"This new protocol is almost universal"

Dental Tribune UK: You were one of the first clinicians worldwide to have worked with Trefoil and evaluated its clinical performance. How did you become involved, and what results have you achieved?
Dr Rubén Davó: I have been collaborating with Nobel Biocare’s clinical research department for many years on various projects. Nevertheless, it was an honour and privilege when they asked me to clinically evaluate the new Trefoil system. From a surgical point of view, we looked at the accuracy of the template guided surgery. We know that the fixation-compensation mechanism allows around 0.5 mm of discrepancy. In our clinical study, we found that structures could be placed properly in more than 99 per cent of the cases.

While we were also evaluating success rates, the second important thing we looked at was the number of patients we were able to treat with the system and how many we had to turn away because of their anatomical circumstances. Looking at our results, we can say that this new protocol is almost universal, as we had to refuse only a few patients, owing to things like an insufficient distance between the mental foramina or a mandible that was not wide enough.

The survival rate for implants and prostheses was near 99 per cent after one year.

Almost 20 years ago, a similar treatment protocol was introduced to the market with Brånemark Novum, but it was discontinued in 2007. What makes the Trefoil system different?
In my opinion, the Brånemark Novum system was ahead of its time. While from a clinical point of view it demonstrated good success rates, the market was not ready for it. You have to remember that, in those days, treatment concepts like immediate loading or guided surgery did not exist. Furthermore, usually a high number of implants were used to rehabilitate edentulous patients. However, the main problems with Novum were related to the prosthetic framework, which posed difficulties from a functional and aesthetic standpoint. As a refined system, Trefoil has completely addressed these problems.

What patient groups are going to benefit from this new protocol?
Potentially all patients edentulous or soon-to-be edentulous in the mandible can benefit from this protocol. Furthermore, Trefoil will increase patient acceptance rates because it applies to a patient group that may avoid this type of procedure (fixed dentures) owing to a lack of time or money.

The goal of Nobel Biocare is to reach more people for whom a lack of financial resources is a limiting factor. That is why it is an ideal solution not only for more affluent parts of the world like Europe or the US but also for markets like India or China. With Trefoil, the number of people that can be treated by means of fixed dentures will be much larger because this protocol does not depend on new technologies or sophisticated therapies. It requires only one surgeon and a basic laboratory to provide patients with fixed immediate teeth.

How difficult is it to learn the Trefoil protocol?
I would recommend doing at least five cases. After that, the clinician should feel comfortable and confident in performing the protocol. While it is not a very complex surgery, the practitioner will need a little bit of training. Nobel Biocare is very aware of that and offers a number of courses in many markets.

You have led some of these courses in Germany, Spain and the UK, to name a few. What has the initial feedback been?
Those who were involved in the clinical studies on Trefoil are teaching the courses now, and this has the advantage that attendees can gain from our experience gained in treating many of these cases. Our goal is to avoid both complications and any possible problems. The feedback has been extremely positive. Many participants have taken the course because they felt it offered the right concepts and provided a good practical learning experience. Consequently, they felt very comfortable performing the surgery.

According to Dr Kenji W. Higuchi, one of the developers of Trefoil, the system will be the next big thing in implant dentistry. Would you agree with that statement?
I think it has become very difficult to innovate in this field because many things have been introduced over the last 20 years. I have no doubt however that, in China, India and other developing countries, this will start a revolution because now more people will have access to these treatment possibilities. Trefoil will also address a gap in many Western countries, where we see many patients that do not want removable dentures, but cannot afford fixed dentures because of a lack of time or their financial situation. The only thing I do not know is how long it will take to gain widespread market acceptance. Usually these things take time, sometimes even years. However, all the positive feedback we have received lately has made us extremely positive about the future prospects of the system.

Thank you very much for the interview.

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