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“His was a truly innovative mind that inspired others.”

by: Professor Thomas Albrektsson

Few people know as much about the early years of Per-Ingvar Brånemark’s research as Swedish Professor Tomas Albrektsson. In the following story, Albrektsson recounts some of the lesser-known, yet very interesting episodes which led up to the advent of osseointegration.

Although a graduate of the University of Lund, in the far south of Sweden, Per-Ingvar (or “P-I”, as he is generally known) Brånemark founded his Laboratory of Experimental Biology at the University of Gothenburg in the early 1960s.

As a young medical student I became a most junior researcher at P-I’s lab at the Department of Anatomy at the end of the same decade.

At this time, most of the research activities of his laboratory were still devoted to microcirculation, particularly in the field of vital microscopy. Although the first fixture patients had already been treated in 1965, implant research was not going to dominate the laboratory until a later stage.

In fact, one of my first memories relating to the implants was a lecture P-I gave in southern Sweden in 1969. 

Not well-received

Back in those days, the use of oral implants was not an accepted form of treatment and the audience needed to be convinced.

Immediately after P-I’s presentation, one of the senior academics of Swedish dentistry at the time rose and referred to an article entitled “Microcirculation—A New Frontier for Research” that had presented P-I’s vital microscopy work for the subscribers of Readers Digest.

This pundant then said sardonically, “This may prove to be a popular article, but I simply do not trust people who publish themselves in Readers Digest.”

Now, this same senior academic had become known to the Swedish public as the authority who recommended a certain brand of toothpicks. P-I rose without hesitation, striking venomously as a cobra with the reply, “And I don’t trust people who publish themselves on the back side of tooth-pick boxes!”

P-I won that battle, but it would take him almost another decade to win the war of attrition, breaking down the resistance of the conservative, senior Swedish academic establishment, and making it possible for the country’s health-care community to accept his oral implant concept.

There were many below-the-belt blows in those days. One was referring to P-I as “only a teacher and an M.D., completely without any odontological knowledge.”

P-I responded with characteristic, tongue-in-cheek humor: “It’s true that I’m not a dentist but, on the other hand, I do find it satisfying to train them.”

Later, I should add, he received his formal academic degree in dentistry as Doctor of Odontology from the University of Umeå in Sweden and also became a member in good standing of the Swedish Dental Society.

But let me return to the Laboratory of Experimental Biology, which under P-I’s leadership, became one of the most dynamic concerns of any University, anywhere.

In a time when academic titles had become much less lucrative in comparison to clinical ones, and other laboratories were searching for PhD candidates with binoculars, P-I (much to the envy of many colleagues) ran an extremely popular laboratory where he only accepted the best junior researchers (myself, of course, excluded) for training. 

Exciting times

By the end of the 1970s, P-I had supervised the writing of thirty PhD theses—quite impressive considering the things he was achieving in his “spare time”. There were few questions concerning his favorite subjects—microcirculation and implants—that were not tackled by gifted people at his lab.

Even if he sometimes directed the work in the manner of a field marshal, his staff accepted it. After all, not only did he have the highest rank, he was also a natural authority to us all.

Some problems were bound to arise, of course. At one point P-I recruited “volunteers” from the staff when he discovered that his interests in microcirculation and implants could be combined by inserting a titanium chamber in the upper arm of his subordinates.

Personally, I avoided participating in this truly heroic series of experiments by referring to the fact that my elder brother, Björn, already was a victim—pardon me, I mean a “participant”. Obviously, it was therefore essential, scientifically, to allow me to remain in the control group to prevent the Albrektsson genes from adversely affecting the outcome of the research. 

Making the news known

While the 1960s and ’70s were a time of struggle for P-I, his time of success would come when his implants would be accepted all over the world.

It’s one thing to do excellent research and develop a superior product, quite another to make the news known.

Here, P-I received invaluable help from Professor George Zarb, who had learned about the Swedish implants through prosthodontic colleagues. Zarb and his team came as the first guests from abroad to be trained in the Brånemark System in Gothenburg. That was before the end of 1978.

It’s hard to imagine now, but all of those who came to our remote country to learn about implants before the breakthrough of recognition that came in 1982 subjected themselves to a degree of risk.

Becoming clinically involved with oral implants at that time was not regarded as the best way to promote one’s career as a clinical scientist.

Therefore, these pioneers remain our dear friends to this day.

Even though he had up to fifteen- years of clinical follow up at the time, P-I himself was hesitant to present his research to the public in Toronto in 1982. He felt, quite simply, that it might be premature.

In fact, at three different times in the spring of 1982, he gave the order that the battle was to be postponed. We, his soldiers, had become so used to gun smoke by that time, however, that we “didn’t hear” our supreme commander.

Due in part to the top-rate organization supervised by George Zarb, and in part due to the contents of the meetings themselves, I believe that almost everyone who participated at the Toronto conference—and that included P-I himself—agreed that the meeting was a real breakthrough for osseointegration.

P-I Brånemark’s success was further documented a few years later when the Brånemark System (still sold and supported by Nobel Biocare today) became the first implant to receive recognition by the American Dental Association.

In the meantime, he had been awarded so many odontological decorations that he couldn’t wear them all at one time, no matter how formal the occasion.

P-I Brånemark was a man of ideas and ambition who never accepted any limits for what could be achieved.

His was a truly innovative mind that inspired others. He performed wonderfully as a guide for young people and—in the best sense of the word—P-I was a visionary leader.

Working with imagination, insight, and boldness, he presented his colleagues and students with a series of challenges that called forth the best in them as they pursued a shared sense of purpose. He taught us to keep our eyes on the horizon, not just on the work at hand. We are all richer for having known him. May he rest in peace.

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About the author
Tomas Albrektsson began work as part of Per-Ingvar Brånemark’s research team in Gothenburg, Sweden in 1967. In the years that followed, he earned his Ph.D. in anatomy and a Swedish professorship in the subject of handicap research. One of the most quoted scientists in his chosen field, Albrektsson lectures around the world and often moderates symposia and conferences on subjects related to osseointegration-based treatment and research.

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