From Stone to Titanium

The idea of replacing lost teeth with artificial ones dates back to ancient times.
But it took centuries of evolution for dentistry to offer truly high-quality solutions.

The earliest known manuscripts on treating dental diseases come from Ancient Egypt and date back to 3700 BCE.
This means that dentistry is at least 5,700 years old!

We even know the name of one of the earliest Egyptian dentists — Hesy-Ra, who served as the court physician to the pharaohs.
His memorial inscription reads: “The greatest of those who deal with teeth.”

The first version of toothpaste likely also came from Ancient Egypt.
It was made from eggshells, pumice, myrrh, and ash, and instead of toothbrushes, people used special wooden sticks.

The Etruscans — a highly developed civilization whose origins remain a mystery — left behind a rich legacy of material culture.
Among their many achievements was a true breakthrough in dentistry: they knew how to craft complex dental prostheses, including removable devices — early prototypes of modern bridges and splinting systems.

According to some researchers, the quality of Etruscan prosthetics surpassed even those used in Europe and America as late as the 19th century.
Their dental techniques were widely adopted in Ancient Rome, continuing the legacy of innovation in oral care.

Numerous records of early dental surgery practices date back to the first centuries of our era.
Mentions of such procedures appear in ancient literary sources from China, India, and South America. There is also extensive archaeological evidence.

A wide variety of materials were used to create dental constructions — including stone, ivory, gold and other precious metals, gemstones, quartz, animal teeth, and even bamboo!

Due to the nature of the materials used, dental prosthetics were often handled not by physicians, but by jewelers and blacksmiths.

The Maya people knew how to drill teeth, but this was mostly for decorative purposes — members of the nobility often adorned their teeth by inserting precious stones into the drilled holes.

In the Middle Ages, the development of dental technology largely came to a halt.
Treatment most often meant simply removing the diseased tooth — and not in the most humane ways.

The placement of prosthetics, usually made from precious metals, was rare and reserved for the wealthy elite, which is why it never became a widespread practice during that period.

At that time, medicine came under the control of the Church, which viewed any form of surgical intervention with suspicion.
It was widely believed that toothache was a punishment for sin, and therefore, treating it was seen as inappropriate.

Until the early 18th century, dentistry remained outside the realm of official medicine — dental care was not provided in hospitals.
Instead, if a tooth needed to be pulled, one would turn to a barber, bathhouse attendant, or folk healer.

In cities, during fairs, traveling healers often set up on market squares — and dental treatment, or more accurately tooth extraction, became a public spectacle, a kind of theatrical performance that attracted large crowds of onlookers.

There were also fantastical superstitions, such as the belief that toothache was caused by a “tooth worm”, which could supposedly be expelled through magic spells, amulets, or herbal potions.

Only a handful of educated physicians attempted to develop scientific methods of treatment. One such figure was the French surgeon Guy de Chauliac, who introduced the term “dentist” and wrote a textbook that would be used by European surgeons for centuries.

In the 15th century, Giovanni di Arcoli from Bologna made improvements to dental instruments and proposed the use of gold foil for filling decayed teeth.

There were also completely fantastical superstitions — for example, the belief that toothache was caused by a “tooth worm,” which could supposedly be driven out with magical spells, amulets, or potions.

Only a handful of educated doctors attempted to develop scientific treatment methods.
One of them was the French surgeon Guy de Chauliac, who introduced the term “dentist” and wrote a medical manual that would be used by European surgeons for several centuries.

In the 15th century, Giovanni di Arcoli from Bologna made several improvements to dental instruments and proposed using gold foil for filling carious teeth.

While writing his seminal work, The Treatise on Teeth, Pierre Fauchard returned to the roots of dentistry.
He studied all sources available to him, reaching back to ancient dental practices — including excavation reports from ancient cities in the Middle East, Etruscan and Roman texts, and the writings of Arab scholars from Andalusia.
Through this research, he helped dispel many of the myths and superstitions about dentistry that had taken hold during the Middle Ages.
The knowledge Fauchard gained from his distant predecessors formed the basis for his descriptions of over one hundred dental diseases, along with their causes and treatments.

Fauchard also made significant progress in prosthetics.
He was the first to develop post-supported artificial teeth and fully removable dentures for edentulous jaws, which were held in place using springs.

He was also a pioneer in dental education, founding the first schools for dental technicians. In addition, Fauchard can be considered the first orthodontist, having designed appliances made of silver and gold plates to correct bite issues and misaligned teeth.

These and similar removable dentures remained the most common type of dental prosthesis until the late 19th century.
They were typically horseshoe-shaped, made from ivory or hippopotamus teeth, and were heavy and poorly fitting.

As a result, they often distorted the patient’s facial features — a fact clearly seen in the case of George Washington, who suffered from dental problems throughout his life and wore several different dentures.

In his famous 1796 portrait, the lower lip protrudes noticeably, while the upper lip appears sunken.
To hide this asymmetry, the artist is believed to have placed a cotton roll under the president’s upper lip.

Here is one of George Washington’s preserved dental prostheses:

While the design of dentures gradually evolved over time, there was little progress in the materials used to make them.
Precious metal alloys, tin, copper, ivory, and animal teeth remained the norm for centuries.

The true revolution in dental prosthetics came with the invention of vulcanized rubber.
For the first time, there was a material that was lightweight, durable, resilient, and moldable — allowing dentures to be crafted with precise fit based on plaster impressions of the patient’s mouth.

At the same time, these rubber-based prostheses were significantly cheaper than their predecessors, making dental care more accessible to people beyond the wealthy elite.

Vulcanite served the dental field faithfully until it was replaced by polymers (acrylics) — a transition that didn’t occur until the 1930s.

By the late 19th century, porcelain bridge prostheses were being mass-produced — a material first experimented with by Pierre Fauchard.

Over time, metal-ceramic constructions proved to be the most reliable.
In these, a platinum-iridium alloy formed the base for a ceramic shell.
With many modifications, metal-ceramic technology became the standard in prosthetics and was widely used throughout the second half of the 20th century.

Starting in the 1980s, metal-free, all-ceramic restorations also came into use — marking the next step in the evolution of aesthetic and functional dental materials.

And finally, one of the most significant achievements in oral surgery has been the development of dental implantation.

In its modern sense, dental implantation is a method of replacing a missing tooth — or even several or all teeth — with an artificial structure consisting of an implant that functions as a tooth root and a crown that replaces the visible part of the tooth.

The scientific foundation of dental implantology was laid in the late 19th to early 20th century.
In 1891, Dr. Nikolai Znamensky gave a presentation at the IV Pirogov Medical Congress titled “Artificial Tooth Implantation”.
In his report, he advocated for placing the implant directly into the jawbone, rather than into the socket of a recently extracted tooth — which had been the prevailing practice at the time.

Unfortunately, his ideas did not gain wide adoption, and later, in the Soviet Union, dental implantology came to a standstill.
In fact, implantation was effectively banned, and it wasn’t until 1986 that the Soviet Ministry of Health adopted regulations lifting restrictions and allowing the field to develop.

Meanwhile, in other countries, implantology research was steadily advancing.
Allotransplants were invented — artificial roots shaped to resemble natural ones.
However, the challenge remained to find a material that would offer high biocompatibility and integration with the bone.

Many materials were tested: gold, silver, platinum, porcelain, plastics, and alloys based on cobalt, chromium, and molybdenum.

In 1913, Edward Greenfield proposed a framework implant made from a platinum–iridium–gold alloy, laying further groundwork for future innovation.

Soon, the first prototypes of modern screw-type implants began to appear.
In 1937, Evin Strock from Harvard University introduced a screw-shaped dental implant made from cobalt-chromium-molybdenum alloy known as vitalium.
Patient follow-ups revealed no postoperative complications or adverse reactions.
These were the first relatively successful implants, and some types are still produced from vitalium to this day.

In 1947, Italian dentist Manlio Formiggini proposed using stainless steel dental implants.
Various other designs of endosseous (intrabone) implants were developed around the same time.

However, all of these efforts remained isolated, driven by individual pioneers and lacking widespread adoption or clinical standardization.

The true breakthrough came in the mid-20th century.

In 1952, Swedish scientist Per-Ingvar Brånemark discovered the phenomenon of osseointegration — and the discovery happened completely by accident.
While studying bone marrow function, he implanted a small titanium chamber into the leg of a rabbit.
When he later attempted to remove it, he found that the bone and the titanium had fused together completely.

This led to the realization that titanium is an ideal material for dental implants: strong, lightweight, corrosion-resistant, and biocompatible with human bone.
It does not provoke immune reactions or cause harm to the body — making it the gold standard in implant materials to this day.

It was the discovery of osseointegration that made modern dental implantation possible.
Within a few years, screw-shaped titanium implants were developed, along with the technology for their manufacture and surgical placement.
In 1962, a patient received the first titanium implants designed for osseointegration — marking the start of a new era in dental implantology.

In 1964, Leonard Linkow introduced blade-shaped implants and became internationally recognized as the founder of the fibro-osseointegration method.

In the 1980s, implantologists adopted a new solution called the Toronto Bridge — a fixed full-arch prosthesis supported by 4 to 6 straight implants.
It was designed to restore an entire dental arch, offering a durable and functional alternative to removable dentures.

In the late 1990s, the All-on-4 technique emerged — a groundbreaking method for restoring dental function in cases of extensive tooth loss or complete edentulism.
Developed by Dr. Paulo Malo, the approach involved placing implants at angled positions in the alveolar bone (angular implantation).

Its main advantages included the ability to bypass anatomical obstacles in the jaw — such as the mental foramen and maxillary sinus — and to deliver full-mouth rehabilitation in a short time.
This innovation made implant-supported restoration accessible even for patients with severe bone loss and changed the standard of care worldwide.

And perhaps the pinnacle of modern dental implantology is zygomatic implantation.
This method is used in cases where All-on-4 is not possible — for example, in patients with severe bone atrophy in the upper jaw, where there simply isn’t enough bone volume to securely anchor standard implants.

In zygomatic implantation, much longer implants (zygomatic or zygoma implants) are used.
These pass through the maxillary bone and are anchored in the zygomatic (cheek) bone, allowing for the restoration of chewing function, speech, and smile aesthetics without the need for complex sinus lift surgery.

There are also related techniques — such as transnasal and pterygoid implantation.
They differ from zygomatic implantation in the location of implant fixation — in the frontal process of the maxilla or the pterygoid process of the sphenoid bone.

Implantology continues to evolve.
Researchers and clinicians are constantly working on more advanced techniques.
Not long ago, implant survival rates were around 60%, but today, the best clinics have reached a 98% success rate.

New implant systems and cutting-edge materials are being developed — all aimed at delivering reliable results, even in the most complex cases.