❖ L’implantologie: historique.
Nous faisons ici une révision de l’historique et des fondements
de l’implantologie dentaire, entre autres à travers la vie
des deux plus grands noms de l’histoire de la médecine dentaire:
Greene Vardiman Black et Per Ingvar Branemark.
◉ L’ANTIQUITÉ DENTAIRE
Le génie humain se préoccupe depuis longtemps du remplacement des dents perdues. On voit ci-bas une photo d’un maxillaire datant de la Rome antique. Il s’agit d’un pont supportant 2 dents perdues, reposées en bouche à l’aide de ligatures en or.
L’image suivante montre un pont dentaire de l’Égypte pharaonienne: une attelle en or fixait deux dents perdues aux dents adjacentes.
La photo ci-dessous montre une mandibule humaine de l’ère Maya, avec quelques dents manquantes remplacées par des pièces de coquillage. Il semble que les dents en coquillage furent tolérées par les tissus vivants et s’intégrèrent partiellement à l’os du « patient »!
Enfin, voici un dentier célèbre, celui du président américain Georges Washington. L’histoire dentaire de celui-ci illustre bien les souffrances que pouvaient infliger à nos ancêtres les maladies dentaires:
◉ HISTOIRE GÉNÉRALE DE LA DENTISTERIE:
Les patients ou collègues curieux de l’histoire de la dentisterie générale peuvent consulter les sites suivants:
Le site de la Société française d’histoire de l’art dentaire:
Le site de l’American Academy of the History of Dentistry:
Le site de l’American Dental Association
Pour en savoir plus, il est aussi intéressant de connaître l’histoire de
Greene Vardiman Black, considéré comme le père de la dentisterie moderne.
Voir les liens suivants:
◉ HISTOIRE DE L’IMPLANTOLOGIE MODERNE:
QUAND UNE VIE CHANGE LE MONDE!
Une revue de l’histoire moderne de l’implantologie à travers les témoignages exprimés
lors de la disparition récente du père de l’implantologie dentaire, le Professeur Per-Ingvar Branemark, décédé le 20 décembre 2014.
In memoriam from friends and colleagues around the world.
by: Frederic Love
December 31, 2014
Professor P-I Brånemark gave so much of himself to so many people, and like all the millions of patients who benefited from his groundbreaking discovery and life’s work, he is also fondly remembered by friends and colleagues from all over the globe.
“Per-Ingvar long remembered the names of his patients, even those he treated very many years ago. He cared for them, supported them and was a much-beloved surgeon.”
— Ragnar Adell
“Few, if any, scientists or clinicians in the world have contributed so much to patients’ everyday well-being and oral rehabilitation as Dr. P-I Brånemark.”
— Ulf Lekholm
“He showed us that many of the world’s great movements begin with one person’s work, often based on a single tenacious conviction.”
— George Zarb
“P-I Brånemark was a man of ideas and ambition who never accepted any limits for what could be achieved.”
— Tomas Albrektsson
“P-I always advocated interdisciplinary cooperation and lived as he taught, which served to expand knowledge in many fields simultaneously.”
— John Brunski
“Professor Brånemark was the most important person in our professional lives and thousands of patients thank him for improving their lives through his scientific findings and research.”
— Burt and Laureen Langer
“Per-Ingvar Brånemark was an expansive thinker, embracing the TEAM approach and bringing it to its highest level for contribution and collaboration.”
— Rick Sullivan
“He taught us not just by science, but by the force of his personal example: Compassion, perseverance, humanity.”
— Peter S. Wöhrle
“P-I Brånemark improved quality of life for millions of people. He will be missed.”
— Bill Becker
“Professor Brånemark changed the direction of dentistry forever and for this patients are forever grateful.”
— Oded Bhat
“Professor Brånemark, will always be remembered for his foresight, his legacy and his work as a humanitarian. Our profession and our patients owe him an immense debt of gratitude.”
— Gerard J. Chiche
The man who made people smile
by: Frederic Love
December 21, 2014
The father of the modern dental implant, Professor Per-Ingvar Brånemark, now belongs to the ages.
“Surround yourself with some of the best minds in your field, and you’re bound to succeed.” — Per-Ingvar Brånemark
Whether he was meeting a patient for the first time or entertaining a lecture hall full of eager—yet often skeptical—students, Per-Ingvar Brånemark brought smiles to people’s faces. Describing and then documenting a world of clinical success that was beyond the imagination of most of his contemporaries, Brånemark was known for delivering “Aha!” experiences to patients and academics alike.
On December 20, 2014, Per-Ingvar Brånemark died after a period of extended illness in his hometown of Gothenburg, Sweden, leaving his family, his friends and his colleagues all over the world in mourning.
Without the work of Per-Ingvar Brånemark, the world might still be awaiting the advent of titanium implants. His observation, in the mid-twentieth century, that the human body would not only tolerate titanium, but also integrate it into living bone tissue (under carefully controlled conditions) revolutionized the fields of dental, maxillofacial and orthopedic rehabilitation.
Based on his original scientific insight—subsequently substantiated and rigorously documented—innovative bone-anchored restorative solutions have improved the quality of millions of people’s lives around the world since then.
Choosing the right path
Students of science often say that luck combined with unique circumstances often dictate the direction in which any research project ultimately turns. No one was more aware of this than Per-Ingvar Brånemark.
As a young researcher in his native Sweden in the 1950s, he was interested in neither titanium nor implants. He was working instead to advance the world’s knowledge of the anatomy of blood flow, and found himself using an optical device that happened to be enclosed in machined titanium. Attached to a rabbit’s leg, this device made it possible for him to study microcirculation in the bone tissue of rabbits through specially modified light microscopes. When it came time to remove the device from the bone, Brånemark was surprised to find that the bone and the titanium had become inseparable.
In a subsequent study of microcirculation, approximately 20 students who volunteered to have titanium instruments inserted into their arms for several months showed no signs of rejecting the titanium-enclosed optics.
At that point, Brånemark changed the direction of his work to investigate the body’s ability to tolerate titanium.
Breaking down borders
Seeing that the body could peacefully coexist with titanium, perhaps indefinitely, Brånemark wanted to find out the reasons why. He realized that he would need to approach this new area of research from several different perspectives simultaneously.
To gain a proper understanding of osseointegration—the term Brånemark coined for the integration of titanium into living bone tissue—he realized that one would need access to expertise in physics, chemistry and biology, at the very least.
Under Brånemark’s leadership, physicians, dentists and biologists would all investigate the interplay between bone and titanium. Together they developed careful, methodical techniques for the insertion of implants. At the same time, engineers, physicists and metallurgists studied the metal’s surface and how the design of the implant might have an effect on bone healing and growth.
In this context, the contributions of two men proved to be decisive for further progress. An American researcher, engineer and materials specialist, Richard Skalak, designed the first implants. Viktor Kuikka, a precision mechanic and watchmaker in Sweden, took on the difficult task of machining both the implants and surgical tools of titanium.
Brånemark found himself working in a headwind. His findings that the body would accept titanium over the long term, and even allow it to integrate in bone, flew in the face of conventional wisdom. In the mid-1960s, physicians and dentists were still being taught that foreign, non-biological materials could not be integrated into living tissue. Initial inflammation and ultimate rejection were considered to be inevitable.
Previous trials with implants had failed, after all, and caused patients considerable suffering. The academic world questioned Brånemark’s research, partly because of the failures of others in the past and partly because he was working in so many different academic disciplines at the same time.
Funding from Swedish research organizations dried up. He was repeatedly turned down when he applied for renewed grants to study tissue anchored implants, yet he persevered. Eventually the US National Institute of Health stepped in and funded his research, which made it possible for him to repeatedly demonstrate the accuracy of his claims and the viability of osseointegration, but it wasn’t until the mid-1970s that the Swedish National Board of Health and Welfare were finally prepared to approve of the Brånemark method.
For the benefit of the patient
In 1965 a Swedish man, Gösta Larsson, became Per-Ingvar Brånemark’s first dental implant patient. Using a very cautious method that his research group had devised to show the greatest possible degree of respect to the living bone tissue, Brånemark inserted a set of titanium implants that Larsson would have for the rest of his life.
This remarkable patient had been born with a deformed jaw, and the four titanium implants that he received that day meant that a set of new teeth could be attached to his jaw. For the first time in his life, he could eat and talk normally. When he died in 2006, his implants had worked without problems as the foundation for a series of oral prostheses for 40 years. Since then, over ten million people worldwide have benefitted from Per-Ingvar Brånemark’s discovery.
Both in Sweden and abroad, Per-Ingvar Brånemark’s achievements in the field of osseointegration have opened up entire new areas of promising research, many of which have led directly to innovative products by Nobel Biocare. The company respects the Brånemark heritage of innovation grounded in good science and continues along that path today.
Some Brånemark-inspired research teams now focus on trying to better understand how the processes of healing and immune defense interact. Others focus on the surface structure and chemistry of titanium implants, in attempts to tweak the surface properties just enough to give the body an even better chance for rapid and safe healing.
As the number of successfully treated patients explodes around the globe, yet other centers scientifically evaluate both new and well-established component designs to ensure that the highest possible standards of safety and efficacy continue to be maintained in the future.
Per-Ingvar Brånemark’s greatest legacy may be the fact that medical and dental schools now teach the use of osseointegrated implants as a routine part of their normal curricula.
The pursuit of leaning for the sake of constant improvement was paramount in his professional life and reflected in this often repeated maxim:
“We must never forget, that from the patient’s point of view, the criteria which differentiate between success and failure are always the key issues we face as a team.”
Two men make history together
by: Frederic Love
December 12, 2014
Brånemark’s osseointegrated implants first changed Gösta Larsson’s life – then millions more.
In 2015, the world of dentistry will be celebrating the fiftieth anniversary of applied osseointegration. Nobel Biocare, always committed to continuously expanding the benefits of implant-based solutions, will continue this tradition with an innovative product concept launch in the Spring. Stay tuned to this channel!
How it all began
Fifty years ago, Gösta Larsson of Gothenburg, Sweden, was an oral invalid. Osseointegrated implants, carefully inserted by Brånemark, would dramatically and forever change his life in 1965, and would do so permanently.
“I never felt any hesitation. Gösta had a great need, one that I felt we could meet, and so we got started.”— Per-Ingvar Brånemark
Twenty-five years later, in 1990, his final implant helped him to overcome hearing loss, when he received a bone-anchored hearing aid, a new application of osseointegration at that time. From the moment Per-Ingvar Brånemark realized the need to scale-up implant production, the sequence of companies that would culminate in Nobel Biocare have stood for unique original research, excellent system quality, thorough clinical trials and reliable customer service.
The picture above was taken half-way between Larsson’s original surgery and the golden anniversary we’ll be celebrating next year. The bandage that protected the surgical wound for his new hearing aid is clearly visible in this photo. Just a few months after it was taken, he enthusiastically contended that it would be difficult for me to find a more satisfied patient—and he was right!
Gone, but not forgotten
Per-Ingvar Brånemark’s patient number one, Gösta Larsson, is no longer with us. He died in 2006—more than forty years after his initial osseointegration surgery, with all of his implants still in place and functioning well. Patient number two, Sven Johansson, who we featured in Nobel Biocare News 1/2012, is still with us, however, and will be celebrating 48 years with his Brånemark System implants next year. No one on the planet has had osseointegrated oral implants longer.
Despite the fact that Nobel Biocare delivers considerably more advanced implants today, the straight-walled, external hex implants that both men received have demonstrated remarkable staying power over the decades. Nobel Biocare has a proud tradition of supporting all the company’s implants indefinitely. It shouldn’t come as a surprise then that the original Brånemark System prosthetic components are still available today for restorative upgrades.
The keys to longevity
As Sven Johansson’s current dentist, Christer Dagnelid points out, to ensure longevity, you need to combine high-quality Nobel Biocare products and skilled clinicians with good teamwork and an individualized recall system.
“The experience we have gained since Gösta Larsson and Sven Johansson were first treated by Professor Brånemark,” says Dagnelid, “has taught us that good implant-related dental care must be based on a long-standing relationship between the patient and dentist, where the number and frequency of return visits are tailored to the different stages of life.”
Per-Ingvar and Gösta—through one man’s insight and the other’s boldness, they have helped millions of orally handicapped people return to a life of dignity over the last half-century.
“His was a truly innovative mind that inspired others.”
by: Professor Thomas Albrektsson
December 23, 2014
Few people know as much about the early years of Per-Ingvar Brånemark’s research as Swedish Professor Tomas Albrektsson. In the following story, Albrektsson recounts some of the lesser-known, yet very interesting episodes which led up to the advent of osseointegration.
Although a graduate of the University of Lund, in the far south of Sweden, Per-Ingvar (or “P-I”, as he is generally known) Brånemark founded his Laboratory of Experimental Biology at the University of Gothenburg in the early 1960s.
As a young medical student I became a most junior researcher at P-I’s lab at the Department of Anatomy at the end of the same decade.
At this time, most of the research activities of his laboratory were still devoted to microcirculation, particularly in the field of vital microscopy. Although the first fixture patients had already been treated in 1965, implant research was not going to dominate the laboratory until a later stage.
In fact, one of my first memories relating to the implants was a lecture P-I gave in southern Sweden in 1969.
Back in those days, the use of oral implants was not an accepted form of treatment and the audience needed to be convinced.
Immediately after P-I’s presentation, one of the senior academics of Swedish dentistry at the time rose and referred to an article entitled “Microcirculation—A New Frontier for Research” that had presented P-I’s vital microscopy work for the subscribers of Readers Digest.
This pundant then said sardonically, “This may prove to be a popular article, but I simply do not trust people who publish themselves in Readers Digest.”
Now, this same senior academic had become known to the Swedish public as the authority who recommended a certain brand of toothpicks. P-I rose without hesitation, striking venomously as a cobra with the reply, “And I don’t trust people who publish themselves on the back side of tooth-pick boxes!”
P-I won that battle, but it would take him almost another decade to win the war of attrition, breaking down the resistance of the conservative, senior Swedish academic establishment, and making it possible for the country’s health-care community to accept his oral implant concept.
There were many below-the-belt blows in those days. One was referring to P-I as “only a teacher and an M.D., completely without any odontological knowledge.”
P-I responded with characteristic, tongue-in-cheek humor: “It’s true that I’m not a dentist but, on the other hand, I do find it satisfying to train them.”
Later, I should add, he received his formal academic degree in dentistry as Doctor of Odontology from the University of Umeå in Sweden and also became a member in good standing of the Swedish Dental Society.
But let me return to the Laboratory of Experimental Biology, which under P-I’s leadership, became one of the most dynamic concerns of any University, anywhere.
In a time when academic titles had become much less lucrative in comparison to clinical ones, and other laboratories were searching for PhD candidates with binoculars, P-I (much to the envy of many colleagues) ran an extremely popular laboratory where he only accepted the best junior researchers (myself, of course, excluded) for training.
By the end of the 1970s, P-I had supervised the writing of thirty PhD theses—quite impressive considering the things he was achieving in his “spare time”. There were few questions concerning his favorite subjects—microcirculation and implants—that were not tackled by gifted people at his lab.
Even if he sometimes directed the work in the manner of a field marshal, his staff accepted it. After all, not only did he have the highest rank, he was also a natural authority to us all.
Some problems were bound to arise, of course. At one point P-I recruited “volunteers” from the staff when he discovered that his interests in microcirculation and implants could be combined by inserting a titanium chamber in the upper arm of his subordinates.
Personally, I avoided participating in this truly heroic series of experiments by referring to the fact that my elder brother, Björn, already was a victim—pardon me, I mean a “participant”. Obviously, it was therefore essential, scientifically, to allow me to remain in the control group to prevent the Albrektsson genes from adversely affecting the outcome of the research.
Making the news known
While the 1960s and ’70s were a time of struggle for P-I, his time of success would come when his implants would be accepted all over the world.
It’s one thing to do excellent research and develop a superior product, quite another to make the news known.
Here, P-I received invaluable help from Professor George Zarb, who had learned about the Swedish implants through prosthodontic colleagues. Zarb and his team came as the first guests from abroad to be trained in the Brånemark System in Gothenburg. That was before the end of 1978.
It’s hard to imagine now, but all of those who came to our remote country to learn about implants before the breakthrough of recognition that came in 1982 subjected themselves to a degree of risk.
Becoming clinically involved with oral implants at that time was not regarded as the best way to promote one’s career as a clinical scientist.
Therefore, these pioneers remain our dear friends to this day.
Even though he had up to fifteen- years of clinical follow up at the time, P-I himself was hesitant to present his research to the public in Toronto in 1982. He felt, quite simply, that it might be premature.
In fact, at three different times in the spring of 1982, he gave the order that the battle was to be postponed. We, his soldiers, had become so used to gun smoke by that time, however, that we “didn’t hear” our supreme commander.
Due in part to the top-rate organization supervised by George Zarb, and in part due to the contents of the meetings themselves, I believe that almost everyone who participated at the Toronto conference—and that included P-I himself—agreed that the meeting was a real breakthrough for osseointegration.
P-I Brånemark’s success was further documented a few years later when the Brånemark System (still sold and supported by Nobel Biocare today) became the first implant to receive recognition by the American Dental Association.
In the meantime, he had been awarded so many odontological decorations that he couldn’t wear them all at one time, no matter how formal the occasion.
P-I Brånemark was a man of ideas and ambition who never accepted any limits for what could be achieved.
His was a truly innovative mind that inspired others. He performed wonderfully as a guide for young people and—in the best sense of the word—P-I was a visionary leader.
Working with imagination, insight, and boldness, he presented his colleagues and students with a series of challenges that called forth the best in them as they pursued a shared sense of purpose. He taught us to keep our eyes on the horizon, not just on the work at hand. We are all richer for having known him. May he rest in peace.
A 44-year success story
by: Christer Dagnelid
January 10, 2012
Sven Johansson has had oral implants longer than anyone else on Earth.
Longevity comes from careful planning, quality products and treatment, and conscientious follow-up.
Gösta Larsson of Gothenburg, Sweden, was the first patient to be treated with implants by Professor Per-Ingvar Brånemark. That was in 1965. When Larsson passed away in 2006, he had had his implants— still in place and fully functioning— for more than forty years.
Brånemark’s second patient, Sven Johansson, also of Gothenburg, received his implants in 1967. This year will mark the 45th anniversary of his treatment, which makes him a part of living history in the field of osseointegration. Sven’s missing dentition was restored with two full-arch gold/ acrylic bridges supported by a total of 11 Brånemark System implants in the upper and lower jaw. Further developed by Nobel Biocare, this signature system is still widely used and much appreciated today.
All too common story
Like so many other members of his generation, Sven had had problems with his teeth from an early age. Born in 1925, by the time he was in his 40s, he was completely edentulous. The usual prosthetic solution at that time—the 1960s—was treatment with full dentures.
Dentures didn’t suit Sven well, however, and he experienced major problems in his relationships to other people as a result.As with so many other denture wearers, he had difficulty eating and he felt insecure in many common social situations.
At the time, Sven was a cab owner and driver in Mölndal, a small town on the outskirts of Gothenburg. One day he received a call to drive a patient to the Brånemark Clinic, which was located there, and the passenger turned out to be none other than Gösta Larsson—Patient No. 1—who had not only been the first to be treated with Brånemark System implants, but had also been treated in both jaws.
Gösta Larsson spoke highly of the professionalism of the people he had met at the clinic, the care he had received there, and the dramatic change he had seen in his life because of the results. His driver, Sven Johansson, decided immediately to book a consultation. After careful X-ray examinations, a thorough evaluation of the amount of remaining jawbone and a psychological exam, Sven was deemed suitable for treatment.
A bold decision paid off
Sven, by nature, is a brave soul. When he decided to subject himself to implant surgery, it had only been carried out once before, after all. When I asked him at a routine check-up this December if he hadn’t been anxious about submitting to the procedure, he simply shook his head and replied, “Not at all!” As it turned out, he had no reason to worry, of course. Always a man of few words, he explained succinctly, “The surgeries went very well. I had no problems.”
Before 1967 came to an end, Sven felt secure once again in social situations that he had tried to avoid ever since becoming edentulous.
His diet improved too. Sven had dreamed for years of once again being able to take a bite out of a large green apple, and that dream came true before the new year as well. In Sven’s own words, “Everything worked perfectly from the first moment.”
In 1976, I took over Professor Brånemark’s dental practice in Mölndal, and thus inherited Sven Johansson as a patient. A good patient, Sven has rarely missed a regularly scheduled dental check-up throughout the 44+ years his implants have been in place. He has practiced good oral hygiene and problems such as peri-implantitis have never been a concern.
Prerequisites for longevity
From our side, as dentists, it is essential to create the conditions for good oral hygiene through the proper design of bone-anchored prosthetic reconstructions. Well-designed occlusion and articulation are also important prerequisites for optimal loading of the implants and essential for implant longevity.
Sven, and thousands of other patients since Sven was first treated, have received instructions in good oral hygiene practices by my wife, Dental Hygienist Eva Dagnelid. From the moment he first received his Brånemark System implants, Sven has never missed a booked recall visit and he has conscientiously followed the oral hygiene advice that we’ve given him.
To ensure longevity, it is also a good idea to follow up every implant patient in an individualized recall program. In as much as the implant treatment amounts to a major investment for the patient, our objective is uncompromising: “Life-long service.”
Over the last 30 years, I have participated in and performed thousands of Brånemark System dental implant cases. High-quality products, skilled clinicians, good teamwork and an individualized recall system have led to great success and implant longevity for me, my colleagues and— most importantly—for our patients.
The experience we have gained since Gösta Larsson and Sven Johansson were first treated by Professor Brånemark has taught us that good implant-related dental care must be based on a long-standing relationship between the patient and dentist, where the number and frequency of return visits are tailored to the different stages of life.
I take my hat off to Sven Johansson, who is rapidly approaching 90, and Professor Per-Ingvar Brånemark. Through a combination of boldness and insight they have helped millions of orally handicapped people return to a life of dignity over the last half-acentury.
The titan of titanium
by: Frederic Love
January 28, 2011
Science is what you know. Philosophy is what you don’t know. Per-Ingvar Brånemark remains interested in both. Nobel Biocare News brings you one of his rare interviews.
At its annual inventor awards ceremony this spring, the European Patent Office (EPO) presented Professor Per-Ingvar Brånemark with the organization’s lifetime achievement award for his discovery and development of osseointegration.
Regarded as the most prestigious prize for European inventors, the award went to Brånemark because, “During the course of his career, he has continued to refine his approach into what has become the gold standard of dental implantation globally—the method of osseointegration.”
According to the EPO, “more than eight million people have benefited from Brånemark’s landmark methods,” since he treated his first osseointegration patient, Gösta Larsson, in 1965.
Serendipity and hard work
I met with Professor Brånemark recently, not far from the University of Gothenburg, Sweden, where he has worked most of his life. When I asked about the award, he replied simply. “I have received quite a few prizes and awards over the years, but this beats everything else. It represents recognition from colleagues and laymen alike that my method has already helped an enormous number of people. What greater commendation can a scientist hope to receive?”
He has come a long way since those early days in the 1950s when, as a young researcher, he was completely absorbed in the study of the anatomy of blood flow.
As part of that work, he attached a titanium-housed optical component to a rabbit’s leg, which made it possible to study microcirculation in the bone tissue through specially modified microscopes. The work at hand was completed successfully, but when it came time to remove the metal-framed optics from the bone, Brånemark famously discovered that the bone and titanium had become virtually inseparable.
“Not long afterwards,” Brånemark said, “we changed the direction of our work to investigate the body’s ability to tolerate titanium.”
To gain a proper understanding of what he would later call “osseointegration,” Brånemark recruited experts from other fields—such as physics, chemistry and biology—to his quest. Physicians, dentists and biologists all joined the effort. Together they developed diligent, methodical techniques for the insertion of implants. At the same time, engineers, physicists and metallurgists studied the metal’s surface and how the design of the implant might have an effect on bone healing and growth.
For the best part of two decades, Brånemark faced opposition from the medical establishment in his native Sweden. “Our findings that the body would accept titanium over the long term, and even allow it to integrate in bone, flew in the face of conventional wisdom,” he explained.
“Theorists’ textbook opposition asserted that our implants would trigger initial inflammation and would ultimately be rejected by the body’s immune system.”
The 1960s were trying times for Brånemark. Funding from Swedish research organizations dried up, yet he persevered. With his physician’s certification at stake, he repeatedly demonstrated the accuracy of his claims and the viability of osseointegration. Finally, in the mid-1970s the Swedish National Board of Health and Welfare approved the Brånemark method.
To reach beyond the world of the university clinic, Brånemark looked for an industrial partner. “I chose Bofors, an antecedent to Nobel Biocare, because they were one of thefew companies who knew how to machine titanium,” says the professor. Thus a long term relationship began.
Over the years, this relationship has had its ups and downs, but both parties have benefited from a longterm devotion to the support and practice of good science. When I asked Brånemark what characterizes good science for him personally, he responded thoughtfully.
“Good science is all about good method. Making observations, collecting facts and data and creating a hypothesis to explain what you’ve seen—it all starts there. Then you have to deduce the implications of the hypothesis and put the implications to the test. It is very important that all data be considered, not just those that support your ideas. Finally, you have to subject your findings to peer review. At the end of the day, there may be no ‘final’ truth, but in our field, a valid hypothesis will inevitably lead to practical achievement as it stands up to the scrutiny of other researchers in the field.”
As successful as Brånemark has been as a scientist, he has also been successful as an evangelist for the “good news” of osseointegration. When I point out that people listen to him, and ask why, he responds with a smile on his face.
“They listen to me because I know what I’m talking about. Before treating the first patient, I had accumulated more than ten years of experience in the lab, for example. I don’t rush to conclusions, and I think people appreciate that.”
When Per-Ingvar Brånemark received one of the many honorary doctorates awarded to him by universities around the world, British Professor Richard Johns of the University of Sheffield told the assembled dignitaries that he regarded Professor Brånemark as an “unreasonable man” and went on to quote George Bernard Shaw. “All progress depends on the unreasonable man. The reasonable man adapts himself to the world: The unreasonable one persists in trying to adapt the world to himself. Therefore, all progress depends on the unreasonable man.”
I follow up with the question, “How much of your success can be accounted for by such personal characteristics as perseverance—stubbornness, if you will—and how much by the apostles you recruited around the world?”
“One person alone can’t have much impact on the world. I’ve been privileged to meet and collaborate with some extremely talented people over the years. In addition to all the dental and medical students who have passed my way, I had something like 44 doctoral candidates at the University of Gothenburg over the years, and almost all of them taught me as much as they learned.”
Per-Ingvar Brånemark has coined many words and phrases that have become commonly used terms in dentistry. “Fixtures”, “anaplastology” and “osseointegration” come immediately to mind, of course. When he introduced the concept of the “third dentition,” Brånemark got thousands of professionals to start thinking of implant-based solutions not as “false teeth” but “total rehabilitation.”
“I chose these words because I found them succinctly descriptive. There’s a beauty in language like that. I certainly didn’t anticipate how widely they would be accepted, but was pleased, of course, to see how quickly they gained traction in both scientific literature and clinical communication.”
When asked to comment on the practicalities of cooperative efforts between science and industry, Brånemark takes the high ground.
“We have always needed each other’s expertise and have generally enjoyed a symbiotic relationship. In an ideal world, maybe talented scientists would also be gifted production engineers and marketers; and maybe industrialists would be able to see beyond the bottom line; but in the real world—in order to achieve our goals—we each do what we do best and turn to others with complementary skills for help with the rest.”
To the question, “Do you think that Nobel Biocare has succeeded in being a good steward of the trust that you long-ago established among dentists?” Brånemark replies: “I think I see a company today that wants to build on its scientific heritage. Together we ushered in a new era, but we all have to remember to respect the molecules. Our method stands for reconstructive biology not carpentry.” Looking toward the future, he adds, “I’ll be very happy if Nobel Biocare keeps the rigorous scientific philosophy of the early years alive in its corporate culture.”
Eye on the horizon
While we’re on the subject of the future, I ask, “What’s next?”
“If you’ll allow me to speculate a bit, I believe that we may be on the threshold of a paradigm shift in the professions we practice. Once we realize that biology—especially immunology—lies at the heart of both modern dentistry and medicine, I think we’ll start educating dentists and doctors along similar lines at the same institutions. Perhaps the traditional partitions between them will even disappear altogether in the next generation or two.”
“As far as my own research is concerned, I see great strides being made in the area of osseoperception, whereby bone-anchored prostheses transmit information that can be intuitively interpreted via the central nervous system. I have patients with osseointegrated limbs, who can actually ‘feel’ the texture of the rugs on which they’re walking today. This aspect of osseoperception is a bountiful field for further research.”
Eighty-two years-old and still full of enthusiasm for the work at hand, Professor Per-Ingvar Brånemark remains the best known personality in the world of osseointegration to this day. He has certainly earned the title, “Father of modern clinical implantology.”
Millions of smiles, millions more to come
by: Jim Mack
December 31, 2014
One man’s groundbreaking discovery and life’s work are just the beginning for the people of Nobel Biocare.
A true pioneer and innovator, Professor Brånemark continues to inspire friends and colleagues at Nobel Biocare. He taught us to put patients first as he unrelentingly pushed the limits of rehabilitation from oral and maxillofacial solutions to ever more advanced uses of osseointegrated implants.
For all of us at Nobel Biocare, the life and work of Professor Per-Ingvar Brånemark embodies everything our company stands for. He set the standards, gave us the guidelines and challenged us to be good stewards of his legacy.
“P-I never stopped thinking about how his invention could be used in applications for helping people in one way or another,” reflects Berit Adielson, one of the original nurses responsible for training and certifying early Brånemark System adopters. “He was a very warm person, interested in everyone around him.” After a moment of thought she adds. “And he was, without question, a very curious man.”
Where would it lead?
It was that curiosity of his that turned a temporary setback into a gigantic long-term breakthrough.
Magnus Persson, VP Global Sales Effectiveness explains. “When his optical chambers, made from titanium, integrated with the bone of rabbits and were difficult to remove, most people would have been upset or would have tried to manufacture the chambers in a different material to avoid the trouble. Not Brånemark!”
Instead, this annoying incident led to a discovery that “opened a path to body-part reconstruction”, as Miho Onodera, Marketing Specialist, Japan, puts it.
Professor Stefan Holst, Global Head, Research, Science & Regulatory Affairs, sees the professor’s greatness in slightly different terms. “As curious as P-I was, his most prominent trait was certainly his social responsibility and his focus on the well-being of the individual patient.
“The way he made the transition from a scientific observation to a global treatment concept, made him a living icon for millions.”
An inspiration in many ways
While Brånemark was inspired by his patients, he in turn inspired many people working at Nobel Biocare.
“I have always found it immensely worthwhile to share a few of P-I’s patient stories with new employees,” says Dr. Ramya Narayanaswamy, Training & Education Manager for the Asia-Pacific region. “It gives them a feel for what our company is all about. This part of the training usually leaves them both inspired and proud, and accentuates our ultimate goal: improving the quality of life of our patients.”
Dr. Alexandra Rieben, Head, External Studies & Clinical Evaluations, has always been impressed by the professor’s tenacity.
“What inspires me most about P-I is the entrepreneurial spirit he personified and the imperturbable vision he pursued to improve the lives of millions of edentulous patients. Although the path he chose was full of trials and tribulation, he stuck to his goals. As a result, after decades of struggle, he gained worldwide acceptance.”
Passing the torch
Brånemark set the standard for how Nobel Biocare approaches treating more patients better: Bold innovation backed by research, development, meticulous clinical follow-up and scientific validation.
Anders Glansk, VP Global Marketing, explains. “Due to the original novelty of osseointegration, P-I knew that only if his research was absolutely definitive and flawless, would he stand a chance to convince people. As a result, the methods he and his colleagues developed in the 60s and 70s are still the golden standard today.”
Hans Geiselhöringer, Executive VP, Global Research, Products & Development expands on the same thought. “It is our responsibility to maintain these standards now and in the future. It has been my personal objective to secure the scientific procedures and standards promoted by P-I and ensure that Nobel Biocare innovates with focus on patient relevance while using a fact-based approach.”
According to Thomas Kaup, Group Manager, Product Development, Brånemark had a great grasp of two specialties: engineering and medicine. “While he was supervising every technical detail he also ensured that the results were based on strong clinical evidence. One could say that he was a cross-functional team all by himself!”
From start to finish, Brånemark’s primary concern was always the best interest of the patient. To that end, he advocated teamwork at every stage of the treatment process. Nobel Biocare maintains that commitment today.
“He emphasized the importance of collaboration and exchanging information on every possibility and option to simplify and improve procedures,” says Camilla Billström, Marketing & Products Manager, Sweden. “That certainly permeates everything we do at Nobel Biocare.”
The professor lives on
Like the millions of patients who have benefited from Brånemark’s dedication and achievement, everyone at Nobel Biocare can also smile knowing that he touched our lives significantly, too.
“Like so many others,” says Joe Day, VP Marketing, North America, “I owe him not only my career, but many brilliant life experiences and wonderful friendships all over the world.”
Melker Nilsson, Executive VP, Head of Global Sales and Customer Development, is of the same mind. “From the first time I heard P-I speak back in 1993, it was clear that working for Nobel Biocare would be more than just a normal job,” he says. “Helping—if only on a very modest scale—to implement his vision to help other human beings improve their quality of life was a great privilege. It still is.”
P-I’s spirit obviously runs deep within Nobel Biocare. “We are very proud of carrying on his pioneering legacy and continue to build on this unique heritage,” says Dr. Pascal Kunz, Global Head, Business Unit Guided Surgery & Digital Dentistry. “It is our mission to continuously challenge the status quo, to carefully observe and improve our products and solutions, and to continue to develop meaningful and ingenious innovation.”
Academy of Osseointegration Honors the Life and Legacy of Professor Per-Ingvar Brånemark
The Academy of Osseointegration (AO) expresses its sincere condolences and honors the life and legacy of Professor Per-Ingvar Brånemark – the “Father of Modern Dental Implantology” and an Honorary Fellow of AO.
“Professor Brånemark was a giant, brilliantly scientific intellect, embodied in an equally large compassionate heart. His caring focus was always on the patient,” said Dr. Edward Sevetz, Jr., Past President, Academy of Osseointegration. “His breakthrough discovery of osseointegrated titanium benefits patients throughout the world, and will forever benefit mankind.”
“Professor Brånemark’s work genuinely transformed the dental landscape and the smiles of millions of people across the globe,” said AO President Dr. Joseph Gian-Grasso. “It is because of him that the Academy of Osseointegration exists, and today we honor his memory and monumental legacy. As an organization, we aspire to encompass his passion and to continue his lifelong work to enhance oral health globally.”
In May 1982, Professor Brånemark introduced osseointegration to North America at a conference in Toronto, Canada, sparking much interest and enthusiasm and creating ripples throughout the dental community. Proponents of the new science were determined to improve the success rate of implants.
After learning of this new technique, Dr. Charles Berman and Dr. Gerald Barrack formed the New York Osseointegration Study Group, a small conclave of friends with a shared passion to understand and share knowledge about this new science. This group evolved into AO, as it is known today.
Because of Professor Brånemark’s, and his predecessors’, ongoing commitment to research, technological advancements and proper training, dental implants are now highly predictable and commonplace with a success rate of about 95 percent.
Today is December 20, 2014. With sadness I received a notice that PI Brånemark died today.
Submitted by Steven Eckert, DDS, MS, Editor of The International Journal of Oral & Maxillofacial Implants
We knew that Professor Brånemark was in declining health. We knew that he would not live forever and yet his passing comes as a shock and brings with it a profound sense of loss.
Prof. Brånemark was a researcher, educator, clinician and visionary. His career changed the practice of dentistry and also changed the world.
Professor Brånemark was an orthopedic surgeon whose research interest was in the field of soft and hard tissue healing. The way that this healing was observed was by implanting a lens encased in titanium to observe cellular activity that occurred at the surface of the lens. Cellular activity was recorded to determine how bone heals adjacent to an induced wound. Once the healing was achieved the animal was sacrificed and the lens apparatus was scheduled to be retrieved. Interestingly, the Titanium lens housing remained affixed to the surrounding bone.
At that point the investigators recognized that this union of bone and implanted Titanium was unique. This may be a serendipitous series of events but serendipity demands keen insight to appreciate the fortunate chain of events. Indeed, this is what Brånemark and colleagues appreciated and this became the first demonstration of osseointegration.
Today we see rapid commercialization of basic science research but in the early 1950’s such translational research was not terribly common. Hence Brånemark did not move osseointegration from the laboratory to the clinical floor until the initial observations were confirmed and demonstrated to be repeatable. The team conducted animal research for more than a decade before initiating human research and that research went on for another decade before it was presented to the world.
Brånemark proved himself to be a charismatic educator. Once osseointegration was presented to the dental community Brånemark was the primary voice to explain the formula. It was not simple nor was it rapid but it was predictable and that level of predictability had not been previously observed in implant dentistry.
As a clinician Brånemark demonstrated the techniques that were developed in his laboratory by operating at different centers throughout the world. Clinical innovation transformed osseointegration from the management of the edentulous mandible to the management of the edentulous maxilla and the ongoing development of techniques to treat partial edentulism with implant retained prostheses.
Beyond the expansion of uses for implants in dentistry, Brånemark’s vision extended to the field of orthopedics. Osseointegration is now utilized in dental, medical and veterinary applications. Indeed he has taken this concept from “calvarium to calcaneus.”
His vision extended beyond devices. He had true compassion for the level of debilitation that patients experience. If you look at his ideas you will see innovative designs that, once embraced, could lead to more economical services for patients who are in need. The Brånemark Novum and the Zygomaticus implant are two examples of devices and techniques that could lead to less surgical intervention with shorter prosthesis free healing times. Ultimately these approaches were designed to reduce cost, which would ultimately bring a better service to a broader number of patients.
From a purely personal standpoint I will always remember the first time I met Professor Brånemark. He was leading a course at the Mayo Clinic where I was a young member of the consulting staff. My wife, Susan, and I attended the banquet that followed the meeting, with any seat available to our guest of honor, Professor Brånemark sat next to Susan and me. He was charming, entertaining and welcoming. I will never forget that evening.
Today we mourn the loss of Professor P-I Brånemark. At the same time we celebrate the honor of having known him and thank our good fortunes for the knowledge that he provided.
Steven Eckert, DDS, MS, Editor of The International Journal of Oral & Maxillofacial Implants