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My Start in Dental Implants
I was in the first class in North America to be trained in the Brånemark Dental Implant technique. It was held in Toronto in 1983 and very well attended by dental specialist, mostly from the greater New York area. It was a three day course taught by Dr. P. I. Brånemark and Dr. George Zarb, a Prosthodontist, and it truly changed the professional careers of many of those in attendance. I was trained in the Prosthodontic applications of the implant technique and went home afterwards to work with a variety of surgeons to restore my patients with dental implant restorations. For the next twenty-five years, I perfected my Prosthodontic work with dental implants and incorporated dental implant surgery into my own practice. My experience over that time period involves the restoration and placement of more than twenty thousand dental implants of various types and brands and clinical experience with a wide array of patient needs.
Dental Implantology before 1983 in the United States was an untried, almost experimental area of dentistry. It was only practiced by a few brave, or actually arrogant, soles with little documentation and questionable results. There were a variety of techniques, the most popular of which was the Blade technique which was popularized by Dr. Leonard Linkow (Reference), the subperiosteal implant technique and the one with screws going through a plate in the anterior mandible.
Dr. P. I. Brånemark had made an interesting discovery in the 1952 that titanium would somehow attach to bone when it was implanted in that bone and left undisturbed for a few months (Reference). He put this discovery to test developing dental implants and the techniques necessary to place and restore them, providing a human patient with dental implants in 1962. He was a meticulous researcher and spent many years researching and developing the techniques that we still use today. In 1972, Dr. Brånemark entered into a commercial partnership with the Swedish Defense Company Bofors to manufacture Dental implants and instrumentation necessary for placing and restoring them. An offshoot of Bofors responsible for this new implant division was NobelPharma which today is known as NobelBiocare and serves to control the dental implant product line.
Dr. Brånemark and NobelPharma took on the obligation of training dentists throughout the world to place and restore dental implants. While Dr. Brånemark was not a dentist, he relied on several dental colleagues to help him design the final release of the dental implant and perfect the techniques for placement and insertion. Most notably, he worked with the Periodontist Jan Lindhe, the oral Surgeon, T. Albrektsson and the Prosthodontist George Zarb of Toronto Canada. The courses provided to dentists were extremely well controlled and limited. General practitioners were not allowed to participate in these courses. Only Periodontists, Prosthodontists and Oral surgeons could take the training which was required to purchase the implants and the instrumentation. Furthermore, the course was set up sot that there was a surgical section and a Prosthodontic section. Only Prosthodontists were trained in the restorative techniques and oral surgeons and Periodontists were trained in the implant placement techniques. This did not change from 1983 until 1989.
The first course in North America was known as the Toronto Conference and was very well attended by dental specialists from the Northeast of the United States and Canada. The course lasted three days and the highlight was viewing the results of a five year clinical trial that Dr. Zarb undertook in Toronto to test out the Brånemark theories. We got to examine and talk with a number of very satisfied patients and the clinical and psychological results were indeed outstanding.
Dentistry realized very quickly that the use of dental implantology as described and developed by Dr. Brånemark and NobelPharma was a very good thing for the profession in general and served a large group of patients extremely well. Specialists across the nation began to attend the training programs to learn the technique and gain the Brånemark certification which was necessary to purchase the implants and supporting products provided first by NobelPharma and then by other companies moving into the dental implant field.
The products and applications have changed greatly since the introduction in 1983 and I have been there step by step, using the technology, learning from my endeavors and ultimately, I hope, improving the lives of my patients. During the past 25 years, I have discovered some interesting facets of the dental implant experience and drawn some definitive conclusions about the discipline of implant supported restorations. I have drawn conclusions relative to Diagnosis and Treatment planning, Implant Design, Surgical Technique, Restorative Design and Longevity and Maintenance of dental implant supported restorations. This article aims to share those conclusions with my colleagues.