dr alex fibishenko

Dr Alex Fibishenko

Oral Implantology & Dento-Facial Surgery

Dr Alex Fibishenko practices exclusively in Oral Implantology, Dento-Facial Surgery and Facial Aesthetics. One of Australia’s most respected implant surgeons, innovators and educators, Dr Fibishenko works in a surgical capacity with selected dentists and specialists. He is founder of All-On-4 Clinic, with numerous purpose-built facilities throughout Australia & NZ, and co-founder of Facelab, the facial aesthetics arm of his clinics.

Dr Alex Fibishenko is Fellow of ICOI and an accredited member of numerous implant educational organisations and societies including Amerian Academy of Facial Esthetics (AAFE). He is a key opinion leader and a frequently invited speaker internationally on advanced surgical concepts in dental implants. Dubbed as Australia’s ‘father of All-On-4’ Dr Fibishenko introduced the ‘Plus’ factor, which helped change the dogma and the way many dentists and specialists think of total implant rehabilitation today, ultimately to patients’ benefit, who enjoy a streamlined process and predictable results.

Visiting Faculty at the Linhart Continuing Dental Education Program NYU College of Dentistry.

New Methods for Preservation of Bone in Full Arch Implant Cases

Regeneration and preservation of jawbone has been an area of great interest for as long as dental implants have been around. Many techniques have been described in the literature including using autografts, allografts, xenograft, in block or particulate forms, all kinds of bones substitutes to regenerate bone that is lost with the loss of teeth.

We have long known that alveolar bone is bundle bone, the existence of which depends on the periodontal ligament when teeth are present, so a newer hypothesis emerged that if we can preserve the periodontal ligament then we can also prevent resorption of bone. To preserve the ligament the tooth is only partially extracted with the superficial parts of the root only remaining and the rest is removed when drilling to insert the implant. This is referred to as PET (Partial Extration Therapy).» Read More

Do Dental Implants Help Preserve Jawbone?

The preservation of jawbone en mass is highly contingent on maintaining good implant health, which is facilitated by positioning of the fixtures in a manner that facilitates hygiene as well as with proper biomechanical considerations.

In my prior article I focused on the causes for bone atrophy, in particular as it relates to Iatrogenic causes and how this can be controlled with timely removal of diseased teeth, avoidance of dentures, and proper positioning of implants.

It was put then to me by a colleague that we are all taught early in our careers that implants preserve the jaw bone, the hard question is: where is the evidence that (well positioned) implants do in-fact preserve jawbone?

If we are talking about alveolar bone that is present around healthy teeth, then as I stated in my prior article on natural atrophy this cannot be stopped, and it cannot be reliably preserved even with implants. What I am talking about in my article is stimulation of deeper basal bone through functional loading.

The picture below illustrates the loss of alveolar bone irrespective of the presence of dental implants …

In the last picture the implants in Quadrant 2 (on the right of the picture) were removed and replaced with new implants in deeper basal bone. Overall this sequence illustrates the difference between placement of implants in alveolar bone, which limits restorative space, hampers hygiene, and does nothing to preserve bone, versus placement in basal bone which allows for improved restorative space, flat and hygienic underside, and involves a bone type that is not naturally predisposed to bundle-bone loss.

 

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Removal of Teeth, Bone Atrophy & Preservation (or Loss) of Bone with Dental Implants

Removal of teeth is something that is very difficult for us as dentists to recommend, and we battle with this every day. When the outlook for the teeth is not great, I often emphasise that a better result can be achieved by addressing things early before the further spread of disease and destruction of bone.

Some of the questions put to me by a colleague on facebook are to do with the effect of tooth removal on bone atrophy…

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Definitive Solutions for Our Patients

I was honored to present back-to-back at NYU Linhart College of Dentistry, New York, followed by the 4th Evidence Based Symposium on Oral Rehabilitation, Beijing.

My presentation was about simplifying the workflow of complex surgical cases, assessment and management of the terminal dentition, Zygoma ‘Plus’ and quality standards in advanced oral implantology.

I showed cases with terminal dentitions ranging in age from 20’s to 70′ with decay, gum disease and total deterioration. The most important question before offering these patients any kind of treatment is how did they get to that point in the first place?

There are many causative factors for tooth loss leading to a terminal state, but perhaps the critical ones are neglect due to poor hygiene, sugar consumption and/or poor compliance. These in turn can be the result of a poor dental IQ (“…I had no idea I had to floss or avoid energy drinks) or due to fear and distrust because of a poor past dental experience.

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All-On-4 Digital Workflow Possibilities with milled PMMA

There have been suggestions, and often a “push”, by technicians to streamline their production process with All-On-4 and full arch implant restorations by integrating a digital work flow and using materials that can be milled quickly and accurately to be used as immediate provisional restorations. One such material that is gaining popularity is milled PMMA, but how does this compare to the quality offered by our existing systems?

PMMA, All-On-4 Dental implants

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Fixed Implant Supported Prostheses VS Over-dentures

Some recent publications have attempted to compare patient experiences or perceptions between those who receive over-dentures versus those who are fitted with fixed implant-supported prostheses.

The ITI, a reputable implant organisation linked to the Strauman implants brand, appears to have postulated following a review of 13 articles on the topic, that it is not entirely clear there is any kind of difference in patient perceptions whether the restoration is fixed or removable, …really? We can also postulate that a denture replacing a single tooth is preferred by the patient to an implant or a bridge, and if we look hard enough we can probably find an argument, …but seriously, who are we kidding?

The ITI will be publishing a consensus about this, and I very much look forward to reading this. Interestingly the result of that consensus appears to already be known, …before any arguments or evidence to the contrary are actually considered?

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The Pre-Terminal Dentition: Considering Dentures | PART 2

A DENTIST’S DILEMMA FOR HIS YOUNG PATIENT WHO WANTED DENTURES

In Part 1 of this series I responded to a dentist’s dilemma about carrying out treatment requested by his young patient and committing her to dentures. It is not uncommon within our professional environment to face this or other similar situations that challenge our moral and ethical compasses. In this segment I explore how these might affect our professional conviction, …and whether this may be limited by an inexperience?

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The Pre-Terminal Dentition: Considering Dentures | PART 1

A DENTIST’S DILEMMA FOR HIS YOUNG PATIENT WHO WANTED DENTURES

One dentist had a dilemma about his young patient who had numerous decayed teeth, and who asked him to remove all of her teeth (including some healthy teeth) and get dentures. The dentist refused and posted his dilemma to the wider professional dental community. Below is the dentist’s post on a professional platform:

Youg_Patient_Wanting_Dentist_to_Remove_All_Teeth

After engaging many dentists around Australia, I was asked to comment and provide my view on this.

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Quad Zygoma Tips

This article is intended for dental professionals only, who have a high level of experience with All-On-4 dental implants treatments. It is in response to a question Dr Senichi Suzuki:
What are the most important factors for Quad Zygomas?
Quad Zygoma is an advanced treatment for patients who, through bone atrophy following tooth loss, trauma, or other causes, have lost so much maxillary bone that they do not have enough remaining jawbone to house standard implants, or even single Zygomas …so double Zygomas must be placed on each side in order to provide adequate support for an immediate set of fixed replacement teeth.

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Transformation that goes beyond a ‘Before and After’

In the world of cosmetic and rehabilitative dentistry, the worst ‘Befores’ are often followed by the best ‘Afters’ because of the psychological impact of the contrast. In other words, when the situation is bad, any kind of an improvement is an improvement.

But to achieve visual aesthetics without the contrast of the situation at the start, and at the same time achieving ideal function and stomatognathic health involves more than just performing routine procedures. It involves thinking outside the square.

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Bar Design for All-On-4 Final Bridge

Post op OPGThere are various methods to make immediate All-On-4 implant-supported fixed bridges. The nature of the treatment often precludes the ability to fit the FINAL bridge immediately after surgery. This is due to a number of factors, including:

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ビジョンある日本人との交流

Click here for ENGLISH versionFibishenko_All-On-4_Japan_Tour_2016 (100 of 1)

仕事として初めて訪れた日本旅行を有名な新幹線に例えるとしたら、主催者および同行者の方々の対応はファーストクラスですが、旅そのものは夜行寝台列車に近いものでした。というのも全ての駅に停車したかと思うくらい色々なところに立ち寄ったからです。

Fibishenko_All-On-4_Japan_Tour_2016 (107 of 29)今回は4日間の滞在期間に4つの都市を訪問しました。空港から鉄道の駅そしてタクシーへと入れ替えたちかえ移動し、東京、名古屋、大阪で合計3つの講義をし、また多くの著名な歯科医師の方々を訪問しました。しかも全て35℃という蒸し暑いさなかに・・・。ですが実際は聞いて想像するほど厄介ではありませんでした。非常に興味深い先生方にお会いできる機会に恵まれ、歯科インプラントによる口腔修復分野においてサブエコノミー経済を築く礎となる関係を築くことができました。

行動しなければ始まらない

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Open Season for Japanese Visionaries …All-On-4 Style

ビジョンある日本人との交流

Fibishenko_All-On-4_Japan_Tour_2016 (100 of 1)

If my first professional visit to Japan was synonymous with the famous Bullet Train, whilst similarly first class as a testament to my hosts and entourage, this one more closely resembled an overnight sleeper train …stopping all stations!

Fibishenko_All-On-4_Japan_Tour_2016 (107 of 29)I visited four cities in as many days, shuffling between airport, bullet trains stations and private cars, conducted three lectures in Tokyo, Nagoya and Osaka, and visited numerous high profile clinicians, …all that in humid 35 degree heat. But it was not as onerous as it sounds. I had the pleasure of meeting some very interesting people, and forged relationships that will likely be a basis to the establishment of a sub-economy in Oral Rehabilitation with Dental Implants. Let me explain …

You’ve Got To Be In It to Win It!

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International Surgical Implant Conference Meet The Culinary Genius of Deb “The Secret Chef” Poratt

I have been running surgical residency programs for 9 years, and had visitors from many parts of the world with the special privilege of hosting some of the world’s most renowned dental implant experts, but never before have I looked forward to an event as much as I did to this month’s conference at my training centre. Weird as this might sound, it was Deb’s Syrian Chicken that got me excited.  She finally succumbed to my nagging and agreed to cater our event, so I knew it was going to be special.

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What defines a Dental Implants Specialist?

The common meaning of the word Specialist is “a person who concentrates primarily on a particular subject or activity; a person highly skilled in a specific and restricted field.” In other words a specialist is expected to have expertise in a specific area, and this can be facilitated through training, focus and experience, as well as through individual skills and talents. However, in dentistry, a “Specialist” does not carry its common meaning, – instead it means a Registered Specialist. As such, clinicians who may indeed fall under the common definition of a “specialist” which the public understands, are actually prohibited from advertising themselves as such.

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All-On-4 Revolution …a shotgun lecture in Tokyo

Meticulous, systematic, minimalist, and bullet-trains, …that’s Japan. So why would an invitation to speak be any different: fly-in Wednesday, do two lectures, visit a couple of clinics and fly out Thursday, …oh, and on 3 weeks notice, …plenty of time, right!?

Bullet Train

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Zygoma Plus Questions Answered

With the advancements made in dental medicine and oral surgery, dental implants have become not only an increasingly viable option, but a preferred solution for patients seeking a more permanent and aesthetically pleasing alternative to loose dentures. However, there are situations where conventional dental implants simply will not work, such as cases with advanced jawbone atrophy caused by long-term denture wearing or from severe infections in the past, cancer or even the common gum disease that can also destroy the jawbone over time.

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Jaw Surgery VS All-On-4 for Missing Teeth and Cl3 Skeletal

A recent dental graduate recently posted a complex case on dental Product Review. He faced a dilemma of how to plan a young 35 years old woman, who had numerous missing teeth and a Class III skeletal discrepancy. Here is an image of this dentist’s post, and me reply below:

Dental Product Review Treatment Planning Dilemma

 

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Dr Alex Fibishenko