Dubbed as the next big thing in dental implants, Trefoil implants is an advanced method to permanently restore failing or missing dentition in the lower jaw. With the increasing edentulous burden it becomes necessary to provide a treatment solution that is not only quick and function but is also affordable to this patient demographic, which consists of retirees and pensioners.

The Trefoil Implant System

The Nobel Trefoil system is one of the newest innovations of the dental implant giant and has been backed up by years of research, starting right with the Father of Dental Implantology, Dr. Per Ingvar Branemark.

Read on to learn more about this novel procedure.

So before we move on, we would like to acquaint you with a few more dental terminologies that we will frequently encounter in the course of this discussion. Do scroll back up to revise the meaning of these frequently used dental terms.


Maxilla The jaw or jawbone, specifically the upper jaw in most vertebrates. In humans it also forms part of the nose and eye socket.
Mandible The jaw or jawbone, specifically in the lower part of the face in most mammals is called the mandible.
Dental Implant The dental implant is a surgical component, shaped like the root of a natural tooth, that is placed within the bone of the maxilla or mandible to support an artificial tooth like restoration.
Abutment The dental implant abutment is that part of the fixture that connects the artificial crown to the underlying dental implant.
Osseointegration The process of the bone intimately adapting to the surface of the dental implant, securing it to the bone is called osseointegration. This procedure may take anywhere between 3-6 months for completion.
Cantilever Technically, a cantilever means that a long beam is supported only on one end and is free on the other end.
Anterior Front or up ahead
Posterior Behind
Prosthesis An artificial replacement of a missing natural body part, which in our case is the tooth.
Provisional Restoration The artificial restoration that is placed temporarily till healing completes or the final restoration is ready is called the provisional or temporary restoration.
Occlusion Defined simply, occlusion is the science of contact of the surfaces of teeth in different situations, eg while biting, while chewing, while talking, swallowing, etc.
Bone resorption The physiological, sometimes pathological process of decrease in the height, width and volume of bone due to various factors like age, disease, medication etc.
Immediate Loading The process of placement of a prosthesis immediately after the implant surgery to assist in esthetics, function, rehabilitation and recovery.

History of Trefoil Implants:

When Dr. Per Ingvar Branemark introduced dental implants way back in the mid 90’s, he came up with a new concept called the Novum Concept. What it essentially meant was the placement of 3 large diameter implants in the mandible, between the 2 mental foramen and loading it with a titanium bar and teeth on the same day. However technical difficulties led to the failure of the titanium bar leading to complications.

When Dr. Kenji Hagachi and his team renewed this project, they realised that it was the absence of a compensatory mechanism between the dental implants and the bar that resulted in the complications. This permits adjustment of the pre-fabricated bar according to anatomical variations.

The Trefoil system and its 5 unit compensatory mechanism.

What is the TREFOIL IMPLANT system

The TREFOIL Implant system is a breakthrough on many levels, beginning right with precision engineering manufacturing to the definitive or final prosthesis. The point of innovation is the prefabricated bar which comes with a 5 unit compensatory mechanism. This eliminates the additional procedure and time endured in casting or milling a titanium framework or a bar. This can then be used to fabricate a fixed and definitive acrylic prosthesis.


The Trefoil Implant System can restore only the edentulous mandible. During the prosthetic phase the upper arch has to be completely rehabilitated for successful completion of therapy. Therefore the maxilla should have natural teeth, restored with fixed partial dentures, complete dentures or implant supported fixed prosthesis.

Dr. Kenji Higuchi and four principal investigators (Dr. Rubén Rosenberg, Dr. Rubén Davό, Prof. Dr. Massimo Albanese, and Dr. Glen Liddelow) placed 330 trefoil implants in 110 patients over 4 continents. The 6 month and 1 year follow up in 2017 found promising results as have the 5 year follow up.

The TREFOIL IMPLANT procedure:

A Guided surgery essentially, the first step is the placement of the 3 straight implants using the Trefoil guides that come in the Trefoil Pure kit. This enables the placement of the implants in the precise positions that have been planned, keeping in mind prosthetic values such as the occlusal plane, interarch distance and freeway space.

Once the implants are placed satisfactorily, i.e., parallel to each other and 3mm away from the mental nerve foramen, the prosthetic phase of the procedure begins. Impressions are recorded with specialized units and transferred to a cast where the laboratory procedure begins. This entire procedure is completed with the incorporation of the prefabricated bar into the acrylic denture and as per the compensation achieved clinically. With the presence of an in house laboratory and a dedicated prosthodontist, this entire procedure can be completed within a day.

Benefits of the Trefoil Implants:

The ALL ON 4 Implant methodology provides a viable solution for resorbed ridges and has proven to give good long term results. The cost effectiveness, immediate function, reduced postoperative morbidity should be taken into account while planning this treatment.

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