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30 Sep 2017 | Australasian Dental Practice

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Trefoil™ - the next full-arch revolution: A definitive fixed solution to treat more patients better

Nobel Biocare has continually led innovation in full-arch solutions for over 50 years. Now, the company has achieved another breakthrough in the efficient treatment of the edentulous mandible. The launch of the new Trefoil system has made the passive fit of a pre-manufactured bar possible for the very first time, using a revolutionary, self-adjusting fixation mechanism and just three implants. An innovation that drives efficiency at every step - from manufacture to definitive restoration - the Trefoil system makes a fixed full-arch implant solution a real possibility for more patients.


More patients benefit from a fixed solution

The benefits of fixed solutions far outweigh the costs of fixed-removables for many patients when considering implant-supported solutions.1 While a removable implant solution may offer a lower price and faster treatment than typical fixed alternatives, many patients aspire to the comfort and ease of a fixed prosthesis,2 proven to significantly improve their quality of life.3 Fixed solutions also offer improved function with a higher bite force, better retention and stability and avoid some of the disadvantages of removable solutions such as more mucosal problems and the wear of components.4

Developed with the needs of the many in mind, the efficiency of the Trefoil system empowers clinicians to provide many patients who are held back by time or by finances with the premium-quality, fixed solution they deserve.

Definitive teeth in a day*

Dental implant patients increasingly demand immediate restoration and reduced treatment time. Meeting this need and avoiding the edentulous condition encouraged the introduction of an immediate loading protocol. Dental professionals seek solutions with fewer surgical steps, yet with high success rates, high patient satisfaction and function on the day of surgery.4,5

The Trefoil system, combining a pre-manufactured titanium bar, three implants, a simplified restorative workflow, acrylic prosthesis and minimized restorative componentry, enables shorter time-to-teeth and reduced chair time compared to conventional treatments that use provisional restorations. With no need for CAD/CAM or temporary prosthetics, the ability to place definitive teeth on the day of surgery* using a pre-manufactured bar and wraparound acrylic technique for the prosthesis, saves substantial time for the restorative clinician, the lab and ultimately the patient.

First pre-manufactured bar with a passive fit

Before the Trefoil system, pre-manufactured bars could be cost-efficient, but none could enable the passive fit that is so crucial to long-term treatment success. In challenging this limitation, Nobel Biocare engineers developed the first pre-manufactured bar with a passive fit, enabled by a unique fixation mechanism with self-adjusting joints. This mechanism provides passive fit by compensating for horizontal, vertical and angular deviations from the ideal placement of the three implants. Accurate drilling with standardized drill guides enables precise parallel implant positioning and placement for passive fit.

Proven implant design with conical connection

A special component of the Trefoil system is the Trefoil Implant. It combines the proven parallel wall implant design,6 a machined soft tissue collar, which allows easy access to the implant while leaving the soft tissue undisturbed after the surgery and a conical connection. The TiUnite surface is proven to maintain implant stability during the critical healing phase through fast bone formation,7-9 and it promotes long-term success.

Treatment success

An ongoing five-year, multi-centre study across four continents, is in progress with results already being reported for implant and prosthetic survival rates.6 This important study has expanded to include 110 patients at the request of clinicians, to meet the needs of their patients.

Treating a whole new patient population with a fixed solution

The decline in edentulism has been predicted to slow and to be partially offset by a growing and aging population.10 High-quality and cost-efficient solutions are crucial in order to serve the needs of edentulous patients and patients with a failing dentition.

In essence, the Trefoil system embodies the Nobel Biocare mission - to treat more patients better. With this improved efficiency comes the opportunity to continue with the vision of P-I Brånemark and bring the benefits of osseointegration to a whole new patient population.

* Depending on clinical preference and close cooperation with the laboratory.

  1. Enami et al. Implant-assisted complete prostheses. Periodontol 2000. 2014 Oct; 66(1):119-31. doi: 10.1111/prd.12041.
  2. S Jivraj, W Chee & P Corrado Treatment planning of the edentulous maxilla British Dental Journal 201, 261 - 279 (2006).
  3. Allen PF, McMillan AS. A longitudinal study of quality of life outcomes in older adults requesting implant prostheses and complete removable dentures. Clin Oral Implants Res. 2003 Apr;14(2):173-9.
  4. Chung S, McCullagh A, Irinakis T. Immediate loading in the maxillary arch: evidence-based guidelines to improve success rates: a review. 4https://www.ncbi.nlm.nih.gov/pubmed/22004059.
  5. Romanos G, Froum S, Hery C, Cho SC, Tarnow D. Survival rate of immediately vs delayed loaded implants: analysis of the current literature. J Oral Implantol 2010;36(4):315-24. https://www.ncbi.nlm.nih.gov/pubmed/20735268.
  6. Higuchi K. et al. An adaptive prefabricated full-arch framework on three implants in the mandible- preliminary results. Oral poster presenta tion accepted to be presented at the 26th Annual Scientific Meeting of the European Association for Osseointegration. Saturday 7th Octo-ber, 2017. IFEMA Feria de Madrid, Spain.
  7. Glauser R, Portmann M, Ruhstaller P, Lundgren AK, Hämmerle CH, Gottlow J. Stability measurements of immediately loaded machined and oxidized implants in the posterior maxilla. A comparative clinical study using resonance frequency analysis. Applied Osseointegration Research 2001; 2:27-9.
  8. Zechner W, Tangl S, Furst G, Tepper G, Thams U, Mailath G, Watzek G. Osseous healing characteristics of three different implant types. Clin Oral Implants Res 2003; 14:150-7.
  9. Ivanoff CJ, Widmark G, Johansson C, Wennerberg A. Histologic evaluation of bone response to oxidized and turned titanium micro-implants in human jawbone. Int J Oral Maxillofac Implants 2003; 18:341-8.
  10. G. D. Slade, A. A. Akinkugbe, A. E. Sanders. Projections of U.S. Edentulism Prevalence Following 5 Decades of Decline. Journal of Dental Research, 2014; DOI: 10.1177/0022034514546165.

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