In some advanced All On 4 Plus® cases different implant combinations may be required:
In highly compromised cases where the bone quality is poor or its structure/volume limited, one or more of the additional procedures below may be indicated to improve the prospects of success and longevity:

When Extra Implants Are Needed: All On 4 Plus®
Four implants are ideal for a clean, balanced design, but sometimes more implants are needed. This can happen if the bone quality isn’t strong or if someone has a powerful bite. Extra implants might also be added if more than 12 teeth are needed. When extra implants are used, they’re placed carefully for comfort, balanced support, and easier cleaning.

Zygoma Implants: Extra Support for Weak Upper Jaws
Zygomatic implants, or "Zygoma," are longer than regular implants. They go through the weaker upper jaw area, often passing the sinus, to anchor into the cheekbones. This method is used when the upper jawbone is very thin or weak. These implants are placed from inside the mouth, along with one or more regular implants in the front part of the jaw on each side.

Quad Zygoma: Maximum Stability for Severe Cases
The Quad Zygoma approach uses two zygomatic implants on each side of the upper jaw, providing maximum stability and support for patients with severe bone loss. This technique is often the best choice when the upper jawbone has resorbed significantly and cannot support traditional implants alone. By anchoring into the cheekbones on both sides, Quad Zygoma offers a stable foundation even in the most challenging cases.
Bone Grafting: Building a Strong Foundation for Dental Implants
Bone grafting is a crucial technique in dental implantology, used to rebuild and strengthen jawbone structure where bone volume is insufficient. This procedure involves adding bone material to areas with low density, creating a solid foundation necessary for successful implant placement. Commonly used in the upper jaw, especially in the sinus regions, bone grafting enables precise implant positioning and increases long-term stability. By enhancing bone quality and volume, grafting not only supports the immediate success of implants but also offers future flexibility for additional implants if needed, making it an essential step for patients with compromised jawbone integrity.

Regular Dental Implants with Sinus Grafting
Bone grafting for regular implants is typically used in the upper jaw to restore bone volume, especially in the sinus areas. This process often occurs alongside implant surgery when there’s a need to rebuild bone, helping to ensure a solid foundation for implants. By increasing bone volume, grafting allows for optimal positioning and stability of the implants, enhancing their longevity and effectiveness. Additionally, this procedure can create more contingency by increasing available bone, offering more implant options in the future if needed. Bone grafting supports a strong and stable foundation, ultimately improving the success and durability of implants.

Zygoma Implants with Zygoma Grafting
In cases of severely limited jawbone structure, zygoma implants paired with bone grafting provide an alternative approach. This advanced technique uses the zygomatic (cheek) bone for implant anchoring, bypassing areas with insufficient bone in the upper jaw. When required, bone grafting can further reinforce areas around the zygoma implants, ensuring improved structural support. This method is especially beneficial for patients with extreme bone loss, offering a solution where conventional implants and grafting may not be feasible. By strengthening the jaw's foundation, zygoma implants with grafting deliver a reliable and stable option for patients with complex bone conditions.