Fre 27 maj / År 40 / Nr 1 2022

The Titan of Titanium

Titanium implants would not be used routinely today were it not for the pioneering work of Per-Ingvar Brånemark. More than half a century ago, he was the first to observe that the human body would not only tolerate titanium, but even integrate it into living tissue.
This insight has revolutionized the fields of dental, maxillofacial and orthopedic rehabilitation since then. Based on his original scientific findings, innovative bone-anchored restorative solutions have improved the quality of life for millions of people around the world.

Students of science will tell you that luck combined with unique circumstances often dictate the direction in which any research project ultimately turns. That was certainly the case for Per-Ingvar Brånemark.
As a young researcher in his native Sweden in the 1950s, he was working to advance the world’s knowledge of the anatomy of blood flow, and found himself using an optical device that happened to be enclosed in machined titanium. Attached to a rabbit’s leg, this device made it possible for him to study microcirculation in the bone tissue of rabbits through specially modified microscopes.
When it came time to remove the device from the bone, Brånemark was surprised to find that the bone and the titanium had become inseparable. In a subsequent study of microcirculation, approximately 20 students who volunteered to have titanium instruments inserted into their arms for several months showed no signs of rejecting the titanium-enclosed optics.
“At that point,” Professor Brånemark says, “we changed the direction of our work to investigate the body’s ability to tolerate titanium.”
Seeing that the body could peacefully coexist with titanium, perhaps indefinitely, Brånemark wanted to find out the reasons why. To gain a proper understanding of “osseointegration”, the term Brånemark coined for the integration of titanium into living bone tissue, he realized that one would need access to expertise in physics, chemistry and biology, at the very least.
Under Brånemark’s leadership, physicians, dentists and biologists would all investigate the interplay between bone and titanium. Together they developed careful, 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.
From the very beginning, Brånemark faced opposition from the medical establishment. “Our findings that the body would accept titanium over the long term, and even allow it to integrate in bone,” he explains, “flew in the face of conventional wisdom.”
In the mid-1960s, physicians and dentists were still being taught that foreign, non-biological materials could not be integrated into living tissue. Initial inflammation and ultimate rejection were considered to be inevitable.
Funding from Swedish research organizations dried up. He was repeatedly turned down when he applied for renewed grants to study tissue anchored implants, 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 bring the method to patients all over the world, an industrial partner was needed. “I chose Bofors, an antecedent to Nobel Biocare, because they were one of the few companies who knew how to machine titanium,” Brånemark reveals.
Since then, Nobel Biocare has carried the Brånemark flag to every corner of the world, and the professor has become a household name among colleagues and laymen alike.
He has become such a celebrated figure in fact, that the Chinese recently opened the Per-Ingvar Brånemark Museum in Xi’an. Its sole purpose is to chronicle the life and accomplishments of this remarkable researcher and clinician, the man behind osseointegration.