Celebrating the life of Prof. Brånemark

Dental Tribune International

Fri. 20. December 2024

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KARLSHAMN, Sweden: Today marks ten years since the death of Prof. Per-Ingvar Brånemark, the Swedish physician and anatomist whose serendipitous discovery of osseointegration in the early 1950s revolutionised the field of dental implantology and paved the way for the development of the discipline as we know it today. An article published in Cureus in November offers an overview of the career and influence of the distinguished clinician, who famously stated: “No one should have to die with their teeth in a glass of water beside their bed.”

Born Per-Ingvar Persson in Karlshamn in 1929, Persson studied at Lund University in Sweden, researching the microscopy of bone marrow and graduating in 1959. It was around that time that he changed his family name to Brånemark. The name translates into English literally as one “who breaks ground”, therefore the young physician seemingly intended to make a lasting impact. Prof. Brånemark began researching dental implants in 1965, and became a professor of anatomy at the University of Gothenburg in Sweden in 1969; however, it was his key discovery of osseointegration some ten years earlier that would be of the utmost importance to his life’s work.

Radiograph of Prof. Brånemark’s first implant surgery showing an implant placed in a rabbit’s tibia and fibula. (Image: CC BY 3.0, no changes made)

In the early 1950s, Prof. Brånemark was researching the relationship between blood flow and bone healing when he inadvertently discovered that titanium could be fused to living bone. He had placed titanium optical devices in rabbit tibiae and fibulae to study the healing process and found that he was unable to remove the devices after the research period. The bond, he ascertained, was so strong that it could only be broken through fracturing. The authors of the article, led by Prof. Deepesh Saxena and Dr Abhinav Sharma, both prosthodontics and implantology specialists at Subharti Dental College and Hospital in India, explained that this discovery was followed by in vivo studies on bone, marrow and joint tissue to “assess the mechanical, chemical, thermal, and rheological reaction of the injured tissue”. Long-term studies were subsequently conducted into the reactions of bone and marrow to the placement of screw-shaped titanium implants, firstly in rabbit tibiae and fibulae and later in canine dental extraction sockets, the implants in the latter being tested for the loading of fixed prostheses after healing. “[The success of the implants] was attributed to the fact that during the healing period, a shell of compact cortical bone was formed around the implant without any intervening soft tissue between the implant’s surface and the living bone,” the authors wrote.

In the first study of osseointegration in humans, optical titanium chambers were placed in the upper arms of 20 of Prof. Brånemark’s laboratory students, and the study found no evidence of inflammation. The conclusion was that osseointegration could be effective in humans. Dr Tomas Albrektsson, a contemporary of Prof. Brånemark at the University of Gothenburg, told the New York Times in 2014: “You have to understand, every male in the lab was considered a volunteer, including my older brother.” He added: “They all have a nice scar in their upper arm to this very day. I’m the only one who got out of it, saying that they needed me as the control group for the Albrektsson genes.”

“I never felt any hesitation. Gösta had a great need, one that I felt we could meet, and so we got started.”—Prof. Per‑Ingvar Brånemark

Gösta Larsson—a resident of Gothenburg—received the very first dental implant surgery in 1965, having four mandibular titanium implants placed supporting a complete fixed-arch metal-resin prosthesis. Larsson’s dental implants served him well until his death some 40 years later. Never having been known to mince his words, Prof. Brånemark was quoted as saying: “I never felt any hesitation. Gösta had a great need, one that I felt we could meet, and so we got started.”

Working against conventional wisdom

Dental innovators of today may sympathise with the initial scepticism Prof. Brånemark received from the medical fraternity of the day. The road to acceptance of osseointegration as a viable medical procedure went against conventional medical wisdom, which held that the body would ultimately reject foreign materials. Numerous grant applications were declined until a grant to study the development of dental implant placement in bone tissue was provided by the US National Institutes of Health. Prof. Brånemark’s dental implant system was authorised by Sweden’s National Board of Health and Welfare in 1970, and its commercialisation began in 1981 when Prof. Brånemark partnered with the newly founded Bofors Nobelpharma, which would later be known by another, more familiar name: Nobel Biocare. Prof. Brånemark presented clinical findings at the Toronto Conference on Osseointegration in Clinical Dentistry in a landmark lecture in 1982, and US Food and Drug Administration approval for the use of his system in the US swiftly followed. Today, most dentists know of the origin of leading dental implant manufacturer Nobel Biocare, but others may be surprised to learn that it was the vehicle that ultimately brought Prof. Brånemark’s dental implant system into the mouths of millions of patients around the world.

When Prof. Brånemark died on 20 December 2014 in Gothenburg, aged 85, he left an indelible mark on dentistry, despite never having studied or practised the profession. He also made lasting contributions to the fields of orthopaedics and otology and received a number of international accolades, such as the Söderberg Prize from the Swedish Society of Medicine in 1992, an honorary doctorate from the European University of Madrid in 2003 and a Lifetime Achievement Award from the Greater New York Academy of Prosthodontics in 2012.

As the international dental community marks ten years without one of the great medical innovators of the 21^st century, let us reflect on the introduction given to Prof. Brånemark by Prof. Richard Johns, dean of the University of Sheffield in the UK, upon presenting him with an Honorary Doctor of Science degree in April 1992. Quoting The Doctor’s Dilemma, a play written by George Bernard Shaw, Prof. Johns said: “The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself.” Prof. Brånemark, he added, was indeed the latter.

Editorial note:

The article, titled “Dr. Per-Ingvar Branemark: The father of modern dental implantology”, was published online on 18 November 2024 in Cureus, ahead of inclusion in an issue.

The ACP P-I Brånemark Archive, an online collection of information and memorabilia published by the American College of Prosthodontists, can be accessed here.