Dr. Nicole Winitsky works at the department of prosthodontics at the Eastman Institute in Stockholm, Sweden, where she treats young adults. She started working with dental implants in 2000 at an implant clinic in Stockholm. Here, she shares her experiences and advice on dental implant restorations.
How did you get started in dental implantology?
I started my dental career in London and after two years I moved back to Sweden. While working in the dental public health sector in Stockholm, I needed new challenges and became interested in learning how to perform implant treatments.
What types of implant cases do you specialize in?
I specialize in treating young adults with aplasia (single or multiple), traumas and other kinds of genetic disorders, such as ectodermal dysplasia. During my residency as a prosthodontist at the Eastman institute in Stockholm, I spent a lot of time in the juvenile prosthodontics department and I became interested in treating this patient group.
How does treating young adults differ from treating the general adult population?
There are quite a few differences. Mainly, treating young adults with implants demands years of planning prior to the actual placement of the implant restoration.
When treating patients that are still growing we have the opportunity to use the growth of the patient to optimize our treatment. This can be done for example with orthodontics. We can open a deep bite to improve the prognosis or extract primary teeth at the right time to decrease the amount of implants needed. Our goal with these patients is for them to end up with as few artificial teeth as possible. This is because we know that implants and prosthetics in young patients will have to last for about 60-80 years if they are treated in their early 20’s. The fewer artificial teeth they have to worry about for the rest of their lives, the better.
Young patients are in many ways clinically demanding cases as they can often have a high smile line, a thin biotype and high translucency in their teeth. This makes it even more important to optimally plan and perform the treatment. Since the reason they need implants is mainly aplasia or trauma the amount of available bone at the implant sites is often limited, meaning bone augmentation is often needed prior to implant treatment.
It is very rewarding to work with young patients since dental treatment makes a real difference in their lives. Implants make a huge difference to a 20-year-old girl who has been using removable dentures since childhood! After planning a treatment like this for 10 years and reaching the goal successfully, often ends up with both the patient and myself having tears in our eyes.
Do implant-based restorations require different considerations to non-implant-based restorations?
Implant treatment requires greater multidisciplinary work. My cases require good teamwork with orthodontists, surgeons, radiologists, dental technicians and dental hygienists. It is only when all of the team members do their very best that optimal results can be reached. As a prosthodontist taking care of the last part of the treatment, I am very dependent on how well the work has been performed up until then. It is therefore crucial to work with the right team members.
What steps do you take before treatment to help ensure a successful outcome?
I perform a thorough examination of the patient, often already at 10 to 13 years of age. Orthodontics is frequently required to help ensure good positioning and spacing for the future implants. By doing this we try to ensure the very best long-term prognosis, which is crucial for these young patients. Correct positioning and spacing is extremely important for successful implant placement. Over the years I have worked with different surgeons and I have found that the best (and perhaps even the only) way to help ensure optimal implant placement is by working with digitally planned surgical guides.
When restoring dental implants what key aspects should be considered?
I always study the patient’s smile line and biotype before deciding how the treatment should be performed. A high smile line requires soft- and hard-tissue augmentation to a greater extent than a low smile line, and a thin biotype requires greater care when handling soft tissue than a thick biotype.
There are also certain considerations that influence whether it is possible to achieve a good emergence profile. For single implant cases it is important to have enough space between the neighboring teeth, both cervically and apically. If you don’t, you risk receiving an implant crown with an atypical anatomy and lack of papillae or placing the implant too close to the neighboring teeth.
What is the most common challenge that you face in your day-to-day work?
My main challenge has been suboptimal implant placements. To overcome this, I aim to perform all my implant treatments using digital planning and surgical guides. The tools we have available today make it possible to optimize implant placement and teamwork. Why should we continue accepting bad implant placements when we have the technology available to us to prevent this?
What has dental implantology been able to offer you professionally?
Being multidisciplinary, implantology have given me as a prosthodontist a better biological understanding of both hard and soft tissue. It also gives me the possibility to offer my patients fixed teeth without touching neighboring teeth.
What advice do you have for someone who is about to restore their first implant?
Choose good team members, learn from your mistakes and those of others, listen to patients’ wishes and always perform the best that you can. And finally, stay curious and keep trying to perform even better next time.