In Memory of Per-Ingvar Brånemark

Per-Ingvar BrånemarkAnyone who has had implants or even joint replacement, owes thanks to Dr. Per- Ingvar Bränemark.
In 1952, while studying the relationship between blood circulation and the healing of bone tissue, Dr. Brånemark was unable to remove the titanium housing of a microscopic lens he had placed in the leg of a rabbit. After finding that the bone had biologically fused to the metal casing, he soon realized the clinical potential of this surprising discovery: Titanium could serve as a bone-anchored foundation for dental prostheses.
In the late 1970’s, a Swedish orthopedist named Per-Ingvar Bränemark introduced what he termed osseointegrated implants to dental practice. The Bränemark technique utilized biocompatible titanium-alloy implants that were atraumatically inserted into the alveolar process. The devices were then recovered by soft tissue surgical flaps to isolate the implants from the oral cavity to permit several months of undisturbed healing. After three to six months, the then-osseointegrated implants were surgically uncovered and subsequently used as fixed foundations for oral prostheses. In the 1980’s oral surgeons and periodontists quickly sought and received approvals from the American Dental Association to include the surgical aspects of implantology into their specialties with general dentists and prosthodontists performing most of the restorative procedures. Here’s a first hand reflection
Known as the father of the modern dental implant, Per-Ingvar Brånemark, M.D., Ph.D., died on Dec. 20, 2014, in his hometown of Gothenburg, Sweden, according to the New York Times. He was 85. As memorialized in Inclusive Implant Magazine, Dr. Brånemark’s impact on medicine can be summed up as follows:
“The only thing that remains of the patient after 1,000 years is the bone and the titanium,” Dr. Brånemark once remarked. Fittingly, with the millions of lives that have improved as a result of implant treatment, and the untold millions to follow, the imprint Dr. Brånemark has left on the world will be as lasting as titanium itself.

Doctors turn leg bone into new jaw

Zimbabwean’s life has been transformed in past two years thanks to the generosity of many.

Dr. Thomas Vecchione, left, and Dr. James Chao performed a check-up on Blessing Makwera this month in San Diego.

Dr. Thomas Vecchione, left, and Dr. James Chao performed a check-up on Blessing Makwera this month in San Diego. — Peggy Peattie

Sure, reconstructive surgery has given Blessing Makwera a blinding smile and the ability to eat whatever he wants.

But it is his voice that makes the most difference, the 22-year-old from Zimbabwe said.

Before a team of San Diego surgeons used a bone from his left leg to replace the part of his jaw that an explosion had torn off, talking was so painfully difficult that he would just give up.

“When you’re in class and the teacher can’t understand what you’re saying, it kinda lowers you down. But if people can understand what you’re saying, you can start to enjoy talking,” Makwera said.

That sense of joy came out recently during a checkup with Dr. Thomas Vecchione, the Hillcrest plastic surgeon who is part of the team responsible for this young man’s transformation.


Blessing Makwera before he underwent reconstructive surgery. / photo courtesy of Operation of Hope Worldwide

Makwera said far more than “thank you” as he chatted with Vecchione and Dr. James Chao, the reconstructive and plastic surgeon who crafted his new jaw from a harvested piece of his left fibula.

He described his desire to become a mechanical engineer, his newfound love of running, his temporary home in Boise, Idaho, and his phone conversations with loved ones back on the family farm in Zimbabwe.

He said the simple joy of being able to make his thoughts and feelings understood is just so … fun.

“It’s something that I’m still trying to wrap my mind around, even today,” Makwera said, flashing a smile at the doctors.

They smiled back. Vecchione offered to introduce him to his son who just landed a coveted engineering job with electric car manufacturer Tesla Motors.

“Tesla? I would love to work there some day,” Makwera said, launching into his master plan to someday help Africa develop more renewable energy.

Everything, it seems, is on the table now that people can understand what he’s saying post-injury.

Faced with the onslaught of words and smiles, Vecchione said Makwera has the one thing he needs to succeed. “Enthusiasm is the key to life, and you’ve got enthusiasm,” the plastic surgeon said.

Makwera’s still-imperfect but vastly improved voice is modulated by a mouth full of implanted teeth and meticulously rebuilt soft tissue in and around his palate, cheeks and tongue.

Those areas were damaged by an unfortunate encounter with a land mine detonator in 2008. The explosion took his teeth and most of his lower jawbone. He struggled to form words or eat even the softest foods.

Eventually, the nonprofit group Operation of Hope Worldwide in the Orange County city of Lake Forest learned about Makwera’s plight. It brought him to the United States and began looking for a health provider willing to donate reconstructive surgery. Sharp HealthCare and a team of associated surgeons answered the call to donate everything needed to rebuild what the detonator took away.

Three surgeries were required to harvest and implant bone, repair soft tissue and eventually have Dr. Joel Berger, a maxillofacial surgeon, implant permanent teeth.

Sharp and the contributing surgeons have not tabulated the value of their donated work, but it is in the hundreds of thousands of dollars.

In between operations, the patient has been able to live with an Operation of Hope volunteer in Boise. The arrangement has allowed Makwera to avoid traveling back and forth to Zimbabwe during his course of treatment, which includes months of recovery after each surgery.

He has tried to make the best use of his recuperation time by enrolling in a Boise community college. His mechanical engineering dreams may be helped significantly by his recent discovery that he is a great long-distance runner.

Jennifer Trubenbach, the president for Operation of Hope, explained that one day, Makwera decided to participate in a Boise marathon with the woman who has been his host there. Although he had not trained for the run, he did well.

“He eats two hot dogs the night before and he runs the marathon the next day and beats her by an hour,” Trubenbach said.

More recently, Makwera has tried out at a university in Idaho interested in having him join its track team.

This from a guy who is missing his left fibula.

Chao, the surgeon who crafted the bone into Makwera’s new jaw, assured the aspiring runner that he would be able to return to regular physical activity once his leg healed completely. The other bone in the lower leg, the much larger tibia, can handle a full load.

“That was pretty surprising,” Makwera said. “I thought it was going to be hard for me to even use the leg, and now I can run 26 miles no problem.”

After harvesting the left fibula, Chao made mitered cuts to help it flex and take a boomerang shape before attaching it with titanium plates to what was left of Makwera’s jaw bone. Delicate microsurgery was needed to connect a vein inside the bone that is about the width of a human hair. The surgery succeeded, enabling Makwera’s vasculature to supply the bone with enough blood to heal and remain alive.

Vecchione, the plastic surgeon, said the case was in the top ten of his career in terms of overall complexity. Chao agreed.

“We needed to get the soft tissue, the muscles, the teeth and the bone all in the same place, all functioning together,” Chao said.

The two physicians believe a fine-tuning surgery is still necessary to manipulate scar tissue preventing the left corner of Makwera’s mouth from taking a more natural shape. There also will be a little more work to make his tongue, which was damaged in the blast as well, more mobile.

“The key is to try to release the tongue as much as we can. If you can move the tip of the tongue a little bit better, you can get better definition in your speech,” Vecchione said.

For his part, Makwera said he is amazed that these doctors are continuing to help him two years after his first surgery.

“I am surprised that someone can do all of this and make everything functional. I’m just grateful to these guys for what they have done and what they are still doing,” he said.

TMD can lead to poor nutrition if the jaw pain and oral disability seriously affects your diet.

Those suffering from TMJ disorder may find it difficult to eat because of chronic pain, inability to open the mouth, and loss of appetite.  Malnutrition and Weight loss are common problems for TMD patients due to the necessity to eliminate certain food types from their diet. Pain experienced when opening the mouth, chewing and swallowing, the need for a soft diet, all may limit caloric intake, resulting in weight loss. Knowing what foods are most beneficial is the start to proper dietary planning.   The TMJ Association offers a new resource through their website: “TMD Nutrition and You,” a nutritional guide booklet specifically developed for people with compromised oral function to help them maintain a healthy diet in spite of their oral disability. Here, from that guide, is a list of foods to include as well as to avoid in a soft diet.


Cold Pack for a Cold Sore?

Ouch!   You know the pain of a cold sore. Caused by the herpes simplex virus (HSV), these raised red lesions on the lips and face can be triggered by stress, menstruation, sunburn, fatigue or emotional trauma.

Cold sores/Cold Therapy

Cold sores are painful blisters which usually appear around the mouth and nose. Cold therapy offers pain relief.

Use a Cold Pack, Like Cool Jaw’s 4″ Soft-side gel pack -The cold reduces the pain and swelling of your cold sore. 15 minutes at a time, apply the pack – move the cold around the area -not keep the ice on one area.

The temperature and weight, constricts local blood vessels and decreases tissue temperature. This constriction decreases blood flow and cell metabolism, this results in the area healing faster, and a decrease in pain.

Total TMJ Care


  • Difficulty Opening and Closing Your Mouth
  • Pain In Healthy Teeth
  • Sinus Pain
  • Sore Jaw In The Morning
  • Pressure Behind the Ears
  • Hearing Loss
  • Teeth Grinding
  • Locked Jaw
  • Teeth Clenching
  • Clicking Sounds When Opening or Closing Your Mouth
  • Unexplained Pressure Behind Your Eyes
  • Unexplained Headaches

These may be symptoms of Temporomandibular Joint Syndrome (TMJ)

Symptoms of TMJ or TMDs (“temporomandibular disorders” is a collective term embracing a number of clinical problems that involve the masticatory musculature, the temporomandibular joint and associated structures, or both.) occur in approximately 6 to 12 percent of the adult population or approximately ten million individuals in the United States.

Unlike other joints in the body, the TMJ is different because it is composed of fibrocartilage. The TMJ is able to withstand greater sheer force than any other joint and moves and functions in a very complex way.  When things go wrong, the consequences are challenging.  It is estimated that 17,800,000 workdays are lost each year for every 100,000,000 full-time working adults in the United States due to disabling TMDs.

TMDs are nine times more prevalent in women than in men.  The largest proportion of women with TMDs is between eighteen and forty-five years of age.

Due to a lack of understanding as to cause of the disease and the lack of definitive diagnostic or therapeutic approaches, patients often have to tolerate symptoms, including debilitating pain and an impact on quality of life over extended periods of time.

What causes TMJ Pain?

Improper fitting together of the teeth and jaw joints
Grinding or clinching of teeth, (bruxism)
Trauma such as head injury or whiplash
Female Hormones
autoimmune diseases, infection, arthritis
dental procedures, or inserting a breathing tube before surgery
Most dentists and physicians have been inclined to believe that the single most important etiological factor for degenerative TMJ disease is altered mechanical loading that surpasses the adaptive capacity of the joint.

Traumatic injuries are also an important etiological factor in the development of TMJ disorders.

What do you do for TMJ relief?

Your Guide To Temporomandibular Disorders

therapygels_0The TMJ Association, Ltd. (TMJA) is a nonprofit, patient advocacy organization whose mission is to improve the quality of health care and lives of everyone affected by Temporomandibular Disorders (TMD).  For over 25 years they have shared reliable information on TMD on their website  There you will find A New Free Educational Brochure: A Resource Guide for Temporomandibular Disorders.  This brochure is a straightforward, easy-to-read guide for patients making health care decisions.  A great place to start!  Remember less is often more, when treating TMJ so check out simple hot/cold therapy.

INFORMED PATIENTS HAVE BETTER OUTCOMES: Explanation of Bite Issues and how an Appliance may help TMD and Why adjustments are necessary.

The Cool Jaw® Learning Center is designed to provide doctors and patients, news and articles of interest relating to progressive methods of practice and patient treatment regarding Oral and Maxillofacial Surgery.

Improving Health literacy—the degree to which people obtain, process, and understand basic health information and services needed to make appropriate health decisions; this is our goal.

Patients who are better informed about their options and who understand the evidence behind certain approaches to care may have better health outcomes.

Take a look at this wonderfully informative video: “Ideal Biological Dental Model 2 – Dr. Martin N. Gorman.”  Dr. Gorman is a Optimal Health-Based Bioesthetic Dentist who also is dedicated to education and the informed patient  Take a look…..

Cool Jaw® is committed to sharing the pertinent information