love your smile with ALL-ON-4 Plus

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1 love your smile with ALL-ON-4 Plus Advanced Oral Rehabilitation with DENTAL IMPLANTS A Permanent Alternative to Dentures Chatswood Dental Centre

Disclaimer All material contained herewith is for general information only and should not be regarded as individual dental or medical advice.

2 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 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.

3 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.

4 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

5 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.

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

6 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.

7 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 finetuning. 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.

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.

8 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

9 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

In such cases, aesthetic gum replacement is the only predictable way to restore healthy proportions and harmony required for a natural looking smile.

10 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 Asymmetric Gingival Recession Inadequate Gum Proportions Female Age 44 SOLUTION Upper All-On-4 Plus rehabilitation (6 implants) 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

11 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 implantsupported replacement teeth thus

12 Alveolectomy Alveolectomy is the reduction and reshaping of the underlying bone that creates the required space for an optimal design and positioning of the implantsupported 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, healthylooking gums, and improved design for a longer-lasting restoration. Predictable Aesthetics Improved Comfort

SOLUTION: Upper and lower rehabilitation on implants with

13 ...it s not only about teeth. The pink aesthetics (gums & lips) is often what makes the difference between ordinary and extraordinary results. PROBLEMS: Splaying Upper Teeth Non Aesthetic Lip Position SOLUTION: Upper and lower rehabilitation on implants with aesthetic gum replacement (without plastic surgery) Improved Design Improved Durability

EXAMINATION DIAGNOSTICS WORK-UP The first step is to make an appointment for an oral examination to go over

If you are suitable for keyhole guided surgery, a special stent will be made to wear during your scan.

14 EXAMINATION DIAGNOSTICS WORK-UP 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. 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. 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. Pre-Operative Procedures

IMPLANTS TRY-IN SMILE DAY 1 Following extraction of teeth (if any), the jaw bone is reshaped with an alveolectomy and the

The wounds are then closed with dissolvable sutures and impressions of the implants are taken for the next stage.

Any necessary adjustments are made as required with your input. You get to see what your teeth look like before we finish.

15 IMPLANTS TRY-IN SMILE 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. DAY 2 The teeth are set in wax and tried in your mouth within 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. 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. Your Treatment

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

16 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.

These materials are more biocompatible and are precision milled, leading to superior adaptation over the implants and improved tissue health.

17 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).

SPACE 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.

18 Bone Grafting In certain cases it may be necessary to improve the volume or quality of bone with bone grafting. It is a surgical procedure that replaces missing bone with a material called a bone graft. SPACE 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 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 in total rehabilitation are described below: GRAFT Featured Treatment: 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.

19 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 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

These implants are especially designed for bony deficient upper jaws.

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

21 Immediate Teeth Immediate Immediate Function Avoid Grafting

22 GALLERY GALLERYGALLERY GALLERY

23 GALLERYGALLERY GALLERY GALLERY

Age 59 GALLERY SOLUTION UPPER & LOWER Standard

24 GALLERYGALLERY PROBLEMS Worn Teeth Missing Teeth Collapsed Bite Unable to Tolerate Dentures Male Age 59 GALLERY SOLUTION UPPER & LOWER Standard immediate All-On-4 rehabilitation Completion: 3 Days GALLERY

Age 62 SOLUTION UPPER Standard immediate All-On-4 rehabilitation

25 GALLERY GALLERYGALLERY PROBLEMS Splaying Teeth Uneven Gums Visible Denture Clasps Chewing Difficulty Collapsed Bite Female Age 62 SOLUTION UPPER Standard immediate All-On-4 rehabilitation with GALLERY Alveolectomy and aesthetic gum replacement Completion: 3 Days

GALLERY SOLUTION UPPER Standard immediate All-On-4 rehabilitation

26 GALLERYGALLERY PROBLEMS Missing Back Teeth Collapsed Bite Inability to Tolerate Dentures Lack of Bone and Gums Female Age 44 GALLERY SOLUTION UPPER Standard immediate All-On-4 rehabilitation with Alveolectomy and aesthetic gum replacement Completion: 2 Days GALLERY

LOWER All-On-4 Plus rehabilitation with bone grafting,

27 GALLERY GALLERYGALLERY PROBLEMS Decayed Teeth Collapsed Bite Excessive Wear Compromised Teeth Male Age 67 SOLUTION UPPER & LOWER All-On-4 Plus rehabilitation with bone grafting, GALLERY Alveolectomy and aesthetic gum replacement Completion: 2 Days

Standard immediate All-On-4 rehabilitation with

28 GALLERYGALLERY PROBLEMS Missing Teeth Tooth Decay Gum Disease Drifting Teeth Male Age 59 GALLERY SOLUTION UPPER Standard immediate All-On-4 rehabilitation with Alveolectomy and aesthetic gum replacement Completion: 3 Days GALLERY

SOLUTION UPPER & LOWER All-On-4 Plus rehabilitation with bone

29 GALLERY GALLERYGALLERY PROBLEMS Loose Upper Dentures Inability to Tolerate Lower Denture Pain To Chewing Severe Bone Loss Female Age 74 SOLUTION UPPER & LOWER All-On-4 Plus rehabilitation with bone grafting, GALLERY Alveolectomy and aesthetic gum replacement Completion: 3 Days

30 GALLERYGALLERY PROBLEMS Missing Back Teeth Tooth Decay Gum Disease Severe Gagging from Dentures Female Age 66 GALLERY SOLUTION UPPER & LOWER All-On-4 Plus rehabilitation with bone grafting, Alveolectomy and aesthetic gum replacement Completion: 3 Days GALLERY

UPPER & LOWER All-On-4 Plus rehabilitation with GALLERY

31 GALLERY GALLERYGALLERY PROBLEMS LCross Bite Advanced Gum Disease Missing Teeth Loose Teeth Female Age 46 SOLUTION UPPER & LOWER All-On-4 Plus rehabilitation with GALLERY Alveolectomy and aesthetic gum replacement Completion: 3 Days

UPPER & LOWER Upper and lower standard all-on-4 rehabilitation

32 GALLERY GALLERYGALLERY PROBLEMS Advanced Gum Disease Splaying and Drifting Upper Teeth Crowded Lower Teeth Age 50 SOLUTION UPPER & LOWER Upper and lower standard all-on-4 rehabilitation with Alveolectomy and aesthetic gum replacement Completion: 3 Days GALLERY

GALLERY SOLUTION UPPER & LOWER Upper & lower All-On-4 Plus rehabilitation

33 GALLERY GALLERYGALLERY PROBLEMS 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.

34 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 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).

35 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).

36 Contact Details CHATSWOOD DENTAL CENTRE 103 Archer St NSW 2067 Sydney Australia T. (02) An Affiliated Clinic with Centre for Aesthetic & Implant Dentistry, Burwood East

A GUIDE TO THE BENEFIT OF DENTAL IMPLANTS A permanent alternative to dentures! Restore your teeth and win back your life!

A GUIDE TO THE BENEFIT OF DENTAL IMPLANTS A permanent alternative to dentures! Restore your teeth and win back your life! We recommend using this guide to learn about the benefits of Dental Implants, the