs them when some of the bio-mechanical complications occur. And he is passionate, (very passionate ) and determined to succeed.

He also has a belief that he can change Implantology, that he will help patients and he will use his position and skills for more than his own gain, and that is a potent cocktail that may lead to success.


In summary don’t write off fixed on 2 just yet, but don’t try this at home!

If you are a patient, ask about the more about what your dentist is doing, how long they has been doing it and what problems they have had before you accept it.

Tomorrow we go to another part of Italy to see a very different approach with Proffessor Tiziano Testori