In honour of Per-Ingvar Brånemark: The first Global Osseointegration Day
To celebrate the discovery of osseointegration by Swedish physician and anatomist Dr Per-Ingvar Brånemark, the first Global Osseointegration Day will be held this year. In an upcoming webinar, Prof. Emeritus Tomas Albrektsson from the Department of Biomaterials of the University of Gothenburg in Sweden will give insights into Brånemark’s discovery and the relevance of osseointegration to implant dentistry. In honour of Brånemark, who was born in 1929 and passed away in 2014, the webinar will be held on his birthday, 3 May. *
Prof. Albrektsson, with his discovery, Brånemark tremendously influenced modern dental implantology. Could you tell us a bit about what motivated him to research this particular area and how exactly he discovered osseointegration?
Brånemark told me about a meeting with an edentulous nurse who had accidentally lost her dentures during a coffee break. He, who was then training to become a physician, thought it was an easy problem to be solved by university dentists, to whom he referred the nurse. However, the nurse had severely resorbed alveolar ridges, and there was not much that could be done for her. In 1953, Brånemark decided to try to solve this problem, but it was not until 1962 that he realised that oral implants could be a solution.
How was osseointegration perceived in the dental community in the first years after its discovery?
Academic dentists did not believe in oral implants at the time, and Brånemark was met with great suspicion, not least since he was a physician without dental training. Between 1968 and 1977, we had perhaps the worst academic feud we have seen in Sweden in modern times. At last, the board of welfare reacted by sending three university professors from Umeå to scrutinise the oral implant work in Gothenburg. These three professors wrote the first positive statement on oral implants ever authored by academic dentists, and since then, we started to train dentists to place oral implants.
How did Brånemark’s discovery shape dental implantology in your opinion? Where would we be without it today?
In retrospect, all the criticism of the implant work conducted in Gothenburg forced Brånemark to scrutinise his clinical results and present improvements that finally resulted in international acceptance after the Toronto conference on osseointegration in Canada in 1982. Brånemark’s achievements resulted in rapid acceptance of his theories, not least in North America, and this led to a widening of clinical indications and further development of the osseointegration principles.
Today, the survival rate of implants is considerably high. What’s the role of osseointegration in this process, and what factors influence it?
Osseointegration is paramount for the success of oral implants. However, with time, we have started to understand that the osseointegration process is dependent on the response of the immune system, which has the ultimate aim of rejecting exogenous materials. In the same manner and in fact acknowledged by Brånemark before he passed away in 2014, the immune system is the primary reason for possible marginal bone loss around oral implants. Bacteria are only secondarily responsible for bone loss and are mainly active when the immune system has started to reject the implant. This reaction occurs in 1–2% of cases over a follow-up of ten years.
Implantology is constantly reinventing itself, digitalisation has introduced many new options, and there are scientific attempts to regrow teeth from stem cells. How do you envision the importance of osseointegration in this rapidly evolving market in the future?
The first time that I heard that stem cell therapy would result in regrowth of teeth was in the 1990s. It seems that we are still far from this possibility in 2021. As I see it, we will continue being dependent on oral implants at least for the next few decades.
Editorial note: Dental professionals can watch the webinar in celebration of the first Global Osseointegration Day live on Monday, 3 May, at 8 p.m. CEST. Registration for the free webinar is available on the DT Study Club website, and participants can earn one continuing education credit.