1982 was a huge turning point for Brånemark and it was a point that he had been working towards for the past 17 years. This included 15 years of clinical follow-up trials. Yet despite the hugely positive results, he was reluctant to present his findings to the public at the Toronto conference, because he felt quite simply, that the world still wasn't ready for dental implants. However, during the past 17 years, Brånemark and his team had been busy... very busy!
Despite placing the first dental implants into an edentulous patient a few months earlier in 1965, Brånemark understood that it wasn't enough. If he was going to convince the sceptics, and there were plenty of them, he knew he needed cold hard evidence of myriad proportions. So rather than sit back and reflect on his achievements, Brånemark embarked on what was then one of the longest clinical trials in dental history.
During the 15 year trial carried out between 1965 and 1980, a total of 2768 implants were placed in 410 edentulous jaws of 371 consecutive patients. All patients were fitted with removable bridges and were examined at yearly intervals thereafter. In 405 of the 410 patients, bridges were attached to implants via an abutment, and only in the remaining 5 jaws could treatment not be completed. This was either due to patient death or for psychiatric reasons. In 34 of the patients, bone-anchored bridges were placed into both the upper and lower jaws and while the mean age of a patient was 53, the gender split was 62% female and 38% male. This lengthy clinical trial allowed Brånemark to lay down some important time periods which helped to document the evolution of dental implants. They were...
By 1980, after placing over 2700 dental implants into the mouths of edentulous patients Brånemark and his team had not only built the template for the fitting of dental implants but over a period of 15 years, had honed it to perfection. So much so in fact that the same basic principles are still in use today.
While results based on observation times of less than one year were regarded as clinically insignificant, that still left 1997 fixtures placed in 172 lower and 146 upper jaws of 284 patients. Of those....
You have to remember that as late as 1974 implant treatment outcomes were seen as very erratic. The success rates for other implant systems for example reportedly ranged from just 39%-66% after 10 years. This was enough for the American Dental Association (ADA) to take the position not to recommend dental implants as normal clinical practice.
However, four years later in 1978, a conference at Harvard University identified both the risks and benefits of dental implant surgery and laid down established standards, many of which are still in force today. The results of Brånemark's 15-year clinical tests not only fell within these acceptable standards but far exceeded them.
So, finally in 1982, after years of resistance from sceptics, he was armed with the cold hard data he needed to prove to the world that dental implants were, in fact, a predictable and best long-term strategy for the replacement of failing or missing teeth. From that point on, the dental industry and the hopes of many people changed, and much of it was down to the work of one man - Per-Ingvar Brånemark!
In the next and final part, we'll take a look at continued ongoing testing and what the findings show for dental implants and osseointegration in the future.
During the early 1970's while Brånemark was deep into his research into osseointegration, other Europeans followed suit. They included André Schröeder at Switzerland's Berne University who was working on a similar implant for clinical application in conjunction with the renowned Straumann Institute.
Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws.Adell R, Eriksson B, Lekholm U, Brånemark Pl, Jemt T. Int J Oral Maxillofac Implants 1990 Winter;5(4):347-59. PMID: 2094653
Anyone who knows anything about dental implants is aware of the story of Per-Ingvar Brånemark and how he accidentally discovered the process he later named as osseointegration. You're probably also aware that despite him being named as one of the most influential people in the dental profession, he wasn't actually a dentist.
Osseointegration and its experimental background., Brånemark PI., J Prosthet Dent. 1983 Sep;50(3):399-410. PMID: 6352924
To put it another way.... out of 418 clinical papers, 262 of them were deemed serious enough to have led to misleading conclusions!
Statistical methodology in oral and dental research: pitfalls and recommendations. Hannigan A, Lynch CD.