The stunning fact that bone can be made to integrate with titanium was first discovered by Brånemark in 1956, when he was studying the properties of blood. A small titanium optic observation chamber had been attached to the leg bone of a rabbit in order to enable observation of live blood cells. Everything went well until Brånemark discovered that the precious instrument could not be retrieved.

Brånemark was annoyed, but didn´t think much about it until some years later. By then, he held a professorship of anatomy at the University of Gothenburg and had progressed to studying blood flow in humans — in this case 20 volunteering students who had titanium observation chambers inserted in their upper arms for several months. Astonishingly enough, no adverse reactions were noticed. This led Brånemark to decide that the biocompatible properties of titanium needed to be studied further. And that he wouldn´t be able to do it alone.

Multidisciplinary approach
A good 40 years before multidisciplinary research became fashionable, the Brånemark constellation included engineers, instrument makers, metallurgists, surgeons, psychiatrists and dental experts as well as medical researchers and biochemists. At one point, it even involved a professor in business studies. The first experiments with titanium screws as a basis for dental fixtures were conducted on beagle dogs. It was discovered that the best results were achieved with very gentle operation methods. If the screws were then left unloaded for a couple of months, the bone would integrate with the titanium and create a strong anchorage.

Once the bone had been allowed enough healing time, the fixture would only become stronger with use.

Waited for long-term results
“What is it that makes the body accept and integrate with a piece of titanium? It is really very strange and wonderful. We were conducting our research for several years, trying to figure out why we couldn´t remove the titanium from the bone. And because we didn´t understand, we progressed slowly and waited to see the long-term results. One must have patience. To me, patience is definitely one of the most important qualities of a scientist."

It goes without saying, that even in the 1960s, this philosophy didn´t comply with the timeframes of conventional research funding organisations. And the multidisciplinary approach was something they simply did not understand. Even today, Brånemark gets angry as he recalls the demands of one government funding organisation.

US funding saved the day
“They said that they couldn´t support our research, since it was impossible to conduct research in two areas at the same time. They demanded that we would kill the dogs. But the dogs were part of our team. The team members went for walks with them and when we had finished our experiments, the members took them home."

In the end, it was the US National Institute of Health that saved the day — as well as the dogs.

In 1965, Gösta Larsson became the first human patient. He was born with his chin and jaw deformed. To him, the titanium fixtures that fixed a set of false teeth to his jawbone, meant that he could for the first time eat and talk normally. Larsson lived until only two years ago, and during all his life, his teeth never caused him any problems again.

Today, the Brånemark method has been used for 40 years, and 95—99 percent of the treatments have been successful. The Brånemark team developed a complete method, proven during many years and including not only an advanced product, but an educational programme and a set protocol for handling the product and conducting the operation.

“If something works, why change it? It may not be the most intellectual solution and it may not result in any professorships, but it is darned good for the patient."

Today, the Brånemark method for dental reconstruction is marketed all over the world by Nobel Biocare. Brånemark himself divides his time between his home in Göteborg and Brazil, where he conducts pro-bono surgery. There are 25 million toothless people in Brazil.

Brånemark´s titanium fixtures have also been found to be very useful for fixing prostheses, for instance in cases of severe deformity of the face.

What does it feel like, to be able to change the lives of so many?
“I operated on a woman in Brazil who had lost half of her face to cancer. She used to be a beauty queen, but she had lost half her face. Every time we meet, we kiss. And she doesn´t cry when she looks herself in the mirror anymore. I think that she has found peace in her soul."

Listening to the patients
This concept, of taking care of the soul as well as the physical problem, is something Brånemark returns to. After treating thousands, he has come to the conclusion that he gets his best results when he sits down with the patient before surgery, holds the patient´s hand and takes time to listen.

“My experience is that when people feel that someone really cares, they heal better. Today, many doctors don´t even take time to look their patients in the face, they just type at their computers. But what if it is the patient that can tell us what we need to know? Some sort of psychological training in order to become a better listener, should really be part of medical education."

At the beginning of discovery
After 50 years of research and gathering knowledge of the human healing process, Brånemark has arrived at a conclusion.

“It is profoundly little that we really do know. We might understand one thing out of 100 000. What is it that makes a wound heal? How does the body know what to do? These are things that we still don´t know."

As a matter of fact, why bone can be made to integrate with titanium is something science still hasn´t been able to fully explain. It is just a fact that it does, and why is for future scientists to figure out. The field of osseointegration offers plenty of scope for further discovery.

Before I leave, Per-Ingvar Brånemark takes my hand and kisses it. He says something in a foreign language. It is Portugese and it means “It could be worse."

Very true. Without Per-Ingvar Brånemark, the world would certainly be a lot worse off.

Text: Sofia Eriksson