What is All-On-4 Plus®

All-On-4 Plus: Perfection Taken One Step Further

Dental implant innovator Dr. Alex Fibishenko developed the All-On-4 Plus system by combining some of the fundamental tenets of his existing system, the All-On-4 method with several other proven techniques. The result is a dental implant system of procedures and methods that addresses appearance and function along with the longevity of the restorative rehabilitation.

All-On-4 patients do not come in seeking implants, yet they desire a beautiful smile and the freedom to enjoy their favourite foods with dental solutions that are free from complications.

That’s why the unique All-On-4 Plus system evaluates each case on an individual basis, taking into account the unique needs of the patient and creating a treatment plan accordingly. The goal is to avoid prolonged treatment whilst determining the need for additional implants that will create long-lasting results. This approach requires advanced techniques that are designed to have a minimally disruptive effect on the day-to-day life of the patient. This could mean four or even more implants inserted with or without bone grafting depending on the density of the patient’s jaw and the specific features of their condition. The indication-specific nature of All-On-4 Plus involves treatment planning that utilises an array of innovative techniques. It is these techniques that have allowed All-On-4 Clinic to provide immediate and final dental restorations with built-in contingency and streamlined efficiency.

“The planning protocols and design of the All-On-4 Plus system allow laboratory technicians and dental practitioners the flexibility and creative license to create flawless individualised results.”

Components of All-On-4 Plus


Natural atrophy and resorption of the jawbone occurs after tooth loss, which results in gum shrinkage. The jaw bone can become further defective and uneven from gum disease, prior infections, trauma or other oral conditions that lead to the unavoidable removal of teeth.

Alveoplasty and alveolectomy are procedures that involve the re-shaping of the jawbone. This practice smooths out rugged areas of the jaw, creating a more favourable condition for anchoring dental implants. The streamlining of rough areas within the jaw also eliminates sections of the jaw that could be prone to resorption, providing access to deeper bone that will facilitate healthier dental implants over a long period of time.

Reshaping of the jawbone improves conditions for the anchoring of fixtures whilst increasing the amount of available space for constructing the new prosthetic teeth. This gives our dental professionals the opportunity to design and implement a dental restoration that will give the patient optimal results. This means that a long-lasting aesthetic is achieved while the transition between natural gums and prosthesis remains discreet.

Straightforward cleaning protocols and overall better hygiene are direct results of jaw re-shaping. This is achieved by a flatter interface where the natural gums make contact with the prosthesis and allows easy maintenance of a properly-aligned assembly.


Bone anatomy varies from patient to patient and even from one section of the jaw to another. This makes every case unique, and sometimes — in the event of an upper jaw restructuring — there simply is not enough bone material to support a standard All-On-4 procedure. In this instance, the anatomy of the upper mouth in relation to the sinuses does not allow for the ideal placement of the back implants. This would then require them to be placed closer together, leading to a shortened arch with an abridged or somewhat incomplete set of prosthetic teeth.

The need for bone augmentation is by no means routine, and is determined on an individual basis. Should an individual’s condition call for this, especially near the sinuses, the latest All-On-4 methods can be deployed to provide significant short and long-term benefits as outlined under sinus grafting.

PRIMARY BENEFITS: Bone augmentation allows the oral surgeon to compose a more comprehensive picture of the bone anatomy. This in turn allows for more room between implants, improved contingency from newly formed bone and more teeth in the arch space.


All-On-4 Clinics employ protocols that position implants in such a way that bulkiness in the mouth is actually reduced, improving speech, hygiene and comfort. This also makes sense from an engineering perspective, as more room in the mouth makes for implants that are easier to restore.


The All-On-4 philosophy is ‘less is more’. This minimalist approach enables us to provide fixtures that effectively support the prosthesis and are easy to clean and maintain. Sometimes, the only way to achieve sufficient support is through additional implants beyond the two-in-front two-in-back design. This is determined by the resistance of the supporting fixture system within the bone VERSUS the force administered to the implants through the prosthetic teeth during normal oral function.

The implants create the prosthetic system foundation, and it is crucial that it be able to withstand the pressures applied by normal everyday function. Problems arise when implants are inserted into inadequate bone or when patients are heavy chewers or hard grinders. In the instance of a thin jawbone, additional implants may be required in order to supply biomechanical resistance and sufficient support. This is done only when required by insufficient bone density or when a patient desires a wider arch that will house more prosthetic teeth.


Within mere days of the implant surgery, the techniques developed by Dr. Alex Fibishenko allow for final restoration to take place. Each tooth is individually designed and positioned several times for greater function and aesthetics, depending on the patient’s oral dynamics. This occurs on the same day as surgery before swelling sets in, allowing the technicians to accurately assess the teeth before processing and finalizing the prosthesis. This is why All-On-4 patients and clinicians enjoy a high rate of procedural success, because the reliability of implant connections is ensured during the process and not retro-actively.


The new replacement teeth are fitted shortly after surgery, and designed with long-term function and aesthetics in mind. Sometimes the improvements affect the force of the bite in such a way that it eclipses the tolerance of the material used to construct the bridge. Certain types of treatment and restorative upgrades are available in this instance, but first a complete diagnosis of the weak areas and the interplay of opposing forces must be performed.

“The prosthesis, or the bridge, is designed with exclusive All-On-4 Clinic protocols using metal reinforcement. This achieves stabilisation of implants and rigid fixation, allowing immediate and long-term restoration.”



Patient has a large sinus cavity, and the upper jaw displays insufficient bone for widely spread out implants as part of a full set of prosthetic teeth.



This treatment plan features sinus grafting and insertion of an All-On-4 functional prosthesis that serves as a final replacement until patient chooses to upgrade.



The grafted bone creates a sufficient bed for additional implants and allows for a full complement of zirconia teeth to be fitted.

All-On-4 Clinic New Zealand Information Video’s

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