Titan of Titanium
An Interview with Professor Per-Ingvar Branemark
Mr. Frederic Love
At its annual
inventor awards ceremony in the spring of 2011, the European Patent Office
(EPO) presented Professor Per-Ingvar Brånemark with the organization’s
lifetime achievement award for his discovery and development of
osseointegration. Regarded as the most prestigious prize for European
inventors, the award went to Brånemark because, “During the course of his
career, he has continued to refine his approach into what has become the gold
standard of dental implantation globally—the method of osseointegration.” According
to the EPO, “more than eight million people have benefited from Brånemark’s
landmark methods,” since he treated his first osseointegration patient, Gösta
Larsson, in 1965.
Serendipity and Hard Work
I met with Professor
Brånemark recently, not far from the University
of Gothenburg, Sweden, where
he has worked most of his life. When I asked about the award, he replied
simply, “I have received quite a few prizes and awards over the years, but this
beats everything else. It represents recognition from colleagues and laymen
alike that my method has already helped an enormous number of people. What
greater commendation can a scientist hope to receive?”
He has come a
long way since those early days in the 1950s when, as a young researcher, he
was completely absorbed in the study of the anatomy of blood flow. As part of
that work, he attached a titanium-housed optical component to a rabbit’s leg,
which made it possible to study microcirculation in the bone tissue through
specially modified microscopes. The work at hand was completed successfully,
but when it came time to remove the metal-framed optics from the bone,
Brånemark famously discovered that the bone and the titanium had become
virtually inseparable.
“Not long
afterwards,” Brånemark said, “we changed the direction of our work to
investigate the body’s ability to tolerate titanium.”
Multidisciplinary Enterprise
To gain a
proper understanding of what he would later call “osseointegration,” Brånemark
recruited experts from other fields—such as physics, chemistry, and biology—to his
quest. Physicians, dentists, and biologists all joined the effort. Together they
developed diligent, methodical techniques for the insertion of implants. At the
same time, engineers, physicists, and metallurgists studied the metal’s surface
and how the design of the implant might have an effect on bone healing and growth.
For the best
part of two decades, Brånemark faced opposition from the medical establishment
in his native Sweden.
“Our findings that the body would accept titanium over the long term, and even
allow it to integrate in bone, flew in the face of conventional wisdom,” he
explains. “Theorists’ textbook opposition asserted that our implants would
trigger initial inflammation and would ultimately be rejected by the body’s immune
system.”
The 1960s were
trying times for Brånemark. Funding from Swedish research organizations dried
up, yet he persevered. With his physician’s certification at stake, he
repeatedly demonstrated the accuracy of his claims and the viability of
osseointegration. Finally, in the mid-1970s, the Swedish National Board of Health
and Welfare approved the Brånemark method.
To reach beyond
the world of the university clinic, Brånemark looked for an industrial partner.
“I chose Bofors, an antecedent to Nobel Biocare, because they were one of the few
companies who knew how to machine titanium,” says the professor. Thus a
long-term relationship began. Over the years, this relationship has had its ups
and downs, but both parties have benefited from a long-term devotion to the
support and practice of good science. When I asked Brånemark what characterizes
good science for him personally, he responded thoughtfully.
“Good science
is all about good method. Making observations, collecting facts and data, and
creating a hypothesis to explain what you’ve seen—it all starts there. Then you
have to deduce the implications of the hypothesis and put the implications to
the test. It is very important that all data be considered, not just those that
support your ideas. Finally, you have to subject your findings to peer review.
At the end of the day, there may be no ‘final’ truth, but in our field, a valid
hypothesis will inevitably lead to practical achievement as it stands up to the
scrutiny of other researchers in the field.”
As successful
as Brånemark has been as a scientist, he has also been successful as an
evangelist for the “good news” of osseointegration. When I point out that people
listen to him, and ask why, he responds with a smile on his face.
“They listen to
me because I know what I’m talking about. Before treating the first patient, I
had accumulated more than ten years of experience in the lab, for example. I
don’t rush to conclusions, and I think people appreciate that.”
Followers Everywhere
I follow up
with the question, “How much of your success can be accounted for by such
personal characteristics as perseverance—stubbornness, if you will—and how much
by the apostles you recruited around the world?”
“One person
alone can’t have much impact on the world. I’ve been privileged to meet and
collaborate with some extremely talented people over the years. In addition to
all the dental and medical students who have passed my way, I had something
like 44 doctoral candidates at the University
of Gothenburg over the
years, and almost all of them taught me as much as they learned.”
Per-Ingvar
Brånemark has coined many words and phrases that have become commonly used
terms in dentistry. “Fixtures”, “anaplastology”, and “osseointegration” come
immediately to mind. When he introduced the concept of the “third dentition,”
Brånemark got thousands of professionals to start thinking of implant-based
solutions not as “false teeth” but “total rehabilitation.”
“I chose these
words because I found them succinctly descriptive. There’s a beauty in language
like that. I certainly didn’t anticipate how widely they would be accepted, but
was pleased, of course, to see how quickly they gained traction in both scientific
literature and clinical communication.”
When asked to
comment on the practicalities of cooperative efforts between science and
industry, Brånemark takes the high ground. “We have always needed each other’s expertise
and have generally enjoyed a symbiotic relationship. In an ideal world, maybe
talented scientists would also be gifted production engineers and marketers;
and maybe industrialists would be able to see beyond the bottom line; but in
the real world—in order to achieve our goals—we each do what we do best and
turn to others with complementary skills for help with the rest.”
Eye on the Horizon
While we’re on
the subject of the future, I ask, “What’s next?”
“If you’ll
allow me to speculate a bit, I believe that we may be on the threshold of a
paradigm shift in the professions we practice. Once we realize that
biology—especially immunology—lies at the heart of both modern dentistry and
medicine, I think we’ll start educating dentists and doctors along similar
lines at the same institutions. Perhaps the traditional partitions between them
will even disappear altogether in the next generation or two.”
“As far as my
own research is concerned, I see great strides being made in the area of
osseoperception, whereby bone-anchored prostheses transmit information that can
be intuitively interpreted via the central nervous system. I have patients with
osseointegrated limbs, who can actually ‘feel’ the texture of the rugs on which
they’re walking today. This aspect of osseoperception is a bountiful field for
further research.”
Eighty-two
years-old and still full of enthusiasm for the work at hand, Professor Per-Ingvar
Brånemark remains the best known personality in the world of osseointegration
to this day. He has certainly earned the title, “Father of modern clinical
implantology.”
*Writer, novelist, and
producer/director at the Swedish Television Company, Orebro, Sweden.
Adapted with
permission from Nobel Biocare News
Vol. 13, No. 1, 2011.