Dr. NeugartenJay M. Neugarten is an oral and maxillofacial surgeon and associate clinical professor at New York Hospital, Cornell-Weil Medical Center and Long Island Jewish Medical Center. Dr. Neugarten’s attention to detail and philosophy of providing optimal, quality care with the least amount of invasive surgery has earned him trust from patients and confidence from referring doctors.

Dr. Neugarten trains clinicians in the new Trefoil system, a treatment which in its first year of clinical study had an average patient satisfaction rating of 9.1 out of 10.1 We interviewed Dr. Neugarten to discover more about how it has met the needs and expectations of his patients.

What factors have driven patient acceptance of the Trefoil system?

In summary: Speed, simplicity, affordability.

For a long while, a significant proportion of patients have been resistant to a fixed full-arch dental implant solution because it can be cost prohibitive.  A typical alternative has been a fixed-removable overdenture – which can provide a satisfactory outcome for some. For patients who consider this alternative as being sub-optimal and cost prohibitive, Trefoil is a whole new opportunity that can meet both their needs and expectations.

From a patient’s perspective, this new method is a streamlined and simple, yet an effective, life-changing solution. It minimizes chair time and worktime.

“Speed, simplicity, affordability.” Cost- and time-efficiency are possible with the Trefoil system due to its pre-manufactured bar placed on just three implants, and with no provisional prosthetics. Image courtesy of Dr. Jay Neugarten.

There has also been a small subset of conventional fixed-solution patients who don’t return for a final prosthesis, despite our advice, because of either cost or inconvenience. Trefoil doesn’t require a provisional prosthesis, so I also see some potential in avoiding these obstacles.

Shorter time-to-teeth is a significant patient expectation. Have you completed a Trefoil treatment in one day?

In one case, yes. It was possible due to a particular set of circumstances. Firstly, the patient only required treatment of the mandible at the time. The maxillary arch was in place – absolutely crucial for positioning the Trefoil central implant based on the positions of 8 and 9. Secondly, the restorative clinician, the lab technician and I were in full coordination for completing the treatment in one day. And, importantly, the patient was willing to be in the practice for a full day. Consequently, complete treatment was achieved in approximately 6 hours, with an approximate chair time of 2 hours.

In all our other cases, restoration has been completed at a separate appointment within one week, and some within as little as 24 hours. A second visit for restorative treatment has not been a deciding factor in our patients’ acceptance or had a negative impact on satisfaction. A number of patients actually appreciate a day or two of downtime following surgery. Nonetheless, the possibility exists for giving patients a definitive, fixed, full-arch solution in just one day*.

You provide training in the Trefoil system. Why are clinicians considering this a new choice for patients?

There is diversity in motivation, reflecting the diversity in local markets. For some, the biggest motivation has been the ability to stand out as a leading practice in innovation, being at the forefront of a new and unique solution, while meeting patient demand for speed and quality. Elsewhere, the biggest driver has been the cost-efficiency of chair time and the pre-manufactured bar, that enables greater patient accessibility to a fixed, full-arch solution.

Before the Trefoil system, a fixed, full-arch solution in the mandible was not viable for certain patients. I’m most excited about offering a new solution to those patients already treated for a fully edentulous mandible but not satisfied with existing options, such as a fixed removable overdenture. I already see the Nobel Biocare Trefoil system as a game-changer.

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


  1. Higuchi K, Davó R, Liddelow G, et al. An adaptive prefabricated full-arch framework on three implants in the mandible: preliminary results. Poster presented at: 26th Annual Scientific Meeting of the European Association for Osseointegration; Oct. 5–7, 2017; Madrid, Spain.

Posted by Chris Kendall