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The History of Dental Implants – and Baby Boomers

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The History of Dental Implants – and Baby Boomers

The History of Dental Implants – and Baby Boomers

July 06, 2006
The following is an excerpt from book-length manuscript currently being marketed under the title: “Silk and Jazz: A Baby Boomer’s Take on Dental Implants.”

By: Jean Johnson for Dental1

When they were just tykes, baby boomers cared little that a man named Per-Ingmar Branemark, M.D., Ph.D., won a faculty position at the University of Gothenburg in Sweden. Nor could they have realized that the interest the biomedical research physician took in bone properties early on in the 1950s might one day influence their health and well-being. It was the same for Branemark. Little did he realize that one day 40 years later the disparate strands of history set into motion by his research and the baby boomers would converge.
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  • Even as baby boomers came of age, it’s unlikely that the baby boomers and Branemark interest coincided. For the boomer’s part, who gave a rip that some researcher couldn’t get the tantalum he needed for his rabbit experiment and had to insert titanium into the bone of the poor animal. Conversely, Branemark’s version of fun was hardly wearing flowers in his hair. He spent summers focused on “oral amputees,” young edentulous women – some of them nurses – without enough bone to wear dentures.

    Edentulism is the polite Latin word dentists use for missing teeth. A patient can be partially edentulous, or like the women Branemark was concerned about, fully edentulous with nary a tooth left. Also, when we lose teeth bone loss can ensue – sometimes so significantly that dentures have little to rest on. A number of the women Branemark encountered were apparently in this category; reduced to the hollow-cheeked, witchlike appearance edentualism foists on its victims.

    Branemark wasn’t alone. As early as 1941, a Swedish physician named Gustav Dahl inserted a metal blade in a patient’s jawbone to support dentures. Blades are long, flat plates with abutments that stick up through the gums. By sinking them deep in the bone, dentists hoped to create enough structure for dentures in fully edentulous patients.

    Then 10 years later, Americans Aaron Gershkoff and Norman Goldberg brought the technique for placing what the profession calls superiosteal implants to the United States, and along with 30 other dentists formed the American Academy of Implant Dentures (later the American Academy of Implant Dentistry). This breed of implant to support dentures is a custom-made fixture that’s screwed into place on top of a person’s jawbone and under the gums.

    Meanwhile, Branemark was making his own headway on the screw-type titanium implants that eventually revolutionized dentistry. That the man was motivated by human suffering seems apparent. Checking in with the plastic surgery department at Gothenburg, he found a treatment for patients with severe cleft palates that left people “dental cripples.” Indeed, Branemark was to remark in 2004: “We must not forget that edentulism is equal to amputation – biologically and psychologically. Respect for the oral invalid is what we should teach young dental students.”

    Certainly the biomedical research physician honored patients with missing teeth. By the early 1960s he was working with orthodontist Ake Olsson on animal experiments. After the team placed titanium posts successfully in the jaw of a Beagle, Branemark was ready. In 1965, he installed four titanium implants in the mandible of a 34-year-old man born with a deformed chin and jaw. Several months later a fixed set of false teeth were placed atop the implants. The patient’s life was transformed.

    Even as life in the late 1960s gave baby boomers some serious pause, so too did Branemark’s dental investigations suffer growing pains. In the five years following his first surgery he achieved only a 50 percent success rate – unacceptably poor. “These early results seemed to confirm,” wrote Tomas Albrektsson, M.D., Ph.D., ODhc, and Ann Wennerberg, D.D.S., Ph.D., “that foreign materials did not work in the oral cavity for a number of reasons including infection.”

    Learn More
    Economic Impacts of Baby Boomers on Dental Implants

    There are 78 million baby boomers with missing teeth and the discretionary income to afford dental implants. More this population is expected to drive the implant market with a 12 to 15 percent growth rate into 2010 and beyond.

    Implant surgery currently enjoys a 95 to 96 percent success rate, higher than any other medical procedure, dentist and author Michael R. Wiland, D.D.S. told the New York Times in 2001.

    Baby boomers born between 1946 and 1964 have a combined spending power of $1 trillion, a figure that equates to $45,000 to $46,000 per household per year. Boomers are better educated than any previous generation with 29 percent holding bachelor’s or even graduate degrees.

    Also, 69 to 75 percent are homeowners, 13 to 22 percent of whom carry no mortgage. Baby boomer spending on health ranks just under that of apparel and entertainment at 4 to 5 percent, with 10 percent devoted to insurance and pensions, 14 percent to food, 18 percent to transportation, and 30 percent to housing.

    The early 1970s, however, were kinder to Branemark. Instead of going back to controlled animal trials, he proceeded empirically changing numerous variables. Experimenting with wider implants, prolonged healing times, and changes in surgical procedures as well as alterations in prosthodontics associated with the actual dental restorations, his results on 150 patients improved. He even coined a new term – osseointegration – that describes the way bone fuses to titanium to create the rigid fixation stable enough to support tooth restoration.

    But Swedish dentists had never heard of such a thing. Bone fusing to metal? What kind of magical nonsense was that? As Branemark himself noted years later in 2004, “It is tempting to compare osseointegration to Ten del, which is the Dalai Lama’s term for describing interactive coexistence.”

    Also, when some of Branemark’s patients returned to their regular clinicians, the dentists reported “patient discomfort” – noting that Branemark was obviously out of his depth in dentistry training. The good physician might be an anatomical and experimental biologist, an overwhelming number of the dentists argued, but his training was not specific to the oral cavity. What ensued was “the most serious academic dispute in Sweden in 50 years,” according to Albrektsson and Wennerberg.

    The acrimony finally settled down in 1976 when the Swedish Board of Health and Welfare authorized three dental professors from universities other than Gothenburg, where Branemark worked, to carry out a clinical review that turned out favorably. The credibility of dental implants was also furthered by developments under way in Switzerland, Germany and the United States, despite problems with technique and design.

    In North America, for example, progress with blades, one of the forerunners to screw type implants, was initially limited to a team from the National Institutes of Health and Harvard University – a team who used a rather odd phone call system to track results.

    Of 55 patients later contacted by phone – 42 of whom did not answer or whose numbers were out of service – one had his blade removed while another man who had several blades installed said they were all loose except for one that already fell out. The remainder contacted, wrote the reporting team, were “doing extremely well and are very, very pleased and happy that they had blades inserted.”

    Despite squabbles in Sweden, design dead ends, and a lack of credible tracking system in the United States, dental implants gradually came into their own. Branemark began to receive international attention and George Zarb, professor of dentistry at the University of Toronto took note. Although Zarb and his colleagues did not obtain good results in their first experiments with oral implants in dogs, Zarb believed in the method enough to lead the first international team to Sweden for training in the Branemark method of implant placement.

    Once home Zarb staged a conference to which he personally invited representatives from all the major dental schools in Canada and the United States. Seventy percent of those invited attended the Toronto Conference on Osseointegration in Clinical Dentistry in 1982. Skepticism ran high, but by the end Branemark won a following. Fifteen years of solid data and the gentleman’s charisma convinced most in attendance. “Branemark’s findings exploded like a bombshell on the consciousness of North American dentists,” Richard Sullivan, D.D.S. wrote in a 2001 issue of the Journal of the California Dental Association. By the mid-1980s the American Dental Association had given 11 different dental implant systems a coveted seal of approval.

    Initially, implants were only used for completely edentulous patients missing all their teeth. But once the Americans started running with the technology, dentists started using titanium posts for short span and single tooth segments. Also, after the initial focus on function, the aesthetics side of the equation came to the fore. No wonder that by the time baby boomers started lining up at their specialists, dental implants had become a billion dollar industry and were enjoying a 95 percent success rate. Thank you Dr. Branemark.

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