love your smile

with ALL-ON-4 Plus

Advanced Oral Rehabilitation

with DENTAL IMPLANTS
Chatswood
A Permanent Alternative to Dentures Dental Centre
Disclaimer
All material contained herewith is for general information only and should not be regarded as individual dental or medical advice. Such advice may only be provided following a
comprehensive examination and diagnostic procedures. The procedures described contain certain risks and may not be suitable for all patients. Any references as to the impact
of cosmetic or implant dentistry on the life or beauty of a patient or their oral function should not be considered literally or as being an accurate representation or prediction of your
own, your partner’s or other patients’ experiences following similar treatment. Results and experiences may vary from patient to patient. Further information and full disclaimer is
available on www.smilenet.com.au
These booklets are the intellectual and physical property of the Centre for Aesthetic & Implant Dentistry and may only be distributed by actively affiliated practices and referring
practitioners. Unauthorised use of any of the material contained herewith is strictly prohibited. © Copyright 2009.
Recent advances in medical and dental technology have led to
expanded areas of clinical practice never before thought possible.
With such advances adding to one of the most researched
and successful treatment modalities in dentistry to date, dental
implants are today considered the standard of care for many oral
conditions, and the best alternative to natural teeth or dentures
for many who have lost or are about to lose their teeth.

The All-On-4 ‘plus’ concept is an outcome-based treatment

planning philosophy for full arch rehabilitation with dental implants
and is focused on patients’ common desire for an uncomplicated
treatment process and optimal immediate results. We provide a
high standard of care by using advanced techniques and 4 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.

It’s about quality of life.

Facts of the Matter
Many people with dental problems
avoid smiling, which cause them
to appear less social, and perhaps
introverted.

The pattern is the same for problems

when eating. Traditional false teeth
are not always reliable, and there are
foods and dishes you can only dream
of tasting. Dental health makes life
easier in every way.

Dental dysfunction can affect nutrition and well-being, as the types of food
that can be consumed are often limited - and it can also be an aesthetic
problem, changing a person’s entire personality.
Smile
a pleased, kind, or amused facial
expression, typically with the corners
of the mouth turned up and the front
teeth exposed : he flashed his most
winning smile|she greeted us all with
a smile|he pleased her with his smile

Its an established scientific fact that the muscles used to smile release
substances into your body that make you feel better.
Dental Implants
A dental implant is a small titanium
fixture that serves as the replacement
for the root portion of a missing natural
tooth. Due to the biocompatible
properties of titanium, when implants
are placed in the upper or lower jaw,
they fuse with the bone and thus serve
as anchors for the replacement teeth.

Implant-supported replacement teeth

look, feel and function like natural
teeth. This means that you can eat
and drink normally with renewed
confidence.

The embarrassment, irritation and

self-consciousness often experienced
by people who have missing teeth,
those who wear dentures or who
have suffered through older methods
of tooth replacement are overcome
with the confidence of permanently
anchored dental implants.

Implant-supported replacement teeth look, feel and function like natural teeth.
This means that you can eat and drink normally with renewed confidence.
 Immediate Teeth
Traditionally, the procedure had been performed
in two steps. The dentist began by installing the
implants, which were left for three to six months to
heal and integrate with the jawbone. During the
healing period, the patient was given a temporary
denture until the permanent teeth could be put in
place in the next stage.

Today, modern implant design and state-of-the-art

surgical techniques allows most patients to have
fixed teeth fitted within a few days from the surgery.
To get it right, a detailed work-up is done before the
surgery to design your smile. After the implants are
placed, teeth are set in wax in Madame Tussauds
style, and tried in your mouth for aesthetic fine-
tuning. It’s completely individualised. You get to
approve your teeth before we finish.

A small percentage of patients may need to improve

the volume or quality of their bone with bone
grafting. This may often be done simultaneously with
the implants, or prior to their placement in a staged
approach.

The aim of total rehabilitation is to help improve your

quality of life and self esteem.
All-On-4
‘All-On-4’ refers to all teeth being supported
by only four implants. It is a modern
technique where the back implants are
tilted 45º to provide the required support
for total rehabilitation (Illustration next
page). The tilting the back of implants helps
overcome bone deficiencies often found in
the back of the jaws and most often avoids
the need for bone grafting.

Since less implants are used by comparison

to older methods, there is less in the way
of achieving optimal results. It also allows
for simpler long-term maintenance and
uncomplicated cleaning.

This procedure is the most common

treatment in our clinic today for full arch
rehabilitation and is suitable for almost all
lower cases and most upper cases.

Featured Treatment:
Lower immediate All-On-4 rehabilitation

Improved Appearance Improved Function

All-On-4 Plus

Each treatment is planned on an individual basis and whilst certain patients may need
additional implants or procedures for appropriate long term support, we aim to avoid
prolonged treatment duration with 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, the All-On-4 ‘Plus’ is our outcome based treatment planning philosophy where we
focus on achieving predictable results with optimal function and aesthetics.

Immediate Results Smile with Confidence

 Aesthetic Gum Replacement
For good aesthetics in a smile there needs to be harmony
between the teeth, gums and the lips. In most patients who
have lost or are about to loose their teeth, the gums loose
their form and symmetry from gum disease or recession.

In such cases, ‘aesthetic gum replacement’ is the only

predictable way to restore healthy proportions and harmony
required for a natural looking smile.

PROBLEMS SOLUTION
Asymmetric Gingival Recession | Inadequate Gum Proportions Upper All-On-4 Plus rehabilitation (6 implants)
Female | Age 44 with Aesthetic gum replacement

beauty
a combination of qualities, such as shape, color, or form, that pleases the
intellect or aesthetic senses, esp. the sight : I was struck by her beauty
Healthy Proportions Pleasing Smile
Alveolectomy
Alveolectomy is the reduction and
reshaping of the underlying bone that
creates the required space for an optimal
design and positioning of the implant-
supported replacement teeth thus allowing
for the optimal choreography of your smile.

The loss of teeth leads to natural resorption

of the jawbone. The resultant changes
and loss of tone in the face are the most
common attributes of an aged look. When
a denture is worn, whether there is too much bulk or inadequate lip support, the plastic
extentions (flanges) of a denture that help with its retention often lead to unnatural aesthetics
or fake-looking teeth.

The ‘alveolectomy’ avoids the need for flanges and enables ‘aesthetic gum replacement’
that mimics the shape of natural bony ridges leading to more natural lip aesthetics, healthy-
looking gums, and improved design for a longer-lasting restoration.

Predictable Aesthetics Improved Comfort

 ...it’s not only about teeth. The pink aesthetics (gums & lips) is often what
makes the difference between ordinary and extraordinary results.

PROBLEMS: SOLUTION:
Splaying Upper Teeth | Non Aesthetic Lip Position Upper and lower rehabilitation on implants with aesthetic gum
replacement (without plastic surgery)

Improved Design Improved Durability

 EXAMINATION
The first step is to make an
appointment for an oral
examination to go over the
treatment alternatives and
determine the solution that
works best for your very
individual needs and
expectations.
Pre-Operative Procedures
DIAGNOSTICS
An OPG and CAT scans
are usually required to
determine implant positions
in full arch rehabilitation. If
you are suitable for keyhole
guided surgery, a special
stent will be made to wear
during your scan.
WORK-UP
Photos and models are used
to plan the optimal set-up
of the replacement teeth
for aesthetics, function and
speech. Surgical stents are
then fabricated to guide
the implant placement
according to the work-up.
 IMPLANTS
DAY 1 Following extraction
of teeth (if any), the jaw
bone is reshaped with an
‘alveolectomy’ and the
implants are placed in the
same visit. The wounds are
then closed with dissolvable
sutures and impressions of
the implants are taken for
the next stage.
Your Treatment
TRY-IN
DAY 2 The teeth are set
in wax and tried in your
mouth within 24-48 hours
after surgery. Any necessary
adjustments are made as
required with your input.
You get to see what your
teeth look like before we
finish.
SMILE
DAY 3 Your replacement
teeth are inserted. We
aim to give you a reason
to smile with confidence.
The initial set of teeth are
constructed from High
Impact Acrylic for optimal
aesthetics and function.
Other teeth options are
available once the implants
are intergrated.
Teeth Options
High Impact Acrylic
Constructed from a highly aesthetic and resilient acrylic material, this bridge is the only choice
for immediate teeth and is designed as the permanent restoration with optimal aesthetics and
function. Over time some wear occurs and this varies from patient to patient. On average,
the acrylic teeth require replacement every 5-8 years. The process of replacing the teeth is
uncomplicated and does not require any additional surgery. In certain patients, such as heavy
grinders or those in whom the improvements to their biting force is beyond the tolerances of
the acrylic material, a titanium or zirconia frame may be required in the future, or where signs
of stress, wear or fracture appear to indicate excessive forces.
Titanium & Zirconia Substructures
Traditional methods of re-inforcement involved the use of a cast gold substructure to support
the teeth. Today’s technology allows the use of zirconia or titanium substructures instead. These
materials are more biocompatible and are precision milled, leading to superior adaptation
over the implants and improved tissue health. Titanium substructures may be used to support
acrylic teeth or zirconia-ceramic teeth, whereas the zirconia substructure is designed especially
for direct layering of ceramic teeth for improved light transmission and long-term natural
aesthetics (above).
Bone Grafting
In certain cases it may be necessary to improve
the volume or quality of bone with bone grafting. SPACE
It is a surgical procedure that replaces missing
bone with a material called a bone graft.

The graft materials most commonly used

are synthetic or bovine bone substitutes, or
autogenous bone (patients own bone) that is
often harvested from within the oral cavity.

Whilst the grafting procedure may sometimes

be required in advance of total rehabilitation,
in many cases it is possible and advantageous
to perform bone grafting at the same time as GRAFT
implant placement to allow for future additional
implants as may be required for long term
support. By performing simultaneous grafting,
we can utilise the patients own bone harvested
from the alveolectomy procedure.

The most common types of grafting procedures Featured Treatment:

in total rehabilitation are described below: Bony defect (above) treated with a sinus graft (below)

Inlay Graft

Used at the time of extraction of teeth, the graft is placed within the residual socket to preserve
the shape of the jaw bone and avoid bony resorption. It is a routine procedure in cases
requiring the removal of teeth.

Onlay Graft

This procedure is used to restore bone width, mainly in the front of the upper jaw. The graft
material is laid on the surface of the jaw.
Sinus Grafting

The sinus is an air space in the upper jaw that can be utilised for bone grafting. Being a protected
space, the graft is less susceptible to external influences, such pressure from a denture, and is
today regarded part of routine dental surgical care used to restore bone height in the back
of the upper jaw, for the simultaneous or subsequent placement of implants. A bone mineral
called Bio-Oss® is used in combination with bio-active growth factors derived from your own
blood to help grow new bone.

1 2 3 4

Bio-Oss® is a safe and effective bone graft material
from specially processed bovine sources. Because
of its similarity to human bone, it is highly successful
in helping new bone to form. ‘Platelet Rich Plasma’
(PRP) is derived at surgery from your own blood
using state-of-the-art equipment. It contains large
reservoirs of bio-active growth factors that have the
potential to greatly accelerate the normal healing
process, naturally. Thanks to such advances in
bone regeneration technology, using Bio-Oss® with
PRP may eliminate the need for additional surgery
to obtain your own bone to use as the graft.
Sinus Graft Procedure:
1. The sinus is accessed from inside the mouth and
the membrane which lines it is gently elevated
2. The Bio-Oss® bone graft particles are placed
beneath the membrane
3. The implant is placed at the time of surgery or after
healing
4. The grafted bone not only replaces missing bone,
but also helps your body regenerate natural bone
and improve bone volume for implant placement
and long term support
 Zygomaticus Implants
Zygomaticus are long implants that are inserted
into the underside of the cheek bones to
support a complete set of replacement teeth.
These implants are especially designed for
bony deficient upper jaws. They may be offered
to patients who are not suitable for the standard
implant procedures and who are not suitable for
bone grafting.

The procedure is performed under general

anaesthetic together with an appropriate
maxillofacial surgeon who is specially trained in
this field.

PROBLEMS SOLUTION
Loose Dentures | Severe Bone Loss Upper Zygomaticus and lower standard All-On-4
Female | Age 42 with Aesthetic gum replacement
Immediate
Immediate Teeth

Immediate Function

Avoid Grafting
GALLERY
YR E L
GALLERYL A G

YRELLAG
GALLERY
GALLERY
GALLERY
GALLERY
 GALLERY
PROBLEMS
Worn Teeth | Missing Teeth
Collapsed Bite | Unable to Tolerate Dentures

YR E L L A G
Male | Age 59

GALLERY
SOLUTION

YRELLAG
UPPER & LOWER
Standard immediate All-On-4 rehabilitation
Completion: 3 Days
 GALLERY
PROBLEMS
Splaying Teeth | Uneven Gums | Visible Denture Clasps
Chewing Difficulty| Collapsed Bite

GALLERY
Female | Age 62

GALLERY
SOLUTION
UPPER

GALLERY
Standard immediate All-On-4 rehabilitation with
Alveolectomy and aesthetic gum replacement
Completion: 3 Days
 GALLERY
PROBLEMS
Missing Back Teeth | Collapsed Bite
Inability to Tolerate Dentures | Lack of Bone and Gums

YR E L L A G
Female | Age 44

GALLERY
SOLUTION
UPPER

YRELLAG
Standard immediate All-On-4 rehabilitation with
Alveolectomy and aesthetic gum replacement
Completion: 2 Days
 GALLERY
PROBLEMS
Decayed Teeth | Collapsed Bite
Excessive Wear | Compromised Teeth

GALLERY
Male | Age 67

GALLERY
SOLUTION
UPPER & LOWER

GALLERY
All-On-4 Plus rehabilitation with bone grafting,
Alveolectomy and aesthetic gum replacement
Completion: 2 Days
 GALLERY
PROBLEMS
Missing Teeth | Tooth Decay
Gum Disease | Drifting Teeth

YR E L L A G
Male | Age 59

GALLERY
SOLUTION
UPPER

YRELLAG
Standard immediate All-On-4 rehabilitation with
Alveolectomy and aesthetic gum replacement
Completion: 3 Days
 GALLERY
PROBLEMS
Loose Upper Dentures | Inability to Tolerate Lower Denture
Pain To Chewing | Severe Bone Loss

GALLERY
Female | Age 74

GALLERY
SOLUTION
UPPER & LOWER

GALLERY
All-On-4 Plus rehabilitation with bone grafting,
Alveolectomy and aesthetic gum replacement
Completion: 3 Days
 GALLERY
PROBLEMS
Missing Back Teeth | Tooth Decay
Gum Disease | Severe Gagging from Dentures

YR E L L A G
Female | Age 66

GALLERY
SOLUTION
UPPER & LOWER

YRELLAG
All-On-4 Plus rehabilitation with bone grafting,
Alveolectomy and aesthetic gum replacement
Completion: 3 Days
 GALLERY
PROBLEMS
LCross Bite | Advanced Gum Disease
Missing Teeth | Loose Teeth

GALLERY
Female | Age 46

GALLERY
SOLUTION
UPPER & LOWER

GALLERY
All-On-4 Plus rehabilitation with
Alveolectomy and aesthetic gum replacement
Completion: 3 Days
 GALLERY
YR E L
GALLERYL A G PROBLEMS
Advanced Gum Disease
Splaying and Drifting Upper Teeth
Crowded Lower Teeth | Age 50

YRELLAG
SOLUTION
UPPER & LOWER
Upper and lower standard all-on-4
rehabilitation with Alveolectomy and
aesthetic gum replacement
Completion: 3 Days
 GALLERY
GALLERY
PROBLEMS
GALLERY
Advanced Gum Disease | Collapsed Bite
Missing Teeth | Unable To Tolerate Upper Denture
Pain When Eating | Age 40

GALLERY SOLUTION
UPPER & LOWER
Upper & lower All-On-4 Plus rehabilitation
with bone grafting, Alveolectomy and
aesthetic gum replacement
Completion: 2 Days
Dr Alex Fibishenko BDSc FICOI

Dr Fibishenko heads the implant clinic at the Centre for

Aesthetic & Implant Dentistry (CAID) in Melbourne, Australia.
Having graduated from the University of Melbourne in 1995, he
pursued his interest in the field of oral implantology and grafting
and received training from some of the pioneers and leaders in
the field in North America, Europe, Asia and Australia.

Dr Fibishenko has been involved in implant work and bone grafting since 1996.
Today, his practice is exclusive to implant and reconstructive procedures with an
emphasis on ultimate aesthetics and restored function. Dr Fibishenko developed
numerous advanced surgical techniques used today to improve the outcome of
oral rehabilitation with dental implants. He works closely with selected dentists and
specialists in Victoria and NSW, and is considered by many of his peers as one of
Australia’s most progressive and leading experts.

Dr Fibishenko is a member of the Australian Dental Association (ADA), Australian

Osseointegration Society (AOS), an accredited member of the Australian Society of
Implant Dentistry (ASID), Fellow of the International Congress of Oral Implantologists
(ICOI), and chairman of the Implant Team Academy (ITA).
Dr Anthony Wasserman BDSc

Dr Anthony Wasserman is the founder and Principle Practitioner

of Chatswood Dental Centre. He graduated from Sydney
University’s dental school in 1971, and gained experience
practicing with leading dentists in Sydney. Anthony established
his first practice in Double Bay in Sydney’s eastern suburbs and
soon moved to the Chatswood area. Anthony went on to
complete four years of post-graduate study in orthodontics, which trained him in
occlusion and treating bite problems.

Anthony is an active senior member of the Seattle International Study Club, with
a special interest in crown and bridge work, implants and cosmetic dentistry. He
is also the founding member of Occlusodontic study club. He has also completed
advanced implant and oral rehabilitation courses, with a focus on facial aesthetics
and smile design.

Dr Wasserman is a graduate of the Pankey Institute of Advanced Dental Education

in Florida, USA, where he also studied the psychology of dentistry, which gives him a
greater understanding of patients’ needs and concerns.

Anthony has also been an active member of the dental community in Australia,
continually upgrading his knowledge of the developments in dental technology
around the world. He was an honorary dentist at Sunshine Home and held the
presidency of the Alpha Omega dental fraternity (NSW).
Contact Details
CHATSWOOD DENTAL CENTRE
103 Archer St NSW 2067
Sydney Australia

T. (02) 9412 3805

An Affiliated Clinic with Centre for Aesthetic & Implant

Dentistry, Burwood East