Dr. Nikolaos Markou – Greece

He graduated from the Hellenic Military Academy of Combat Support Officers with the rank of Second Lieutenant Dentist in 1995 with excellent performance. He completed his
three-year specialization in Periodontology at the School of Dentistry of the National and Kapodistrian University of Athens (NKUA) in 2005. In 2010, he was a six-month invited
Research Associate at the Postgraduate Program in Periodontology and Implantology at Tufts University in Boston. To date, he has participated as a speaker in numerous
conferences, while his works have been published in Greek and foreign language magazines. He served for numerous years in the Armed Forces in positions of responsibility, including as the Director of the Periodontal Department of 401 Athens Military Hospital. At the same time, he is preparing his doctoral thesis at the School of Dentistry of the University of Athens. He also participates in the Educational Activities of the School of Dentistry of the University of Athens as a Scientific Associate of the Department of Periodontology and for the last 7 years he has been consistently elected to the Board of Directors of the Hellenic Society of Periodontology and Implant Dentistry
and he is the Greece and Cyprus Section Communications Officer of the International Team for Implantology (ITI). He owns TimeToSmile Periodontal Clinic, a private practice limited in Periodontics and Implants in the centre of Athens.

Root coverage. From white to pink aesthetics

Gingival recession, a gradual apical displacement of the soft-tissue margin compared to cemento–enamel junction has been associated with localized gingival inflammation, mainly caused by a variety of factors, namely traumatic toothbrushing, thin buccal bone, plaque accumulation and orthodontic movement leading to buccal tooth displacement.

Predictable root coverage including single and multiple maxillary and mandibular gingival recessions has become one of the most challenging surgical procedures in everyday clinical practice. The outcome of treatment is generally based on a variety of clinical parameters, such as tooth position, keratinized tissue width, interproximal clinical attachment loss and vestibule depth.

To date, a plethora of surgical techniques have been utilized, including soft tissue grafts and advancement flap procedures. The use of connective tissue graft remains the gold standard, ensuring high predictability, gain of clinical attachment and high percentage of root coverage.

The main disadvantage of the classical coronally advanced flaps technique, which is the appearance of scar tissue in the area of the vertical incisions, prompted researchers to search for new techniques, among which the envelope technique for isolated and the tunnel technique for multiple recessions are mostly highlighted.

According to recent data, the modifications of coronally advanced flap and tunell technique have been associated with an improved aesthetic appearance, better post-operative healing and predictability and stability over time.

In the current presentation the biologic rationale, the indications and contraindications for the use of various surgical techniques will be presented through evidence-based clinical cases and critically discussed.

Suturing under the surgical microscope

Microsurgical and minimally invasive surgical procedures have been widely used in periodontal plastic surgery during the last decade, aiming at achieving an enhanced surgical outcome, not amenable to traditional surgery. The benefits of microsurgery rely on the reduced surgical trauma and the more precise approximation of the wound margins, associated with faster healing, superior esthetic outcome and less complications.

A growing body of evidence suggests that the consistent use of microsurgical procedures can reduce patient postoperative morbidity, increase vascularization of soft tissue grafts, allow for a more natural tissue appearance and lower the incidence of tissue scarring, a fact justified as clinically relevant, especially when it comes to the esthetic zone.

Magnification is absolutely essential for improved visualization of the surgical field and better manipulation of tissues during microsurgery, The use of standard loupe systems provide 4.5X to 6X magnification, which in most of the cases is deemed sufficient. In contrast to loupes, high-power magnification with the use of a surgical microscope is generally associated with greater time and costs and cannot be performed in a daily clinical setting. In addition, operating microscopes have a small field of view that must frequently be adjusted during surgery, requiring special training from the operator. The decision to utilize loupes or a microscope rely on the nature of surgery and the expected treatment outcome.

The scope of this workshop is to provide a basic armamentarium in periodontal plastic surgical procedures with the use of magnification.