Welcome to our dental clinic

Our office is situated in the downtown area of Thessaloniki. We are specialized in complex and difficult cases of advanced periodontal disease in need of implant tooth rehabilitation. Esthetics is a prime objective in every approach. The team is comprised of specialized clinicians in different aspects of dentistry. Head of team is Dr. G. Makris.

  • The office works on appointment basis accepting however emergency problems in need of immediate care
  • The working schedule of the clinic is from 10:00 am to 9:00 pm.

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The philosophy of the team focuses
on the "holistic approach" of treatment.

This approach is based on the thorough diagnosis of all aspects of mouth function and plans the clinical steps to accomplish the original goal of the therapy.


Let’s give some examples:
  1. An absolute prerequisite to make a filling is the establishment of gum healthlightbox. The least amount of bleeding will hamper the gluing properties of the material and thus will produce micro-leakage and microbial infiltration. Thus before any operative approach the treatment of inflamed gums is an absolute step. This is the reason why the metal margins of crown restorations appear afterwhile ugly when someone smiles. Periodontal treatment will eliminate edema of the gums. These will produce resession: the gums will move away from the crown and thus the margins of the metal will appear. Additionally black holes will occur between the crowns of teeth and sensitivity in cold and warm will provoke discomfort when chewing.
  2. Absolute prerequisite for implantlightbox placement is the completion of periodontal treatment. Why? Periopathogen bacteria from periodontal pockets will attach to implant surface and this is a high risk factor for implant rejection.
  3. Absolute prerequisite for an esthetic restoration in the anterior teeth is the establishment of complete homogeneitylightbox of adjacent teeth in color, shape and appearance through lips.
  4. Absolute prerequisite for implant placement is the thorough examination of general health. The simplest drug (aspirin) to more complex (diphosphonates) can induce serious problems of healing procedures.

What should be this step procedure?

  1. First to teach the appropriate dental health. Why? The most serious dental diseases are caries (rotten tooth) and gum problems. Both conditions are infection diseases. Which means disease produced by bacteria. So if we do not learn how to remove microbial agglomerations away from our teeth on a daily basis this would be a serious risk to develope disease and thus will affect prognosis of our restorative works.
  2. Secondly we have to reduce the microbial load from our mouth. In which way? Well caries is broken down dental structure infiltrated with millions of bacteria. Bleeding gums are the result of acute inflammation caused by the invasion of bacteria inside the tissues.
    So this step includes the following procedures aiming to reduce microbial load.

    1. Cleaning of tooth caries (soft diseased material of tooth).
    2. Treatment of gum disease (removal of calculus and diseased tissue).
    3. Extraction of the destroyed and not maintanable teeth.
    4. Root canal treatment.
  3. Only after completion of the above we proceed to the final step: the restorative phase

Dental Implants

Dental Implants


  • Single implants

    Are needed mostly in cases of missing teeth, or more rarely posterior teeth.
    These teeth can be lost due to:

    • accidents (fails or hits)
    • extensive caries
    • bad endo work
    • fractures
    • repeated abscesses
    • gum disease

    In these cases dental implants provide the best solution. Adjacent teeth can be preserved unimpaired and not be included in the bridge. Single implants can be restored with porcelain jackets, which provide function and esthetics.
    In the 1st case two of the teeth presented excessive mobility due to terminal gum disease. Teeth were removed. Two single implants were placed and porcelain jackets restored hers.

  • Case 2

    In the second case treatment was more complex.

    It demanded plastic surgery of gums and regeneration of underlying bone tissue.

    Subsequently a single implant was placed.
    Prosthesis followed and a small esthetic arrangement of the adjacent teeth was done.

  • Case 3

    Young woman with primary teeth (milk teeth) still in her mouth. The permanent teeth were
    congenitally missing.

    These «baby teeth» fell in the age of thirty. She has done orthodontic treatment for esthetic
    reasons and to provide space for the lost teeth.

    Now she does not want to cut down adjacent teeth in order to place a fixed bridge.
    Two individual implants with porcelain crowns solved the problem!

  • Case 4

    Patient who wears denture in the upper jaw.
    She wishes to have:

    In this case four to six implants are needed to replace the denture. The new teeth are now fixed and function as her own. They are esthetic and the palate is open, as it was in the past. Now she can enjoy her meals without her tongue touching the cold, metal surface of the denture all the time.

    • Fixed teeth
    • Open palate for comfort and better taste
    • Pretty teeth-smile
  • Case 5

    Individuals who wear partial dentures (Vitalium) and wish to replace it with fixed teeth. In this case the false teeth are the front of the upper jaw. The patient feels embarrassed when the vitalium moves around and she is afraid of smiling. She wishes to:

    Three implants were placed. A new fixed prosthesis combined with her natural teeth was placed. Now she is happy and she can function properlly. She laughs all the time and she feels good with herself.

    • Have fixed teeth
    • To get rid of the vitalium
    • Be pretty
  • This patient lost a number of teeth due to gum disease. He wishes to:

    The treatment plan in this case is more complex and takes more time. Requirements:

    • Treatment of gum disease
    • Provisional fixed bridge to evaluate factors such as
    • Prognosis of treated teeth
    • Esthetics
    • Mobility etc.
    • Get rid of the bad odor of the gum bleeding
    • Avoid eventually denture placement
    • Have pretty smile
    • Have fixed teeth

    Only when inflammation is under control, we proceed to the placement of implants. In this particular patient we placed three implants and a bridge was made in combination with his natural teeth. All of his demands were satisfied > Healthy mouth > Fixed and pretty teeth

  • Patient wearing full dentures, mostly in the lower jaw.

    The denture is very mobile, the cannot chew well and feel very uncomfortable and insecure in their social life. They wish for a good and secure retention of their denture.

    The best solution would be two implants on which the denture could be attached.

    The heads of the implants are connected with the inside part of the denture. The retention is perfect.

    The denture does not move at all and the patient can function normally in his social life.

  • Restoration

    Restoration of missing central incisor with single implant




What is a dental implant?

The implant corresponds to the tooth’s root. It has the shape of a screw and it is placed in the jaw’s bone. What shows in the mouth (the «tooth») is a porcelain crown which is supported by the implant.

lightbox

Where dental implants are used?

An implant can be used when one, more than one or all the teeth are missing.

A. One tooth missing
An implant replaces one tooth, usaually a front and rarely a posterior, in order the adjacent unimpaired teeth won’t be harmed.

B. More teeth missing
It is indicated in cases that posterior or front teeth are missing and the placement of a removable partial denture is not desirable. Placement of implants helps construct of a fixed bridge. Futhermore, implants are used in cases where the gap between teeth is extended making the construction of a bridge difficult or even impossible.

C. All the teeth are missing
Implants offer two options:

  • When a patient doesn’t want to wear a denture. With implants one can have teeth as if were hiw own.
  • When a denture is well tolerable by the patient but it has poor retention.
    Then, only two implants can improve dramatically retention and function of the denture.

Can the human organism reject dental implants?

No. Implants are manufactured by pure titanium, a material compatible with the human organism. Besides, titanium is being used for many years in orthopeadics without causing any problems.

Is it possible for an implant to fail? If so, what is the failure percentage?

Yes, in very few cases. The reasons are technical. Still, even in this case it can be replaced without a problem. The failure percentage depends on the doctor’s experience. In sepcialized and well-experienced dentists this percentage is less than 1%.

How long do implants last and how much they cost?

With proper care implants can last a lifetime. At first glance implants are far more expensive than a conventional bridge or a denture. In the long run one must have in mind that a bridge or a denture must be remanufacrured 2-3 times and then realizes that the overall cost of implants is much lower.


Is age a contraindication in the placement of implants?

No. The only exception are children. In that case, growth must be completed before the implant placement (after the age of 16-18).

Is the placement of implants a painful procedure? How many days must I be absent from my job?

Usually is less painful than a tooth extraction. In the case that many implants are being placed in the same operation, mild pain and swelling can be observed, but nothing that cannot be settled by a simple painkiller. In most cases the patient can return on his/her job immediately after the operation. When many implants are placed the intercession of a weekend allows the patient to return to his/her job without any annoyance.

How long will it take to have my new teeth?
During that time I will be edentulous?

After the first visit usually it takes 6-12 weeks for the therapy to be completed. As long as therapy lasts provisional restorations are made in order to achieve satisfactory mastication and esthetics.

Do I have to quit smoking during therapy?

As in many other cases, smoking can cause various problems.
So, decreasing or even quitting smoking is recommended at least the first week after the operation because smoking affects the process of healing.

Do implants need special care?

No. As natural teeth, daily brushing is sufficient as well as frequent visits to the dentist.


Periodontology

Periodontology

Periodontology

What is the microbial (or dental) plaque?

This is an organized agglomerate of bacteria originating from the microbial flora of the mouth attached mainly on the surface of the teeth. The maturation of the plaque increases its infectious potential and so becomes aggressive to the tooth itself and the tissues around the teeth. In the mouth microbial plaque can be recognized as an off-white colored agglomerating where the tooth meets the gums. The only way to remove the plaque and thus to protect tooth and gums, is by the mechanical action of the tooth brush.

What is calculus?

This is the calcified hard structure initially found in areas where the saliva exits from the salivary glands (for example inferior surfaces of lower front teeth). Absolute prerequisite to have calculus is the presence of dental plaque. Then mineral ions infiltrate the organic matrix of plaque and form crystals and thus starts the mineralization process. Calculus is harmful because its surface is porous and microbial plaque can “hide” and mature inside protected cavities. So its presence is more harmful. At this time removal of calculus can be accomplished only by the specialized dentist.

What is gingivitis?

This is an infection of soft tissues around teeth that produce bleeding and local swelling. These symptoms ( blood on the pillow is frequent) can appear to recede and then again “flare up”. So it can be of a cyclic nature. However these main symptoms can be aggravated due to hormonal disturbances ( puberty- pregnancy- menopause etc) and to systemic diseases ( diabetes). Treatment of this infection can totally reverse disease to health.

What is the treatment of gingivitis?

Removal of microbial plaque and calculus, education in effective daily tooth brushing and removal of local factors that increase plaque accumulation ( bad fillings etc) are the main elements of treatment. This treatment can be accomplished under anesthesia in two or three visits in the office.

What is periodontitis?

When the infection from the soft tissues (gingivitis) propagate to the underneath supporting bone. This process produces destruction of bone and decreases tooth support. There is gum recession and finally this can result in tooth loss depending to different factors but mainly to the rapidity of this bone loss. This condition can be diagnosed as early, medium, advanced and aggressive. Treatment cannot reverse destroyed tissues but can succeed in arresting the disease and in some specific cases localized regeneration can be accomplished.

What are the symptoms of periodontitis?

Periodontitis does not produce pain as in the case of caries in the tooth. In early stages symptoms (swelling- bleeding- pain) come and go (cyclic nature). It is only in late stages that tooth mobility appears and teeth move in other positions. Abscesses can occur, taste is bad and oral breath is annoying.

What is the cause of periodontitis?

These are infections associated with very virulent and aggressive bacteria that usually develop in anaerobic conditions. There is also a predisposing family factor (genetics) and most of the times reduced interest in daily oral health.

What is the treatment?

Since we have an infection, treatment should be antimicrobial. This does not mean antibiotic therapy. Treatment should aim to “clean” thoroughly teeth underneath the gums. This is performed under local anesthesia in quadrants. Access to tooth cleaning can be done surgically ( open flaps) or conservatively (closed curettage) depending on the severity of the disease. Daily oral health should be thorough and applied intensively in order to preserve results of treatment.

Does periodontits produce pain?

Very seldom so, this can only happen in acute stages of the disease. Abscess formation with pus exudation can provoke pain. Usually there is a feeling of “etching” on gums. You want to “frot” the gums in order to remove this symptom.

Why does my mouth smell bad?

Periodontal diseases are infections of inflammatory nature. This means that there is an ongoing process of tissue destruction. Bi-products of this destruction are sulfur chemical unions that produce bad smell and cannot be hidden with mouthwashes.

What means a ”pocket” in periodontal disease?

In advanced periodontitis pocket formation occurs. Because of bone destruction and when the gums are not receding there is a gap between the margin of the gingiva and the level of the supporting bone. In other words there is a crypt underneath the gums that bacteria can agglomerate and be “protected” from the action of the toothbrush. When a critical volume of bacteria is reached then a ”burst” occurs- like a microabscess- producing a localized destruction. The bone, recedes and a new equilibrium is established until the next “burst”. Thus pocket formation is potentially very dangerous in tooth prognosis. One aspect of periodontal treatment is to eliminate pocket formation.

What does it mean ”surgical approach” to periodontal treatment?

When the depth of the pockets extends beyond 5mm measured from the margin of the gum then this pocket is a potential aggravating factor of the disease. It is estimated that the extent of the pocket surface in the case of periodontal disease equals the surface of the palm of the hand. The bacterial population of this area is enormous. Three objectives of the periodontal surgery are 1. elimination of pockets, 2. access to the hidden areas of the tooth in order to clean then from bacterial plaque and calculus, 3. establishment of a tissue contour that enables better oral health of the patient.

Is laser therapy better than the surgical one?

Laser is a high energy beam. Despite the fact that every laser instrument could be different, there is no scientific evidence that lasers are more effective in periodontal treatment. On the contrary there is evidence that some of them “burn” the tissues producing extensive esthetic damages.

Does the surgical approach is painful?

It depends on the surgeon! How aggressive is the technique and whether is needed to approach surgically the area, when there is a possibility of a conservative approach.

Is it possible to surgically intervene locally?

Of course! The case of surgical approach should be targeting only in areas that need such intervention. After conservative treatment this approach could be very localized where is truly needed. Sometimes periodontists overtreat patients!

Why we observe recession of gum in periodontal disease?

In some cases due to anatomic reasons (very thin gingiva) bone resorption is followed by tissue recession. This is more frequent in front teeth. So we can say that there are two cases of equal periodontal destruction. One can appear with recession and no pockets while the other with pockets and no recession.

Does treatment can restore recession?

Most of the times the answer is no. Sometimes localized recession defects can be treated by plastic surgery. It is important however to understand that even in these cases there is no proper regeneration of the lost tissues but rather an esthetic approach of “covering” this recession.

Do the spaces between teeth will close after treatment?

Unfortunately no! Spaces have been formed because the edema and inflammation have been gone. The gum in a physiologic manner seek to take its place near the underlying supporting bone. Gingiva now appear pink, firm and healthy. Spaces can be closed only by restoratives means (see bonding).

Does periodontal disease affect general health?

There is scientific evidence that supports a relationship between cardiovascular disease and periodontal disease. Periodontopathic microbes can induce formation of atherosis in the vessels. There is also general agreement that the same periodontopathic bacteria of the mouth can enter circulation and affect remote organs.

What can I do with tooth mobility?

The fist step is periodontal treatment. Reduction of inflammation will reduce tooth mobility. Empirically if tooth mobility does not affect our masticatory function means no intervention. If on the contrary we estimate that this is the case we can proceed in tooth splinting. Teeth are ”bonded” together to withstand better masticatory function. Additionally occlusal adjustment can be done to equilibrate masticatory contacts in all teeth. These are not invasive, reversible methods with a high success rate.

How we maintain the results of the treatment?

This is the main issue. Every individual is educated in oral health witch comprises effective tooth brushing with use of interdental brushes. Interdental cleaning is an absolute mean of oral health because tooth brush cannot have access in spaces between teeth. We try continuously to modify and educate our patients in daily propper oral health. Every patient then, depending on its effort will participate in a prevention programme every 3 to 6 months.

Does the treatment of my periodontal disease will solve once and for all my problem?

Unfortunately no. Treatment will arrest the progress of the disease. However every individual will have to understand the primordial importance of oral health ( brushing- interdental cleaning), to understand that smoking aggravates the disease and integrate in his life regular visits 2-3 times a year for professional cleaning.

Is my periodontal disease contagious for my family?

No, these infections are not transmitted. However it is not pleasant to live with a person that has a bad breath and sure enough this is not a good example for the children. Oral health is an important part of our body health.

Esthetic Dentistry

Esthetic Dentistry

  • Full restoration of upper anterior teeth with all ceramic crowns. Periodontal treatment preceded the prosthetic work.

  • Esthetic bond composite restoration.

  • Esthetic bond composite restoration.

  • Old filling on the central incisor replaced by composite resine restoration.

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    Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s

Are there different approaches to esthetic dentistry?

In every office there is different approach in dental treatment. According to our principles esthetic dentistry cannot be performed without treatment of periodontal disease or caries removal.
The second philosophical approach is minimal intervention. Teeth that are prepared (cut) cannot be restored in their previous situation. It is a non reversible approach. It should be known that prepared teeth can develop sensitivity, pain, and this can lead to root canal treatment.
Therefore our approach to dental esthetics is a minimal intervention.
What are the procedures? A. Minor tooth movement, this is a targeted and of short duration orthodontic movement,
and B. Bold adhesive techniques.
That is bonding of teeth with tooth-like materials that absolutely match the color of the tooth. The procedure is like modeling the tooth in the desired shape and color with material behaving like tooth. This minimal approach cannot create Hollywood- type smiles. If this is the desire of the individual then more invasive techniques are needed.

Minor tooth movement. What is the invisalign technique?

This is an orthodontic technique based on the prevision of the final result we expect using CAD-CAM technology.

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This procedure enables the prefabrication of a series of splints that can move teeth in the desired position. Every splint moves the teeth for some millimeters and then after 2-3 weeks another one continues the movement. This treatment can last 6- 12 months depending on the aim of the study. We use this method for small movement in adult patients to accommodate their esthetic needs. The advantage of the method is that do not have to wear wires or brackets. The splints are transparent and cannot be distinguished in the mouth. They have to be worn as long as possible except eating time.


Crowns

What is the difference between a metal-ceramic crown (MC) and an all-ceramic crown (AC)?

The MC is a crown placed on a tooth with a metal frame covered with porcelain. An AC is a crown fabricated totally with porcelain. The esthetic outcome of both is excellent. The disadvantage of MC could be that sometimes due to gum recession the appearance of the metal frame on the edge of the crown is unaesthetic, thus there is an esthetic advantage of AC.

Do MCs and Fcs present the same strength?

Unfortunately MCs present fewer strength problems. AC crowns develop more often fractures thus they are not recommended to cover teeth with extended restorations or when these teeth bear excursive occlusal forces.

What is the difference between an AC crown and a laminate?

An AC demands complete grinding of tooth whereas a laminate demands minimal grinding of the facial aspect of the tooth.

What is the difference between bonding and laminate?

Bonding is a procedure that tooth-like substance is attached to the tooth modeling its appearance. The laminate needs very careful grinding of the facial aspect of tooth, impression, fabrication of the new facial structure of tooth. So the main differences are reversibility of tooth (no tooth grinding, possibility to reverse in previous situation), time (fewer visits), cost (no laboratory involvement), so lower cost for the patient.

Is it possible to remove bonding or laminates?

Bonding can be detached very easily without intervening the integrity of tooth. Laminate should be detached and replaced by a new one following all the procedure again (impression- fabrication- placement).


Tooth Bleaching

What is the tooth bleaching?

This is a procedure that aims to whiten the tooth. It is a chemical reaction that reduces or eliminates deep color staining of the tooth. The dentist can give information on the potential whitening (how many shades will drop), on the hazards and on time and effort needed.

What is the procedure?

This can be done by the following methods.

  1. In the dental practice. This is for immediate results using a whitening solution of high concentration, enhancing its effect by external light emission of special wave length. This procedure can last for 1 to 2 hours.
  2. At home. This is a procedure so that the individual can control its whitening effect. It is imperative to use custom made plastic splints inside of which the bleaching solution is placed. This one is of lower concentration (10-20 %) and the final result appears after 10 to 15 days. This method is the safest and more conservative.
  3. A combination of both procedures.

Does it hurt? Does it harm teeth?

It can produce tooth sensitivity, which is reversible following directions. It does not harm teeth but it should proceed slowly, having patience

What is the lasting effect?

This can last from 1 to 5 years depending on the nutrition habits and the coloration of food. Also it depends on smoking, frequency of coffee and wine drinking. Repetition of the procedure can be done in cases of relapse.

Is this a procedure for everybody?

Basically yes. It is not indicated for persons that have extensive caries, recession of gums and extensive denudation of teeth, pregnant women, different oral pathological conditions, children and people with allergies to whitening solutions.

Does bleaching change color of crowns and bridges?

Definitely no! This solution can act only on the enamel surface. In the end of the procedure it is also imperative to change all fillings (at least in the front teeth) since their color will not match the whitening result of the teeth. This should be considered when cost analysis is discussed.

Dr. George Makris

Dr. George Makris

dr-makrisDr. George Makris is a periodontist graduated from the postgraduate programme of Periodontology at the University of Pennsylvania, probably one of the most prestigious postgraduate programmes in USA. Moreover he is graduate of the postgraduate programme of Periodontology of Paris University in France with two certificates in Oral Biology and Periodontology, His PhD degree was awarded from the University of Paris (with honors). Since 1992 he is As. Professor in the Department of Periodontology and Implant Biology of the University of Thessaloniki. He is author of a textbook “Biology of Dental Implants” which is part of the curiculum in the dental school of Thessaloniki.

He is a member of:



The Team

His team comprises dentists with postgraduate studies in Oral Rehabilitation, Implantology, Esthetic Dentistry, Oral Pathology and Oral Surgery. Moreover the team is working together for more than ten years. This has resulted in the development of a common philosophy in treating the most complex cases of mouth rehabilitation. The team has a continuous participation in postgraduate seminars and scientific meetings all over the world.

Textbook

Textbook



Biology of Dental Implants

Read the Textbook (Greek)


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