Trefoil™ is a ground-breaking and affordable fixed full-arch implant solution for patients who have missing or failing teeth in the lower jaw. The system is based upon the Brånemark Novum technique – developed by Professor Brånemark, the father of modern implant dentistry more than 20 years ago! Trefoil™ incorporates many of the same surgical steps as the original novum protocol, but the prosthetic aspects are a highly evolved improvement of the original approach, making prosthetic treatment as straightforward as it possibly can be.
The Trefoil™ system is not intended to replace existing implant solutions, but offers a more affordable premium alternative.
The system is versatile and may be used even where there is massive bone loss, and can provide a truly definitive “Teeth in a Day” treatment. Whilst patients may benefit from a shorter treatment time of just 4-6 hours, including surgery and provision of a definitive bridge, there is also the option to extend treatment, opting for a more conventional provisional phase followed by the fitting of a definitive bridge after a full prosthetic work-up, where appearance needs to be carefully refined.
With meticulous radiographic planning, surgery takes place using Brånemark’s original guided surgery protocol in which a series of cleverly constructed surgical guides are used to incrementally prepare sites for, and then to fully guide the positioning of three specially designed implants into predetermined positions in the anterior mandible.
Figure 1/ The Trefoil™ implants, framework and prosthesis
Figure 2/ Using the Trefoil™ Surgical guide ‘Positioning Template’ for the central implant
Figure 3/ The Trefoil™ ‘V’ Template in use for the distal implants
Figure 4/ The specially designed conical connection implants for the Trefoil™ system. Available with 11.5 or 13mm threaded bodies and 4.5 or 6mm collar heights.
The Trefoil framework is pre-fabricated in titanium alloy; it has a unique fixation mechanism which compensates for minor 3 dimensional deviations in implant placement. The robust pre-manufactured framework achieves a passive fit, such that there is then no need for the CAD/CAM production of a definitive bar. There are fewer prosthodontic and laboratory stages, and laboratory costs and chair-time are reduced. Remarkably, a single one-size framework is used for all patients – this has been shown to be suitable for the vast majority of mandibles.
We were the first in the UK to use the Brånemark Novum system back in the late 1990’s, and so it was exciting to revisit the concept in its evolved new format many years later, as the first practice in the UK to offer Trefoil™.
The surgical approach is challenging and requires careful case selection, detailed planning and rigorous execution. An understanding of the restorative and surgical space requirements is of paramount importance. Experience of guided surgery techniques will make surgery intuitive.
As usual, a prosthodontically led approach will help to ensure success, whilst carefully following the step by step surgical protocol will result in a straightforward and predictable treatment.
Whilst there is the option to carry out the treatment as part of a one-day protocol, there is no reason to feel obliged to work in this way. For some of our patients it has made more sense to go through a number of try-in procedures to give our technicians more time to complete the prosthesis so as to achieve the best possible and most durable definitive result.
Our excellent experience of using the system aligns nicely with that of friends and colleagues Dr Ruben Davo, Alicante, Spain, Dr Glen Lidlow, Perth, Australia and Dr Kenji Higuchi, San Francisco, who have participated in a multicentre study in which more than 110 patients have been treated.
Figure 5/ The compensation mechanism on the Trefoil™ bar
Figure 6/ The Trefoil™ framework with wax try-in
Figure 7/ Completed Trefoil™ prosthesis
Dr Andrew Dawood
Dr Dawood is running a Trefoil Study Club on Thursday 21st June from 6:30pm- 8:30pm.