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31 Jan 2015 | Australasian Dental Practice

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Two men who made history together

Obituaries Implant Surgery

In 2015, the world of dentistry will celebrate the 50th anniversary of applied osseointegration without its creator. Per-Ingvar Brånemark, the Swedish orthopaedic surgeon and research professor whose accidental discovery made him the father of the modern dental implant, died on December 20 last year in Gothenburg, Sweden, his hometown.

Prof. Brånemark's osseointegrated implants have changed the practise of dentistry for evermore and affected the lives of millions of patients worldwide; like everything however, it all began with the first one.

Fifty years ago, Gösta Larsson, also of Gothenburg, was an oral invalid; a cleft palate, jaw deformities and no teeth in his lower jaw made life a struggle for Gösta. Osseointegrated implants, carefully inserted by Prof. Brånemark, would dramatically and forever change his life in 1965 and would do so permanently.

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 realised 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 halfway between Mr Larsson's original surgery and the 2015 golden anniversary. The bandage that protected the surgical wound from his new hearing aid is clearly visible. Just a few months after it was taken, Prof. Brånemark enthusiastically contended that it would be difficult for him to find a more satisfied patient - and he was right!

An enduring legacy

Mr Gösta Larsson, patient number one, passed away 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, celebrates 48 years with his Brånemark System implants this year. No one on the planet has had osseointegrated oral implants longer!

Staying power

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 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," Dr Dagnelid said, "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."

The enduring legacy of Prof. Per-Ingvar Brånemark and first patient Gösta Larsson is that through one man's insight and the other's boldness, millions of orally handicapped people have literally been returned to a life of dignity over the last half-century. And dentistry has changed accordingly as a result.

"I never felt any hesitation. Gösta had a great need, one that I felt we could meet, and so we got started," Prof. Brånemark was once quoted as saying.

Implants in dentistry

Brånemark's work in the field of osseointegration reinvigorated the realm of implant dentistry and brought it from being a shunned field into one that became recognized and incorporated into dental school curricula and training programs.

Early modern dental implant technology consisted of blade and transosteal implants. Blade implants, introduced in 1967, consisted of a metal blade that was placed within a bony incision that subsequently healed over the horizontally situated piece of metal but allowed a vertical segment to perforate the healed surface. Transosteal implants, the application of which was strictly limited to the mandible, consisted of a number of screws which were inserted into the inferior aspect of the mandible, some of which extended through and through into the oral cavity.

It was previously thought that both of these implant types relied on mechanical retention, as it was heretofor unknown that metal could be fused into the bone. With the advent of our current understanding of osseointegration however, rootform endosteal implants became the new standard in implant technology.

The phenomenon of osseointegration was first described by Bothe et al. in 1940 and later by Leventhal et al. in 1951. Prof. Brånemark's studies, and his subsequent coining of the phrase osseointegration, occurred a year after Leventhal during vital microscopy studies in rabbits using titanium optic chambers. He and his team found that titanium oculars placed into the lower leg bones of rabbits could not be removed from the bones after a period of healing. He then developed and tested a type of dental implant utilising pure titanium screws, which he termed fixtures.

Although the field of implantology was eschewed by academia until that time, the extensive and weighty documentation of implant efficacy and safety and early replication by reliable, independent researchers resulted in the widespread embrace of implantology by the dental community.

In 1978, the first Dental Implant Consensus Conference was held, sponsored jointly by the National Institutes of Health and Harvard University. It was a landmark event, at which retrospective data on dental implants were collected and analysed and criteria and standards for implant dentistry were established.

In 1982 in Toronto, Prof. Brånemark presented work that had begun 15 years earlier in Gothenburg. His investigations into the phenomenon of osseointegration, or the biological fusion of bone to a foreign material, reinvigorated the field of implantology. The Toronto conference brought widespread recognition to the Brånemark implant methods and materials and is one of the most significant scientific breakthroughs in dentistry since the late 1970s.

Awards and accolades

Prof. Brånemark was awarded many prizes for his work, including the coveted Swedish Society of Medicine's Soederberg Prize in 1992 - often referred to as the 'mini-Nobel' - and the Swedish Engineering Academy's equally prestigious medal for technical innovation. He has also been honoured with the Harvard School of Dental Medicine Medal for his work on dental implants in the US and held more than 30 honorary positions throughout Europe and North America, including the Honorary Fellowship of the Royal Society of Medicine in the UK. In 2003, he received an honorary doctorate from the European University of Madrid. He was the winner of the European Inventor Award 2011 in the category Lifetime Achievement.

The greatest achievement of all, however, is how the tireless work of Prof. Per-Ingvar Brånemark has changed the world of dentistry and continues to change the lives of millions of people who benefit from it everyday. May he rest in peace.

This article was adapted from Nobel Biocare News with input from Wikipedia and other sources.

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