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obituary I move the device from the bone, Brånemark was sur- prised to find that the bone and the titanium had be- comeinseparable. In a subsequent study of microcirculation, approxi- mately 20 students who volunteered to have titanium instrumentsinsertedintotheirarmsforseveralmonths showednosignsofrejectingthetitanium-enclosedop- tics. At that point, Brånemark changed the direction of hisworktoinvestigatethebody’sabilitytotoleratetita- nium. _Breaking down borders Seeingthatthebodycouldpeacefullycoexistwithti- tanium,perhapsindefinitely,Brånemarkwantedtofind outthereasonswhy.Herealisedthathewouldneedto approachthisnewareaofresearchfromseveraldiffer- entperspectivessimultaneously. To gain a proper understanding of osseointegra- tion—thetermBrånemarkcoinedfortheintegrationof titanium into living bone tissue—he realised that one wouldneedaccesstoexpertiseinphysics,chemistryand biology,attheveryleast.UnderBrånemark’sleadership, physicians,dentistsandbiologistswouldallinvestigate theinterplaybetweenboneandtitanium.Togetherthey developedcareful,methodicaltechniquesfortheinser- tionofimplants.Atthesametime,engineers,physicists and metallurgists studied the metal’s surface and how thedesignoftheimplantmighthaveaneffectonbone healingandgrowth. _Meeting resistance Brånemark found himself working in a headwind. His findings that the body would accept titanium over thelongterm,andevenallowittointegrateinbone,flew in the face of conventional wisdom. In the mid-1960s, physiciansanddentistswerestillbeingtaughtthatfor- eign, non-biological materials could not be integrated into living tissue. Initial inflammation and ultimate re- jectionwereconsideredtobeinevitable. Previoustrialswithimplantshadfailed,afterall,and caused patients considerable suffering. The academic worldquestionedBrånemark’sresearch,partlybecause of the failures of others in the past and partly because he was working in so many different academic disci- plinesatthesametime. FundingfromSwedishresearchorganisationsdried up.Hewasrepeatedlyturneddownwhenheappliedfor renewed grants to study tissue anchored implants, yet he persevered. Eventually the US National Institute of Healthsteppedinandfundedhisresearch,whichmade itpossibleforhimtorepeatedlydemonstratetheaccu- racy of his claims and the viability of osseointegration, butitwasn’tuntilthemid-1970sthattheSwedishNa- tionalBoardofHealthandWelfarewerefinallyprepared toapproveoftheBrånemarkmethod. _For the benefit of the patient In1965aSwedishman,GöstaLarsson,becamePer- IngvarBrånemark’sfirstdentalimplantpatient.Usinga very cautious method that his research group had de- visedtoshowthegreatestpossibledegreeofrespectto thelivingbonetissue,Brånemarkinsertedasetoftita- nium implants that Larsson would have for the rest of hislife. This remarkable patient had been born with a de- formedjaw,andthefourtitaniumimplantsthathere- ceivedthatdaymeantthatasetofnewteethcouldbe attachedtohisjaw.Forthefirsttimeinhislife,hecould eat and talk normally. When he died in 2006, his im- plants had worked without problems as the foundation for a series of oral prostheses for 40 years. Since then, well over ten million people worldwide have benefited from Per-Ingvar Brånemark’s discovery. Both in Sweden and abroad, Per-Ing- var Brånemark’s achieve- mentsinthefieldofosseoin- tegration have opened up entire new areas of promis- ingresearch. Some Brånemark-inspired researchteamsnowfocusontry- ing to better understand how the processes of healing and immune de- fense interact. Others focus on the surface structureandchemistryoftitaniumimplants,inat- tempts 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 ex- plodesaroundtheglobe,yetothercentresscientifically evaluate both new and well-established component designstoensurethatthehighestpossiblestandardsof safetyandefficacycontinuetobemaintainedinthefu- ture.Per-IngvarBrånemark’sgreatestlegacymaybethe factthatmedicalanddentalschoolsnowteachtheuse of osseointegrated implants as a routine part of their normalcurricula. The pursuit of learning for the sake of constant im- provement was paramount in his professional life and reflectedinthisoftenrepeatedmaxim:“Wemustnever forgetthatfromthepatient’spointofview,thecriteria whichdifferentiatebetweensuccessandfailureareal- waysthekeyissueswefaceasateam.”_ I 47implants1_2015