As befits the founder of the durable dental implant, Per-Ingvar Branemark, the Swedish orthopedic surgeon and research professor who struggled long and mightily to gain acceptance of modern dental implants, died on December 20, 2014 at the venerable age of 85. His legacy lives on in the enduring implants of countless patients whose lives he transformed and who would do well to honor his groundbreaking research and tenacity.
Implants have been a major advance in dentistry, liberating millions of elderly people from painful, ill-fitting dentures, a diet of soft foods and the ignominy of a sneeze that sends false teeth flying out of the mouth. Addressing those problems, however, was not Dr. Branemark’s initial interest but rather the study of how blood flow affects bone healing.
In 1952, he and his research team put optical devices encased in titanium into the lower legs of rabbits in order to study the healing process. When the research period ended and they attempted to remove the devices, they discovered to their surprise that the titanium had fused into the bone and could not be removed
Dr. Branemark called the process “osseointegration” and reoriented his research in realizing that if the body could tolerate the long-term presence of titanium, the metal could be used to create an anchor for artificial teeth. Alas, gaining acceptance of this concept by the dental profession proved daunting and demanded a long period of testing on rabbits and supportive students who willingly had small titanium instruments inserted into their upper arms that still bear small scars.
Even after years of experimentation, though, it was difficult to convince the medical and dental establishment that titanium could be integrated into living issue. The conventional wisdom was that the introduction of any foreign material into the body would inevitably lead to inflammation and, ultimately, rejection.
After Dr. Branemark gave a lecture on his work in 1969 one of the senior academics of Swedish dentistry rose and referred to an article in Reader’s Digest describing Dr. Branemark’s research, adding, “This may prove to be a popular article, but I simply do not trust people who publish in Reader’s Digest.”
As it happened, that senior academic was well known to the Swedish public for recommending a particular brand of toothpick. So Dr. Branemark immediately rose and struck back, saying, “And I don’t trust people who advertise themselves on the back of boxes of toothpicks.”
A turning point came in 1982 at a professional meeting in Toronto, where Dr. Branemark made the case for osseointegration and won widespread recognition for his materials and methods. Since then, millions of people worldwide have been spared dentures because of his work including his first patient, a man with a cleft palate, jaw deformities and no teeth in his lower jaw. The operation giving him four titanium implants allowed him to use dentures until his death four decades later.
Today Titanium implants have spread well beyond dentistry: Osseointegration is now used in medical and veterinary applications and Dr. Branemark’s long odyssey of research and advocacy has been vindicated. He would not, however, prefer to be known as the father of dental implants. According to his wife, a nurse who worked closely with him for 40 years, he felt the word was star crossed. “Before they found out how to do it properly, before it was a science, implants destroyed a lot of patients,” she said. “He wanted to find another word — ‘fixtures’ is what he called them — for the titanium that integrates into the bone.” [ Abridged and edited from the New York Times 12/28/14]