The ALL ON 4 PLUS concept is an outcome-based treatment planning philosophy for full arch rehabilitation with dental implants.
The All On 4 Plus® concept was introduced by Dr Alex Fibishenko, borrowing from some of the most basic and minimalist elements of All On 4 as well as other proven techniques with full set teeth replacement on dental implants, whilst additionally incorporating methods and procedures that can make a difference in terms of function, comfort, and appearance as well as durability of the restoration.
At the All On 4 Clinic we recognise that patients don’t want ‘Implants’, they come to us because they want a beautiful smile, to be able to enjoy all foods and desiring uncomplicated options in the event of the unforeseen.
With our unique All-On-4 Plus® approach each treatment is planned on an individual basis, and whilst certain patients may need additional implants or procedures for long term results, we aim to avoid prolonged treatment duration with further advanced techniques that afford minimal disruption to our patients’ day-to-day life and function. Whether it’s with four or more implants, with or without grafting, All-On-4 Plus® encompasses indication-specific treatment planning incorporating All On 4 Clinic’s innovative techniques that have a built-in contingency and facilitate the delivery of an immediate final restoration in the most streamlined process.
The design of All On 4 Plus® and planning protocols are such that they give the dentist and laboratory technician creative licence and flexibility in creating optimal individualised results.
All-On-4 Plus® incorporates:
1. RESHAPING OF THE JAWBONE AND GUM SURGERY
When teeth are lost the gums shrink because the underlying bone undergoes natural atrophy and resorbs. Prior infections, gum disease, trauma or other conditions of the teeth that have lead to their necessary removal also results in defects in the jaw bone and an uneven surface.
The re-shaping of the jawbone with a procedure called alveolectomy, or alveoplasty, removes the rugged areas of the jawbone to leave a flatter surface and more favourable surroundings for dental implants. By removing the rugged areas, we also eliminate the parts of the jaw that are most susceptible to resorption, and can rely on the deeper bone that is of a better quality for improved heath of the dental implants over time.
Apart from improving the conditions for the placement of the fixtures, the re-shaping of the bone also improves the amount of space that is available for the construction of the teeth, which improves our ability to design a restoration that is more durable and aesthetic, and helps ensure that the transition between the prosthesis and natural gums remains hidden.
The re-contouring of the jawbone also creates a flat interface of the prosthesis where it contacts the natural gums, which helps patients in cleaning and maintaining good hygiene.
2. BONE AUGMENTATION (WHEN REQUIRED)
Every case is different, and the bone anatomy can even vary in the same patient between the left and the right sides. In some cases, particularly in the upper jaw, there may simply not enough bone for as standard All On 4 approach because the anatomy of the sinuses is such that they do not allow for implants to be placed sufficiently towards the back and they would be placed closer together instead of being more ideally spread out. This may result in a shortened arch situation with less than a full complement of teeth in the prosthesis.
Whether it is at all required is assessed on an individual basis, but bone augmentation, particularly of the sinus spaces, using traditional or some of our own newer methods, may offer a number of benefits both short and long term as described under sinus grafting.
MAIN BENEFITS: Improved surgeon’s visualisation of the bone anatomy, wider spread of the implants with potentially more teeth in the arch-space, and improved contingency by having newly formed bone.
3. CRITICAL IMPLANT POSTIONING USING ALL ON 4 CLINIC’S PROTOCOLS
We use unique methods to ensure the dental implants are positioned in a way that makes them not only simpler to restore from an engineering perspective, but also reduces the bulkiness in the mouth for improved comfort, speech and hygiene.
4. ADDITIONAL FIXTURES (ONLY WHEN INDICATED)
We strongly believe in a minimalistic approach to the number of implants that we place to support a full set of replacement teeth for one primary reason: to improve your ability to clean. However, every case is different, and sometimes there are conditions that require us to place additional implants for improved support. These conditions can be divided into two main categories: the forces that are applied on the implants through the prosthesis during function VERSUS the resistance of the system of the supporting fixtures and the bone to withstand those forces.
For long-term health we need to ensure that the foundations of the system are able to withstand the insults from function. In situations where the insults are significant, such as in patients who are heavy grinders, or where the foundations are inadequate, such as the case in very poor quality bone, there may be a tipping point disturbing the healthy equilibrium, leading to potential problems. The placement of additional implants improves the support and the biomechanical resistance, and is only used when deemed required, or when a significant increase in the size of the arch and the number of teeth is desired.
5. DELIVERY OF FINAL PROSTHESIS WITHIN 2-3 DAYS USING ALL ON 4 CLINIC’S INNOVATIVE TECHNIQUES
The techniques developed by Dr Alex Fibishenko allow for the delivery of a final restoration within days of the surgery. The teeth are completely individualized and are tried in the mouth for fine-tuning, typically on the same day as the surgery when the swelling has not set in and we are able to accurately assess the new teeth before finalizing and processing the final prosthesis. Not only does this improve our patients overall experience, but it also improves reliability of the implant connections, because the connections are processed not retro-fitted, and is one of the reasons that we enjoy a high rate of success of our dental implants.
6. INDICATION-SPECIFIC RESTORATIVE UPGRADES (WHEN REQUIRED)
The replacement teeth that are fitted within days of the surgery are designed with the final aesthetics and function, and as the permanent restoration. However in certain cases the improvements in the forces of the bite may be beyond the tolerance of the material used to make the immediate bridge. However, when that is the case, before deciding on any course of action, it is important to diagnose the weak areas of the bridge and the direction of the forces so as to have a better understanding of what type of treatment or restorative upgrades would be required for longer term function.
The bridge, or prosthesis, is designed to unique All On 4 Clinic specifications with metal reinforcement, and provides a rigid fixation and stabilisation of the implants, thus allowing it to be fitted both immediately and as the permanent restoration.
Patient has large sinus spaces and not enough bone to spread the implants sufficiently for a full complement of teeth.
All-On-4 Plus® treatment with sinus grafting and insertion of a FINAL prosthesis that functions until the patient decides she wants more teeth or upgrade.
FUTURE EXTENTION & UPGRADE
Additional implats are inserted in the grafted bone and the fitting of a Zirconia bridge extending further back for a full complement of teeth.