Per-Ingvar Brånemark passed away on December 20 at the age of 85. Throughout his career as a research professor, he overcame fierce opposition to dental implants and revolutionized methods for treating toothlessness. Tomas Albrektsson, who knew Professor Brånemark for half a century, offers a personal portrait of the man who was once his thesis supervisor.
An extremely gifted scientist, Per-Ingvar was also as witty and quick on his feet as they come. Various language editions of Reader’s Digest, hardly a medical journal of note, published an article in the late 1960s about his research on microcirculation. At the end of his first lecture about dental implants in Landskrona, Sweden in 1969, a member of the audience who turned out to be a senior academic of Swedish dentistry, rose and commented, ”This may prove to be a popular article, but I simply do not trust people who publish themselves in Reader’s Digest.” As it happened, that senior academic was well known to the Swedish public for having recommended a particular brand of toothpick. So Per-Ingvar immediately rose and struck back, saying, “And I don’t trust people who advertise themselves on the back of boxes of toothpicks.” Young and naive as I was, I thought they were just poking fun at each other, but it turned out to be the opening shot of an eight-year battle with the dental profession. When someone cast aspersions on dental implants several years later because Per-Ingvar was not a practitioner, he lost no time in replying, ”Teaching them anatomy is good enough for me.”
Doctoral thesis on microcirculation in bone
Per-Ingvar completed his medical training at Lund University in 1959 with a doctoral thesis on microcirculation in the fibula of rabbits. Grinding the bone to a state of transparency permitted the use of intravital microscopy to analyze blood flow in both bone and marrow tissue. The thesis, which was widely cited both in Sweden and abroad, landed Per-Ingvar an appointment at the Department of Anatomy in Gothenburg just a year later. He was appointed as an Associate Professor of Anatomy (later a full professorship) in 1963, which qualified him for laboratories of his own and the opportunity to surround himself with a team of researchers.
Collaborates with Lennart Nilsson on groundbreaking photos
Per-Ingvar continued to pursue his studies of microcirculation in animal models and ultimately in humans. A plastic surgery technique was used to prepare soft tissue cylinders on the inside of the upper arm. He then inserted optical devices encased in titanium that enabled intravital microscopy of microcirculation in male volunteers. By the late 1960s, he was able to produce the highest resolution images of human circulation in the history of medicine. Many people are familiar with Lennart Nilsson’s photos of circulation that were taken at Per-Ingvar’s laboratories and developed at the Department of Anatomy.
Per-Ingvar used a hollow optical device surrounded by titanium to study microcirculation in rabbit bone, permitting both bone and blood vessels to grow through a cleft where they could be examined by means of light microscopy. During such an experiment in 1962, he discovered that the optical device had fused into the bone, a process that he eventually dubbed osseointegration. He revealed his incomparable strength as a researcher at that very moment, realizing immediately that the discovery had clinical potential and determining to focus on the development of dental implants, an enterprise that had hitherto been regarded as beyond the scope of medical science. Per-Ingvar grasped a fundamental truth—toothlessness represents a significant disability, particularly for people who cannot tolerate dentures for one reason or another. He operated on his first patient in 1965, a mere three years later.
From opposition to triumph
The academic community was largely distrustful and hostile to the new approach. Not until 1977 was the debate put to rest when three professors at Umeå University announced that Per-Ingvar’s technique was the recommended first-line treatment. Opposition in other countries eventually waned as well and dental implants, originally manufactured by a mechanic in the basement of the Department of Anatomy, scored one international triumph after another. An estimated 15-20 million osseointegrated dental implants are installed every year, and a number of different academies in the field hold annual conferences attended by as many as 5,000 participants each. The University of Gothenburg features a permanent exhibit on osseointegration technology, not to mention a museum in Per-Ingvar’s honor at the University School of Stomatology in Xi’an, China. Brazil hosts the P-I Brånemark Institute Bauru.
Not only dentistry
Back in the 1970s, Per-Ingvar started collaborating with ear specialists and technicians at Chalmers University of Technology to explore the additional potential of osseointegrated implants. Hearing aids designed to treat certain conditions used such implants inserted behind the ear. Hundreds of thousands of patients around the world have had operations based on the technology, initially developed in Gothenburg under Per-Ingvar’s direction. Those of us who were on the team at the time will never forget a teenage girl who suffered from the effects of thalidomide. The drug had caused not only limb deformities, but hearing loss in many patients as well. Equipped with the new hearing device, she learned to speak flawlessly. The team also targeted facial deformities occasioned by congenital or acquired injuries. A number of implants installed in the viscerocranium (facial skeleton) served as fasteners for silicon prostheses, a much more attractive option than attaching them to the patient’s glasses. Following the first operation in 1977, the technology is in widespread international use.
Fueled by a passion to help difficult-to-treat patients
Titanium implants installed in the femur (thigh bone) were the next spinoff of Per-Ingvar’s research Patients with above-knee amputation levels cannot have socket prostheses outside soft tissues and may have to rely on a wheelchair to get around. Inserting titanium screws in the femoral stumps permitted the installation of a prosthesis and the ability to walk again. I can still remember the first patient as if it were yesterday. A teenage girl had been run over by a streetcar in Gothenburg and had above-knee amputation levels in both legs. She was consigned to spending the rest of her life in a wheelchair. The operation was highly successful and she learned to walk again. Per-Ingvar was fueled by a passion to help difficult-to-treat patients, and many of his clinical discoveries from the first dental implant on were made in response to cases that had been regarded as hopeless.
Acclaimed around the world
Per-Ingvar’s innovative genius, fortified by a large research laboratory at the Department of Anatomy, skyrocketed Gothenburg-based pharmaceutical companies like Nobel Biocare and Astra Tech into leading positions in the global market. He was devoted to the academic community’s social responsibility long before many of his colleagues were aware of, much less accepted, the concept. Ultimately the world came around and he was awarded honorary doctoral degrees by 29 universities and honorary memberships by more than 50 scientific associations—not to mention the Swedish Engineering Academy’s medal for technical innovation, the Swedish Society of Medicine’s Söderberg Prize, the European Inventor Award for Lifetime Achievement and many other distinctions around the world.
/Tomas Albrektsson