The Osseointegration Book represents the combined knowledge and experience of the many doctors, scientists, and engineers who transformed a controversial approach to dental and medical rehabilitation into standard and accepted practice. This multicontributed book explores the background and history of osseointegration and its profound and lasting impact on all areas of medical and dental practice. It presents the broad range of clinical applications of osseointegration from its origins in dentistry to facial reconstruction and orthopedics. Anyone with an interest in the inception and development of osseointegration and its incalculable influence on the past and future direction of medical and dental treatment will find this an absorbing read.

512 pp; 1,200 illus;

ISBN: 0-86715-347-4; 0867153474;
978-1-85097-090-3; 9781850970903;

Table of Contents
1. Scientific Enquiry in Late 18th Century Cornwall and the Discovery of Titanium
Colin M. Bristow and Ron J. Cleevely

2. “A Very Cornish Tribute to Two Remarkable Scientists, the Revd William Gregor and Professor Per-Ingvar Brånemark”
Richard Johns

3. Why Osseointegration Would Work and How It Did in the First Patients Treated. Basic Facts and Philosophical Thoughts
Per–Ingvar Brånemark, Kerstin Gröndahl, and Barbro K. Brånemark

4. Interactions between Bone Marrow Stem Cells and Extracellular Matrix in Bone and Cartilage
Song Li, Anders Lindahl, Ulf Nannmark, and Shu Chien

5. Surface Properties and Osseointegration
Ingemar Lundström and Pentti Tengvall

6. Connective Tissue as the Environment Receiving Tissue Implants
Dick Heinegård

7. Osseoperception
Björn Rydevik, Veronica I. Shubayev, and Robert R. Myers

8. Psychological and Quality of Life Aspects of Edentulousness and Treatment with Dental Implants
Ulf Berggren, Catharina Hägglin, Ulrika Hallberg, and Lillemor R–M Hallberg

9. High Quality Radiology – A sine qua non in Planning and Monitoring of Osseointegration-based Treatment in the Oro-facial Area
Hans–Göran Gröndahl and Kerstin Gröndahl

10. Transfer of Mechanical Load across the Interface
John B. Brunski and Per-Olof J. Glantz

11. Osseointegration and Orthodontics
Kenji Higuchi

12. Soft Tissue Reconstruction and Management
Patrik Velander, Julian Pribaz, Christoph Theopold, and Elof Eriksson

13. Soft Tissue Reactions towards Perimucosal Implants
D. van Steenberghe, R. Jacobs, and M. Quirynen

14. Soft Tissue Management and Esthetic Considerations
Patrick Palacci

15. Prosthetic Treatment of Atrophic Maxillae and Maxillectomized Patients Based on Osseointegration
Carlos Eduardo Francischone, Laércio Wonhrath Vasconcelos, Hugo Nary Filho, Carlos Eduardo Francischone Jr, and Ivete de Mathias Sartori

16. Maxillectomy Cases
Ruben Rosenberg Roffe and Claudio Brenner Agosin

17. Rehabilitation of Maxillectomy Patients
Luciano Lauria Dib and Joaquim Augusto Piras de Oliveira

18. Osseointegration and Medical Bio Engineering: Maxillectomy Cases
Peter Blenkinsopp

19. Craniofacial Reconstructions
John Wolfaardt, Gordon Wilkes, Gösta Granström, and Kerstin Bergström

20. The Bone Anchored Hearing Aid – BAHA
Anders Tjellström

21. Osseointegration in Hand Surgery: Permanent Fixation of Joint Prostheses and Thumb Prostheses to Bone – the Swedish Experience
Göran Lundborg and Christer Sollerman

22. Osseointegration in Hand Surgery: Permanent Fixation of Joint Prostheses and Digit Prostheses to Bone – the United Kingdom Experience
David Martin

23. Bone-anchored Amputation Prostheses for the Upper Limb
P–I Brånemark

24. Osseointegration for the Skeletal Fixation of Limb Prostheses in Amputations at the Trans-femoral Level
David A. Ward and Kingsley P. Robinson

25. Physiotherapy for Patients Having a Trans-femoral Amputation
Kerstin Hagberg

Preface
Osseointegration has been and still is a phenomenon subject to much debate as well as research. Behind the nuances of semantics and rigor of scientific scrutiny, the development of the concepts and practice of osseointegration has created a quiet revolution in one aspect of dentistry, and other restorative and orthopedic prostheses, with very favorable practical results. The perceived nature of the effects and challenges of this revolution varies with the role of the observer and the nature of his or her involvement, whether as a patient, oral surgeon, prosthodontist, orthodontist, audiologist, hand surgeon, orthopedist, plastic surgeon, scientist, engineer, scholar, or businessman.

For the completely edentulous patient receiving a full, fixed prosthesis mounted on osseointegrated fixtures, it has brought a level of function, security, permanence, esthetic and psychological satisfaction that was previously impossible. The level of the patient’s satisfaction and function is the prime achievement of osseointegration. Furthermore, the application to single teeth, combined teeth and fixture support, and other craniofacial, plastic surgery and orthopedic applications are still being explored and successfully expanded.

From the standpoint of medical practitioners such as surgeons, prosthodontists or general practitioners, the development of osseointegration has meant availability of a new treatment modality which is a challenge to understand and master and to consider to use or adapt among many treatment modalities. It has not been a method that simply extends previous techniques. It has required special training and new ways of thinking and practice. It has thus been a challenge to master and has allowed a very sound and reliable new treatment to be carefully considered for each new and different patient.

For research scientists, biologists and engineers, osseointegration has raised a series of interesting, often perplexing, and wide-ranging questions that have been rewarding to pursue insofar as answers have been developed and still leave much unanswered. The research questions start at a material level: what are the surface properties that enhance osseointegration? Furthermore, what form should a fixture and prosthesis take? On the biological side, there are many more and more difficult questions: what cell and matrix components are responsible for the decision to integrate or not integrate a fixture in bone? What factors affect the decision? What are the controls and limits to the rate and strength of osseointegration? What are the immunological and soft-tissue responses that are needed or to be avoided? The total complexity of these fundamental biological questions is just now being unraveled in a rigorous, scientific way. The understanding and control of long-term changes due to bone resorption and/or growth and densification are not understood in detail and obviously involve complex cellular mechanisms of sensing and response. Molecular genetics and genetic engineering may even play a role.

From the standpoint of a manufacturer and businessman, the development of osseointegration presents challenges of optimization and precision control in production of a new line of products. Furthermore, for a complete and successful product line, new tools and equipment must be provided. In addition, a system of training courses is necessary if the end products are to be successfully used. These requirements and their satisfaction has led to an entirely new industry complete with regular and systematic training programs, curricula of universities leading and training in clinical procedures, patient selection, maintenance, handling of complications and health care. Furthermore, the production methods, materials selection, and engineering design being used today are not necessarily the optima possible or practical in the future, so there is room for creative industrial innovations.

Finally, from the viewpoint of the historian of science or of a socially minded commentator or governmental administrator, the development of osseointegration is a clear, classic example of high technology applied for the benefit of peoples’ health instead of for their destruction, which unfortunately has received the lion’s share of funding in the past. It may be useful to consider the socio-scientific structures and research funding mechanisms that may best allow for similar new developments to arise and prosper in the future. From a historical viewpoint, the discovery and practical application of osseointegration has been an explosive vent, a twinkling of the eye in an evolutionary time scale. But for those involved on a daily basis, it may seem at times to be a slow, difficult and thorny road in practice. Perhaps there is no other way.

Richard Skalak and P-I Brånemark
Göteborg, Sweden
Edited by Per-Ingvar Brånemark Branemark Osseointegration Center Göteborg, Sweden