Dental Tribune Nordic Edition No. 3, 2015

Dental Tribune Nordic Edition | 3/201504 NORDIC NEWS The concept of osseointegration has been applied to dental implants for several decades. As an orthopaedic surgeon and engineer, Dr Rickard Brånemark has continued the work of his famous father by adapting the concept to the treatment of am- putees. In an recent interview with Dental Tribune at the EAO congress in Sweden, Brånemark explained the benefits and future possibili- ties of osseointegrated amputation prostheses. Dental Tribune: Dr Brånemark, could you please give an outline of the development of osseointegrated prostheses? Dr Rickard Brånemark: The work started by my father was the foun- dation of what we do in ortho- paedics today. Using his concept, I developed new treatments for amputees based on osseointegrated implants, which I have been per- formingforabout25–30yearsnow. Since 1998, I have mostly worked with my own companies, namely Brånemark Integration, the dental company I started with my father, and Integrum, which does all the developmentfororthopaedicosseo- integration. However, we now also have multinational collaborations with universities in Gothenburg, Vienna, San Francisco and Chicago, and hopefully also Göttingen in the nearfuture.AstheSwedishimplant system has recently been approved by the US Food and Drug Adminis- tration (FDA) for the treatment of amputees, I am currently establish- ing an orthopaedic osseointegra- tion centre in San Francisco and am workingcloselywiththeUSDepart- ment of Defense, which has many soldiers with amputations and is thus very interested in supporting ourwork. What do you consider the main challengesofthistreatment? Anchoring something to the bone is the core of osseointegration technologyandthatisafairlyrobust technology we have proven in mil- lions of dental implants. However, in orthopaedics, we face additional challenges. There are, for example, no materials available today that are strong enough to withstand 20–50yearsofhighphysicalactivity. Therefore, we have developed and continue to develop new materials and surfaces that better withstand thehigherloads. Anotherimportantconcernisthe mucosal area and skin penetration, whichismaybeevenmorechalleng- ing. We are working with a concept very similar to the old Brånemark protocol and the bone-anchored hearingaidinthatwehaveasmooth surface that is not an attachment. There are many groups working with attachments and, as far as I know, all have failed, especially in theorthopaedicfield. However, just like with every surgical procedure, the outcome largely depends on the skills of the surgeontoo. For the last six years, you have also been using osseointegration in con- junction with implanted electrodes. Could you tell us more about this programme? Yes, we are also developing the next generation of amputation prostheses. In addition to the os- seointegrated implant, we are able to attach electrodes to muscles and nerves to have a brain-controlled prosthesis, which helps us to direct the prosthetic device in a much better way and provides feedback. This is extremely important for trulyrestoringfunction. The main advantage of our approach compared with our com- petitors is that they have to use wireless technology because they do not have the means to bring wires out of the body owing to the risk of infection. However, we have this fantastic osseointegrated im- plant to use as a conduit so that the wires can pass through the implant system. Similar to a fibre- opticInternetconnection,thewired connectioninaroboticarmismuch better,stableandrobust. We have already successfully treated one patient. However, our research is still in the early phase, but I think we could do amazing thingsinthefuture. Do you think that osseointegrated prostheses could potentially replace traditionalprosthesesinthefuture? This treatment would not apply to amputations of the lower leg as a result of poor circulation caused by diabetes or vascular diseases related to smoking. Such patients constitute about 90 per cent of the amputee population. However, the younger population who have been inroadorwaraccidentsorwhohave musculoskeletal tumours, which are more likely to occur in younger patients, will be candidates for this treatment. If the technology continues to be as promising as it appears now, the majority of patients will opt for it— just like they now have the choice between dentures or fixed dental implants, which are much better for the patient. There will be a shift, but this will take some time. The introduction of dental implants took about 17 years; similarly, this shift could take another ten to 20 years. However, receiving FDA approval and having the system in use by the military could definitely speeduptheestablishment. Overall, this treatment offers many alternatives to conventional treatments. However, there is often too much conservatism in the den- talandmedicalfieldswhenitcomes to innovations, but I think we need to stay open-minded to new crazy ideas. This research shows what might be possible in the future. We might be able to restore sensory function of a non-existing limb, creating good artificial sensation. It also shows that the dental and the medical professions should work more closely together. As one can see, there are many synergies that could be drawn from the fields of dental and orthopaedic research in our case. The idea of translation of knowledge was also the original idea of the EAO, which has now become a purely dental meeting. Thisisapitybecausewehavetocol- laboratemore,butmaybetherewill be more cross-disciplinary presen- tationsandmeetingsinthefuture. Thankyouverymuchfortheinterview. “We need to stay open-minded to new crazy ideas” An interview with Dr Rickard Brånemark,Sweden The Dental Tribune International C.E. Magazines www.dental-tribune.com Shipping address City Country Phone Fax Signature Date PayPal | subscriptions@dental-tribune.com Credit Card Credit Card Number Expiration Date Security Code €44/magazine (4 issues/year; incl. shipping and VAT for customers in Germany) and €46/magazine (4 issues/year; incl. shipping for customers outside Germany).** Your subscription will be renewed automatically every year until a written cancellation is sent to Dental Tribune International GmbH, Holbeinstr. 29, 04229 Leipzig, Germany, six weeks prior to the renewal date. 4 issues per year | * 2 issues per year *** €56/magazine (4 issues/year; incl. shipping and VAT) ** Prices for 2 issues/year are €22 and €23 respectively per year. CAD/CAM cone beam cosmetic dentistry* DT Study Club (France)*** gums* implants laser ortho prevention* roots I would like to subscribe to \ SUBSCRIBE NOW! fax: +49 341 48474 173 | e-mail: subscriptions@dental-tribune.com AD Dr Rickard Brånemark DTNE0315_04_Branemark 02.11.15 10:59 Seite 1 \ SUBSCRIBE NOW! fax: +4934148474173 | e-mail: subscriptions@dental-tribune.com DTNE0315_04_Branemark 02.11.1510:59 Seite 1

Dental Tribune Nordic Edition No. 3, 2015

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