Dental implants were invented more than 2000 years ago. We’ve moved on a bit from shells, bone fragments and animal teeth hammered into the jaw though. Thankfully.
The first implants were, as all ancient medical practices seemed to be, a bit barbaric and ineffective. Around 4000 years ago, the Chinese were using carved bamboo pegs that were driven into the bone where the missing tooth had been. Bamboo, of course, does not fuse to the bone and it would rot over time, making it wholly ineffective and probably highly painful.
Then in Egypt about 2500BC, they were using gold, precious metals, ivory, shells and even transplanted human teeth to insert into the gap. Some of these were quite advanced, with natural-shaped roots. These did not seem to be functional teeth, but for aesthetic reasons, either installed while alive or as part of death rituals.
Around 300AD, Phoenicians created the first fixed bridge, creating faux teeth using ivory, and gold wire to create the bridge and attach these ivory ‘teeth’ semi permanently. This was the first hint of modern dentistry as we know it.
In the 1930’s, archaeological excavations by Wilson Popenoe and his wife found that ancient Mayans created dental implants from about 600AD. Pieces of shells were carved into teeth. The amazing thing about these ‘teeth’ is that some actually fused with the jawbone. These were the first functional tooth implants.[1]
In the middle ages, dentists would collect teeth from people in poverty, deceased humans or dead animals, and use these as dental implants. However, these surgeries frequently resulted in infections and diseases, so they were not popular.
Then in the 1700’s, a dentist called Dr. Hunter transplanted a tooth into the comb of a live rooster. The tooth embedded in the comb, and the blood vessels grew into the pulp of the tooth. This inspired more experimentations. But with most of these experimentations, these were unsuccessful as the body eventually rejected the foreign material. In the 1800’s, a variety of materials were experimented with – gold, silver, iridium tubes, porcelain, alloy- all failures. But failure is always the start of a scientific success.
In the early 1900’s, Dr Alvin and Dr Moses Strock experimented with orthopaedic screws made from vitallium. They had seen how orthopaedic surgeons had used screws in hip bones, so they extrapolated that information to create a vitallium screw. This biocompatible screw design provided more support than previous designs, both in terms of physical shape and the material used.
Then in the 1940’s, Drs Formiggini and Zepponi designed a spiral-screw. This was implanted and resulted in the patient’s bone growing into the metal—success!
Finally, in 1957, there was the final significant breakthrough- although it was an error in itself. An orthopaedic surgeon called Per-Ingvar Brånemark inserted a titanium cylinder in rabbit bone. His intention was to study how the bone healed, but instead, the bone and the titanium fused. This process was called osseointegration (bone fusion), and is the basis of modern-day implant success. He experimented further on humans and animals, and the first titanium dental implant was placed in a 34 year old patient in 1965. These implants lasted 40 years, until the patient died of old age.
Brånemark’s methods quickly were recognised in the medical community when he released the results of his studies. He partnered with Bofors, which later became Nobel Biocare, a supplier of dental implants and related technology.
The final leap in implant technology was in 1983, Dr Matts Andersson developed Computer Aided Design and Manufacturing (CAD/ CAM) as a way of creating extremely precise, repeatable dental crowns.
Since then, there has been a wide variety of developments. Companies started experimenting with different finishes on the titanium, plasma- spraying, adding coatings, and designing screws that would adhere faster and more firmly.
In 1992, use of ceramics for the crowns was initiated. The natural look and feel of these made them aesthetically pleasing, but their osseointegration properties meant that ceramics offered further benefits and strengths.
The future of implants is around increased success rates, faster healing, and better quality implants. Antibiotic coatings for implants are being studied, which remove or greatly decrease the risk of infection. Different growth factors are being experimented with, to augment bone healing. Implant coatings are being designed to help people with osteoporosis and other bone deficits. Nanotechnology is growing new bone so bone grafts will no longer needed. In the lab, implants like OSSTEM TS3 BA with a plasma sprayed resorbable coating of hydroxyapatite and calcium phosphate have improved osseointegration by as much as 150%.
The continued use of imaging to better see the patient’s mouth and jaw to create the perfect implant make the process smoother and healing time faster. Complex surgeries are aided by machines that create precise maps of the mouth, and then guided assistance with the procedure, allowing for highly precise surgeries. Even the use of stem cells is being looked into—maybe the future of dental implants is simply growing a new tooth.
World-wide millions of osseointegrated dental implants are inserted every year.[1] The success rate for this is around 95% +, a big leap from even ten years ago. Risks and complications have been drastically minimised. As we head into the future, the success rate will continue to increase, the technology will make it more accessible for those previously unsuitable for the process, and the surgery will be faster, less painful and with a faster recovery time.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4028797/
