Topics: Dental implant, Amputation, Osseointegration Pages: 8 (1916 words) Published: April 22, 2013
Rickard Brånemark, MD MSc PhD Centre of Orthopaedic Osseointegration (COO) Department of Orthopaedics Sahlgren University Hospital Göteborg, Sweden


In 1952 Per-Ingvar Brånemark used a titanium implant chamber to study blood flow in rabbit bone and noted that the chambers could not be removed at the end of the experiment. He called the discovery “osseointegration.”

The success of osseointegration is due to the careful surgical technique where, for instance, only low-speed drilling is done, the use of specially designed pure titanium implants, and a careful and controlled period of rehabilitation. This slide shows bone growing within the implant.

This photomicrograph shows the threads of the titanium implant (left) in direct and intimate contact with bone, which has remodeled to occupy the thread space. Once the bone has formed there is additional time required for it to mature and harden, and this process is also part of osseointegration.

Over 40 Ph.D. dissertations have been conducted in Gothenburg, Sweden to investigate the basic scientific foundations of osseointegration in the dental and orthopaedic sciences. While the scientific basis of osseointegration is not completely understood, it is clear that there is a special relationship between pure titanium that promotes activation of osteoclasts/osteoblasts and bone remodeling.

In fact, the presence of pure titanium may stimulate stem cells to differentiate into osteoblasts, the bone building cells, as this scanning electron micrograph depicts. The cell is in contact with a pure titanium implant.

The surface TiO2 layer is extremely inert to corrosion. The Tiperoxy compound that forms on this layer deactivates inflammatory cells, thus reducing the “foreign body reaction” and enhancing the biocompatibility of pure titanium and the establishment of osseointegration.

A patient with a 30+ year history of osseointegration. Osseointegration was first implemented in the dental sciences in 1965. There are now approximately 1,000,000 people throughout the world with osseointegrated devices.

Osseointegrated dental fixtures can be used to support a single tooth prosthesis, or it can support more complicated prostheses in the cranial facial area, as is shown below. Extensive biomechanical tests have been performed on the stresses affecting these devices.

What is it like to be a transfemoral amputee? Consequences of non-vascular transfemoral amputationa survey of quality of life, prosthetic use and problems. Kerstin Hagberg, RPT and Rickard Brånemark, MD, PhD Dep of Orthopaedics, Göteborg University Sahlgren University Hospital, Gothenburg, Sweden

This issue is being quantified with scientific techniques; See, Prosthet Orthot Int. 2001 Dec;25(3):186-94. Prosthetics and Orthotics International, 2001, vol. 25, pp 186-194

Persons with an established non-vascular unilateral transfemoral amputation... make extensive use of the prosthesis have impaired quality of life have considerable problems related to the amputation and the prosthesis one fourth consider themselves to have a poor or extremely poor overall situation

Improving the physical as well as the psychological well-being for this group of individuals is an important and challenging task! We think this challenge may be met in carefully selected individuals by osseointegrated bone-anchored prostheses.

Amputation prostheses
Socket prosthesis • pressure • pain • sores • difficult don/doff • volume changes • new sockets Bone anchored prosthesis • no pain • no pressure • easy don/doff • improved function • no remaking • osseoperception

Early bone-anchored amputation prostheses
Before osseointegration, the permanent attachment of prostheses to bone was not possible. Early attempts failed because of the formation of fibrous tissue between the implant and bone.


In 1990, the first patient was...
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