All On 4 Plus Dental Implants…when Results Matter

Home of All On 4 Plus® dental implants, Melbourne based, Centre of Aesthetic and Implant Dentistry (CAID) owns the original trademark. The concept, made popular by its innovator Dr Alex Fibishenko, has taken the world by storm as it borrows from the most fundamental principles of the standard All On 4 dental implants treatment, whilst additionally incorporating those elements that can make a difference in terms of aesthetics, function, comfort, predictability and longevity.

All On 4 Plus® dental implants treatment in our Melbourne clinic is an outcome-based contingency planning philosophy and patient management system for immediate total rehabilitation on dental implants. The treatment is designed especially for highly atrophied or compromised upper jaws where the prospects of success with standard treatment may not be ideal. It focuses on achieving predictable aesthetics, optimal function, uncomplicated long-term maintenance and improved contingency. At its core is a streamlined approach that draws on documented data and years of experience and development, and which addresses patient’s common desire for an uncomplicated treatment process.

At CAID, we plan each treatment on an individual basis and aim to provide a high standard of care by using advanced techniques and four or more implants as determined by individual clinical situations, to support immediate fixed replacement teeth that look, feel and function like beautiful natural teeth; thus ensuring that our patients can smile and function with confidence. All On 4 Plus Dental Implants in our Melbourne integrated dental and surgical centre can be completed in as little as 2 days. We always aim to avoid prolonged treatment duration with advanced techniques that afford minimal disruption to our patients’ day-to-day life and function.

All On 4 Plus ® dental implants treatment encompasses a combination of any or all of the following principles:

1. Creating Space and Good Foundations

The loss of teeth, infections and gum disease result in defects in the jawbone and uneven alveolar bony surfaces that prevent implants from being placed in ideal surroundings, often making them susceptible to bone loss and further atrophy. As a result, the interface of the prosthesis is also not flat, making it more difficult to clean; and the reduced available restorative space makes the prosthesis more susceptible to breakages.


Reshaping of the alveolar bone with an alveolectomy eliminates the uneven surfaces and leaves a flat bony surface that is more conducive to appropriate implant placement in better quality bone, and improves their long-term prospects of success. By reducing and making even the underlying bone, an alveolectomy also creates a flatter interface that is simpler to maintain and keep clean; and improves the space that is available for the construction of the bridge. Thus, it enables ‘Aesthetic Gum Replacement’ to better mimic the shape of the lost natural bony ridges leading to more natural lip aesthetics, healthy-looking gums, and improved design for a longer lasting immediate restorations.

2. Recycling the Bone with Simultaneous Bone Grafting

The bone that is collected from the alveolectomy can be recycled and used to repair deficient parts of the jawbone at the time of implant placement with bone grafting. That is, we take the bone from where we don’t want it and place it where we might need it. The defects left behind after extractions, for example, can be repaired with this method.

In some cases, the sinuses are in the way of ideal implant placement in the upper jaw and may sometimes make a case unsuitable for immediate implants. Accessing the sinus spaces where required is only a minor extension of the overall surgery, but it allows the surgeon to clearly visualise the bony anatomy and to place the implants in the best possible bone and position to facilitate the immediate restorative.

Accessing the sinuses additionally affords the opportunity to resurrect this deficient area of the upper jaw by performing bone grafting within these protected spaces. This is commonly known as a sinus graft – a well-documented and a highly predictable procedure. Done simultaneously with All On 4 dental implants, our team in Melbourne has many years of experience using this advanced technique that offers significant benefits in full set replacement:

  • It allows the surgeon to re-shape the back segment in manner that is similar to an alveolectomy, thus playing an important role in the final aesthetics, durability of the prosthesis, and hygiene;
  • The bone grafting, once mature can be used in the event of a complication to replace a failed implant, or to place an additional fixture should this later be deemed as being required for long term support;
  • In cases where more teeth are desired than the typical 10-12 teeth with standard All On 4, additional dental implants may be placed in the future by our Melbourne team, and the prosthesis can then be extended further back to support up to 14 teeth.

3. Boosting the Quality of the Gums (Biotype)

It is widely recognised that the biotype (the quality rating of the gums) has an affect on comfort, ease of cleaning and potentially also on implant success. All On 4 Plus dental implants surgery in our Melbourne clinic involves surgically manipulating the natural gums to enhance the biotype that surrounds the implants – also known as mucoplasty.


4. Additional Dental Implants …when requiredWhilst we always strive for a minimalistic approach to the number of implants that we use in order to facilitate simpler hygiene, we also always take into account additional factors that may affect the prospects of long-term success. Additional implants may be required in situations where:

  • The surgeon was unable to reach adequate implant stability. Adding an implant at that time could make the difference between being able to fit an immediate fixed prosthesis, versus having to wear a interim denture for some months, which may adversely affect the long term health of the implants;
  • To improve biomechanics in poor quality bone, or when grafting was performed, so as to improve the ability of the implants to withstand functional forces in the long term.

5. Proprioception

When fixed replacement teeth are fitted using All On 4 dental implants technique, the forces of the bite dramatically improve. Unlike natural teeth, implants do not move within the bone, and the bite is often described as being very ‘solid’. As such, when oral rehabilitation is performed in the upper and lower jaws, it is often difficult for patients to gauge how hard they are biting, a phenomenon known as Proprioception. Where possible, we may decide to keep one or more of the very back teeth, if they are suitable, so as to provide proprioception that is invaluable in the initial period while adjusting to the prostheses.

Whether it’s with four or more implants, with or without grafting or other simultaneous procedures, All On 4 ‘Plus’ dental implants treatment is as streamlined as it is driven towards achieving predictable results with optimal function and aesthetics, plus a contingency plan for the long term.


To find out more about bone grafting options or suitability for All On 4 dental implants, contact our Melbourne clinic today on (03) 8845 5400.