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What problems can tooth implantation solve?

• Single tooth missing. In this case there is no need to remove the neighbor teeth nerves and turn-process these neighbor teeth for tooth crown attachment
• A few teeth missing in a row. Tooth implantation provides a possibility to place a stationary dental prosthesis instead of a removable dental prosthesis.
• All teeth missing

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Tooth Implantation History

In 1965 professor Ingvar Branemark was a head of research group at the University of Goteborg (Sweden) and his studies finally resulted in osteo-integration discovery (titanium prosthesis integration into tissue). Branemark’s researches were aimed at jaw bone healing and regeneration after injury. The most remarkable thing about this is that osteo-integration phenomenon was discovered accidentally.

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Tooth Implantation History

История имплантации зубов

In 1965 Prof. Per-Ingvar Brånemark headed a group of researchers at Gothenburg University in Sweden conducting researches which eventually lead to the discovery of osseointegration (titanium integration into the bone tissue) phenomenon. Brånemark's research was aimed at studying the aspects of bone regeneration after a trauma, and the most notable is the fact that osseointegration (from Latin os - bone) phenomenon was discovered accidentally. On the basis of this phenomenon an inference on titanium's bioinertion was made, and later studies lead to the creation of the most progressive tooth replacement system in all the history of dentistry.

The first scientific studies

At first Brånemark didn't intend to develop a procedure of titanium components integration into the bone as his interest was aimed at the study of blood cells regeneration and behaviour in vivo. His thesis was based on the study of the bone and the marrow blood supply as there wasn't enough information on the subject at that time.

Brånemark wanted to study the bone tissue regeneration, the bone, the marrow and the blood interaction, and to describe the processes occurring in the marrow after a trauma
In order to do this task he conducted a series of experiments in which he used a small chamber which was surgically installed into a rabbit's femur to study blood supply in the bone. It was the first step leading to the discovery of osseointegration phenomenon.

As a body of the chamber Brånemark used titanium. This metal was discovered in 1791 but its pure form was received more than 100 years later. Its commercial production required new methods of mechanical processing development to achieve such a structure of surface as to be taken in by live tissues. Titanium has a property of being very resistant to chemical influence and is more resistible to corrosion than perfect stainless steel. Thanks to these properties, pure titanium became an ideal metal for Brånemark's experiments. Besides, this metal was recommended by an orthopedist surgeon Hanse Amnevse from Lund who investigated different metals used as hip prostheses. Brånemark received an example of the metal produced by Avesta Jernverk and started using pure titanium for chamber production.

When introducing a titanium chamber into the femur Brånemark followed the most sparing surgical procedure in order to minimally injure the tissue. He suggested the bone to have limited healing ability and has to be treated as carefully as other fragile body tissues such as an eye or the brain. After several months of experiments Brånemark proved that bone regeneration is a dialogue function of the bone tissue and the bone marrow. On the other hand he sadly noticed that the chamber placed into the rabbit's femur had become the bone's structure incompatible part and cannot be used again thus requiring additional expenses on conducting research.

The first patient

After several years Brånemark established and described the main principles of the full adhesion of a titanium structure and the bone: components need to be highly precise and the bone tissue needs to be minimally injured and components need to be absolutely sterile to avoid infection.

The next step was studying all titanium's biophysical properties for its usage in medical purposes. Clinical tests on volunteers were required to receive reliable results. The first plan was to work with the traumas of the hip and the knee joints received in car accidents. Though, by chance, the first practical tests were fortunately performed to restore missing teeth.

The first patient was Gosta Larsson who had had dental problems for a long time. During his visit to his dentist he by chance heard of the research at the University of Gothenburg and decided to become a volunteer in this early research. He had lost all his teeth on the lower jaw as early as at the age of 34. He had a palate cleft, the upper jaw and chin deformation and experienced continuous pain and serious difficulties when eating and talking. He had already almost reconciled to these problems when he heard of the new research.

In spite of the fact that the technologies used by Brånemark and his colleagues were not accepted by the majority of maxillofacial and traumatic surgeons the treatment Gosta Larsson underwent was the first and it was successful. 4 implants were installed on the patient's lower jaw to fix a removable denture. After the treatment Larsson was able to chew, to eat and to talk and lived a full life with this prosthesis till his death in 2006.
The accidental choice of a patient with dental problems became an initial point for the development of an absolutely new area of dentistry which was implantology.
Anatomic and immune characteristics of the maxillofacial area made it possible to speak of the best prognosis of implants osseointegration in the jaw and of their long-term usage. However, hostile attitude of the Dentists' Society of Sweden to Brånemark in person (Per-Ingvar Brånemark wasn't a dentist by education) prevented the development of implant dentistry. Personal and professional attacks aimed at Brånemark made him introduce osseoinegration phenomenon into practice very carefully.

The discovery spreads all over the world

When George Zarb, one of the most influential researchers in the area of the development of artificial tooth root replacement (University of Toronto, Canada) learned of the research conducted by Brånemark he immediately left for Gothenburg and spent six months there persuading Brånemark to share the results of his studies with the world. Zarb and his group were the first who did research outside Sweden parallel with Brånemark.
In order to expedite the spread of the osseointegration conception in 1982 in Toronto (Canada) on the basis of one of the dental clinics with the support of the Universities of Toronto and Gothenburg the conference on oseoinegration was held. Zarb personally wrote invitations to many famous researchers and scientists inviting them to study a new original method of dental replacement.

The majority of dentists took part in the conference only due to Prof. Zarb's invitation and later noted that they hadn't expected that the new technology would prove to be better than all the previous trials.

Despite the 15 years of clinical investigation conducted not only in Sweden Brånemark was worried whether the high dental society accept his presentation. Once the conference was finished, however, his research was highly assessed and during the following years many participants of the conference even became his colleagues.

Since then, several world-known institutes joined the team of osseointegration developers and researchers in such countries as the United States, Canada, Australia, Belgium, Sweden, Spain, Italy, Brazil, Chile, Japan and Korea.

(after Chapter 1of "Close To The Edge: Branemark And The Development Of Osseointegration" - McClarence - Quintessence Publishing, Berlin, Germany,2003).