Recommended by PD Dr. med. Dr. med. dent. David Schneider
Insights from this study for clinical practice
This study demonstrates the roots of using titanium implants in dentistry.
Published in 1983, this paper by Dr. Brånemark describes a process that is central to modern-day implant dentistry: osseointegration of titanium screws.
The paper sets out how early studies of bone formation in animals paved the way to evaluating implants with titanium screws in dogs. That study had positive results, showing such successful implant integration that (post-sacrifice) the titanium fixtures could not be removed from the host bone without being cut away, and had an anchorage capacity of 100 kg.
From animal studies, the paper moves on to treating edentulous patients. While reports at the time suggested that anchoring to living bone did not work in the long term, the findings in dogs indicated that this approach could have positive outcomes.
«We now suggest that the edentulous jaw can be provided with jaw bone-anchored prostheses according to the principle of osseointegration with good and predictable long-term prognosis.»
Dr. Brånemark in the cited publication
To support osseointegration, Dr. Brånemark lists three key principles:
Remove a minimal amount of remaining bone, and maintain the basic topography of the area
Retain the original or transitional denture during the healing period
Only one shape and dimension of implant should be required
With these principles, even if osseointegration is not successful the fixtures can be removed, and the jawbone is not left with major defects.
Dr. Brånemark also emphasizes the importance of leaving sufficient time for the bone to heal. He recommends that fixtures should be left non-load-bearing for 3–6 months, and adds that bone remodeling continues for even more than 1 year. Where there is not sufficient bone for anchorage, the paper describes Dr Brånemark’s work on autologous bone grafts.
Of course, osseointegration is not important only in dentistry. Dr Brånemark also describes other applications, including anchoring of hearing aids and maxillofacial prostheses. In joint reconstruction he describes two main advantages of osseointegrated prostheses: mechanical stability, and that the components (being removable from the fixtures) are easily replaceable.
PD Dr. med. Dr. med. dent. David Schneider
This early publication shows the first findings in connection with the ingrowth of titanium screws in the bone, the basis for the use of titanium implants in dentistry.
This comprehensive overview of osseointegration, from concept to experimental findings and finally clinical application, is fascinating reading for the modern dental practitioner. Dr. Brånemark’s closing words are as relevant today as when he wrote them more than 40 years ago:
«I hope that my material will provoke and catalyze similar experimental work and clinical application elsewhere.»
