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Dental Tribune United Kingdom Edition

Dental Tribune United Kingdom Edition | 1/20156 Per-Ingvar Brånemark passed away on 20 December 2014 at the age of 85. Throughout his career as a researcher, he overcame fierce opposition to dental implants and revolu- tionisedmethodsfortreatingedentulouspa- tients. An extremely gifted scientist, Brånemark wasalsoaswittyandquickonhisfeetasthey come. Various language editions of Reader’s Digest, hardly considered a medical journal of note, published an article in the late 1960s about his research on microcirculation. At the end of his first lecture about dental im- plants in Landskrona in Sweden in 1969, a member of the audience, who turned out to be a senior academic of Swedish dentistry, roseandcommented,“Thismayprovetobea populararticle,butIsimplydonottrustpeo- ple who publish themselves in Reader’s Di- gest.” As it happened, that senior academic waswellknowntotheSwedishpublicforhav- ing recommended a particular brand of toothpick. Brånemark immediately rose and struck back, saying, “And I don’t trust people who advertise themselves on the back of boxes of toothpicks.” Young and naive as I was, I thought they were just poking fun at each other, but it turnedouttobetheopeningshotofaneight- year battle with the dental profession. When someone cast aspersions on dental implants several years later because Brånemark was not a practitioner, he lost no time in reply- ing, “Teaching them anatomy is good 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. Grindingthebonetoa state of transparency permitted the use of intravital microscopy to analyse the blood flow in both bone and marrow tissue. The thesis, which found wide recognition both in Sweden and abroad, landed Bråne- mark an appoint- ment at the Depart- ment of Anatomy of the University of Gothenburg just a year later. He was ap- pointed as Associate Professor of Anatomy (later received a full professorship) in 1963, which qualified him for laboratories of his own and the opportu- nity to surround himself with a team of researchers. Brånemark continued to pursue his stud- iesinmicrocirculationinanimalmodelsand ultimatelyinhumans.Aplasticsurgerytech- nique was used to prepare soft-tissue cylin- ders on the inside of the upper arm. He then inserted optical devices encased in titanium that enabled intravital microscopy of micro- circulation in male volunteers. By the late 1960s, he was able to produce the highest resolution images of human cir- culation in the history of medicine. Many people are familiar with Lennart Nilsson’s photographsofcirculationthatweretakenat Brånemark’s laboratories and developed at the Department of Anatomy. Brånemark used a hollow optical device surrounded by titanium to study microcirculation in rabbit bone, permitting both bone and blood ves- sels to grow through a cleft where they could be examined by means of light microscopy. During such an experiment in 1962, he dis- coveredthattheopticaldevicehadfusedinto thebone,aprocessthatheeventuallydubbed osseointegration. He revealed his incompa- rablestrengthasaresearcheratthatverymo- ment, realising immediately that the discov- eryhadclinicalpotentialanddeterminingto focus on the development of dental im- plants, an enterprise that had hitherto been regarded as beyond the scope of medical sci- ence. Brånemark grasped the fundamental truth that edentulousness represents a sig- nificant disability, particularly for peo- ple who cannot tol- erate dentures for some reason. He op- erated on his first patient in 1965, a mere three years later. The academic community was largely distrustful and hostile to the new approach. The debate was not put to rest until 1977, when three profes- sors at Umeå Uni- versity in Sweden announced that Brånemark’s tech- nique was the rec- ommended first- line treatment. Op- position in other countries eventu- ally waned as well and dental im- plants, originally manufactured by a mechanic in the basement of the Department of Anatomy, scored one international triumph after an- other. Nowadays, an estimated 15–20 million os- seointegrated dental implants are installed every year, and a number of different acade- mies in the field hold annual conferences at- tended by as many as 5,000 participants each. The University of Gothenburg features a permanent exhibit on osseointegration technology and there is a museum in Bråne- mark’s honour at the Faculty of Stomatology ofXi’anJiaotongUniversityinXi’aninChina. The P-I Brånemark Institute has been also es- tablished in Bauru in Brazil. Not only dentistry Backinthe1970s,Brånemarkbegancollab- orating with ear specialists and technicians at Chalmers University of Technology to ex- plore the additional potential of osseointe- grated implants for developing hearing aids inserted behind the ear. Hundreds of thou- sands of patients around the world have had operations based on the technology initially developed 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 thalido- mide.Themedicinehadcausednotonlylimb deformities,butalsohearinglossinmanypa- tients.Equippedwiththenewhearingdevice, she learnt to speak flawlessly. The team also targeted facial deformities occasioned by congenital or acquired in- juries. A number of implants installed in the viscerocranium 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 wide- spread internationally. Titanium implants installed in the femur were the next spin-off of Brånemark’s re- search. Patients with above-knee amputa- tions cannot have socket prostheses around soft tissue and may have to rely on a wheel- chair to get around. 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 pa- tient as if it were yesterday. Another teenage girl had been run over by a streetcar in Gothenburg and had above-knee amputa- tions in both legs. She was consigned to spending the rest of her life in a wheelchair. The operation was highly successful and she learnt to walk again. Acclaimed around the world Brånemarkwasfuelledbyapassiontohelp difficult-to-treat patients, and many of his clinical discoveries from the first dental im- plant on were made in response to cases that had been regarded as hopeless. His innova- tive genius, fortified by a large research lab- oratory at the Department of Anatomy, also skyrocketed Gothenburg-based pharmaceu- tical companies like Nobel Biocare and AstraTechintoleadingpositionsintheglobal market. He was devoted to the academic community’s social responsibility long be- fore many of his colleagues were aware of, much less accepted, the concept. Ultimately, the world came around and he was awarded honorarydoctoraldegreesby29universities andhonorarymembershipsbymorethan50 scientific associations—not to mention the Royal Swedish Academy of Engineering Sci- ences’s medal for technical innovation, the Swedish Society of Medicine’s Söderberg Prize, the European Inventor Award for Life- time Achievement and many other distinc- tions around the world. WORLD NEWS Per-Ingvar Brånemark— An innovative genius Prof. Tomas Albrektsson, Sweden, remembers the man who changed dentistry with the discovery of osseointegration of dental implants Per-Ingvar Brånemark DentalTribune Group Editor Daniel Zimmermann talking to Per-Ingvar Brånemark at a conference in Gothenburg in 2009.(Photo Archive) Prof. Tomas Albrektsson is working as a professor at the universities in Gothenburg and Malmö in Sweden. He can be contacted at tomas.albrektsson@ biomaterials.gu.se. 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