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Per-Ingvar Brånemark passed away on 20 December 2014 at the ageof85.Throughouthiscareeras a researcher, he overcame fierce oppositiontodentalimplantsand revolutionised methods for treat- ingedentulouspatients. An extremely gifted scientist, Brånemark was also as witty and quickonhisfeetastheycome.Var- ious language editions of Reader’s Digest, hardly considered a med- ical journal of note, published an article in the late 1960s about his research on microcirculation. At the end of his first lecture about dental implants in Landskrona in Sweden in 1969, a member of the audience, who turned out to be a senior academic of Swedish dentistry, rose and commented, “This may prove to be a popular article, but I simply do not trust people who publish themselves in Reader’s Digest.” As it happened, that senior academic was well known to the Swedish public for havingrecommendedaparticular brand of toothpick. Brånemark immediatelyroseandstruckback, saying, “And I don’t trust people who advertise themselves on the back of boxes of toothpicks.” Young and naive as I was, Ithoughttheywerejustpokingfun ateachother,butitturnedouttobe the opening shot of an eight-year battle with the dental profession. Whensomeonecastaspersionson dentalimplantsseveralyearslater because Brånemark was not a practi- tioner, he lost no time inreplying,“Teaching themanatomyisgood enough for me.” Brånemark com- pleted his medical training at Lund Uni- versity in 1959 with a doctoral thesis on microcirculation in the fibula of rabbits. Grinding the bone to a state of transpa- rency permitted the use of intravital mi- croscopy to analyse the blood flow in both bone and marrow tis- sue.Thethesis,which found wide recogni- tion both in Sweden and abroad, landed Brånemark an ap- pointment at the Department of Anatomy of the University of Gothenburg just a year later. He was appointed as Associate Pro - fessor of Anatomy (later received afullprofessorship)in1963,which qualified him for laboratories of his own and the opportunity to surround himself with a team of researchers. Brånemark continued to pur- suehisstudiesinmicrocirculation in animal models and ultimately in humans. A plastic surgery tech- nique was used to prepare soft- tissue cylinders on the inside of the upper arm. He then inserted optical devices encased in tita- nium that enabled intravital mi- croscopy of microcirculation in male volunteers. By the late 1960s, he was able to produce the highest resolution imagesofhumancirculationinthe history of medicine. Many people arefamiliarwithLennartNilsson’s photographs of circulation that were taken at Brånemark’s labo - ratories and developed at the De- partment of Anatomy. Brånemark used a hollow optical device surrounded by titanium to study microcirculation in rabbit bone, permitting both bone and blood vessels to grow through a cleft where they could be examined by means of light microscopy. During such an experiment in 1962,hediscoveredthattheoptical device had fused into the bone, a processthatheeventuallydubbed osseointegration. He revealed his incomparable strength as a re- searcher at that very moment, realising im- mediately that the dis- covery had clinical po- tential and determining to focus on the develop- mentofdentalimplants, an enterprise that had hitherto been regarded as beyond the scope of medical science. Brånemark grasped the fundamental truth that edentulousness re - presents a significant disability, particularly for people who cannot tolerate dentures for some reason. He oper- ated on his first patient in 1965, a mere three years later. The aca- demic community was largely distrustful and hostile to the new ap- proach. The debate was not put to rest until 1977, when three pro- fessorsatUmeåUniversityinSwe- den announced that Brånemark’s technique was the recommended first-line treatment. Opposition in other countries eventually waned as well and dental implants, origi- nallymanufacturedbyamechanic inthebasementoftheDepartment of Anatomy, scored one interna- tional triumph after another. Nowadays, an estimated 15–20 millionosseointegrateddentalim- plantsareinstalledeveryyear,and anumberofdifferentacademiesin the field hold annual conferences attended by as many as 5,000 par- ticipants each. The University of Gothenburgfeaturesapermanent exhibit on osseointegration tech- nology and there is a museum in Brånemark’shonourattheFaculty of Stomatology of Xi’an Jiaotong University in Xi’an in China. The P-I Brånemark Institute has been alsoestablishedinBauruinBrazil. Not only dentistry Back in the 1970s, Brånemark began collaborating with ear specialists and technicians at Chalmers University of Technol- ogy to explore the additional po- tentialofosseointegratedimplants for developing hearing aids in- sertedbehindtheear.Hundredsof thousands of patients around the world have had operations based on the technology initially devel- oped in Gothenburg under his direction. Those of us who were on the team at the time will never forget a teenage girl who suffered from the effects of thalidomide. The medicine had caused not only limb deformities, but also hearing loss in many patients. Equipped with the new hearing device, she learnt to speak flawlessly. The team also targeted facial deformitiesoccasionedbycongen- ital or acquired injuries. A number of implants installed in the visce- rocranium served as fasteners for silicon prostheses, a much more attractive option than attaching them to the patient’s glasses. Since the first operation in 1977, the use of the technology has become widespread internationally. Titanium implants installed in the femur were the next spin-off of Brånemark’s research. Patients with above-knee amputations cannot have socket prostheses around soft tissue and may have to relyonawheelchairtogetaround. Inserting titanium screws in the femoral stumps permitted the installation of a prosthesis and the ability to walk again. I can still remember the first patient as if it were yesterday. Another teenage girl had been run over by a street- car in Gothenburg and had above- knee amputations in both legs. She was consigned to spending the rest of her life in a wheelchair. Theoperationwashighlysuccess- ful and she learnt to walk again. Acclaimed around the world Brånemark was fuelled by a passion to help difficult-to-treat patients, and many of his clinical discoveries from the first dental implantonweremadeinresponse to cases that had been regarded as hopeless. His innovative ge- nius, fortified by a large research laboratory at the Department of Anatomy, also skyrocketed Gothenburg-based pharmaceuti- cal companies like Nobel Biocare and Astra Tech into leading posi- tions in the global market. He was devoted to the academic commu- nity’ssocialresponsibilitylongbe- fore many of his colleagues were aware of, much less accepted, the concept. Ultimately, the world came around and he was awarded honorary doctoral degrees by 29universitiesandhonorarymem- bershipsbymorethan50scientific associations—not to mention the Royal Swedish Academy of En - gineering Sciences’s medal for technical innovation, the Swedish Society of Medicine’s Söderberg Prize, the European Inventor Award for Lifetime Achievement and many other distinctions around the world. DT World News DENTALTRIBUNE Asia Pacific Edition No. 1+2/20158 Dental Group Editor Daniel Zimmermann talking to Per-Ingvar BrånemarkataconferenceinGothenburgin2009.(PhotoArchive) Per-Ingvar Brånemark. Per-Ingvar Brånemark— An innovative genius Prof. Tomas Albrektsson, Sweden, remembers the man who changed dentistry with the discovery of osseointegration of dental implants P r o f . To m a s Albrektsson is working as a professor at the universities in Gothenburg and Malmö in Swe- den. He can be contacted at tomas.albrektsson@ biomaterials.gu.se. Contact Info DTAP0115_08_Albrektsson 09.02.15 10:57 Seite 1 DTAP0115_08_Albrektsson 09.02.1510:57 Seite 1