Family, Cosmetic & Implant Dental Care in a
Comfortable, Relaxed Environment.
Serving Henderson and Las Vegas, Nevada.

Cosmetic dentistry has become such a common term that almost every dentist calls themselves a “cosmetic dentist”. The American Dental Association does not recognize

Cosmetic Dentistry Marielaina Perrone DDS

Cosmetic Dentistry As An Art

cosmetic dentistry as a specialty in dentistry. The fact is, that even though cosmetic dentistry is not officially recognized,  it does take extra skill, experience, and training. A good cosmetic dentist is concerned with both the esthetic outcome as well as the functional outcome working together in harmony.

Common procedures used in cosmetic dentistry include teeth whitening, porcelain crowns, dental implants, limited tooth movement, gum sculpting, dental bonding, and porcelain veneers. With the exception of teeth whitening, all of the other procedures require extra skill on the part of the cosmetic dentist. The goal in any cosmetic dentistry procedure is to have the final product look and feel as natural as possible. This includes proper treatment  planning before and skilled preparation during the procedure. Choosing the ideal procedures, utilizing the highest quality materials, and pairing with the best dental laboratories are what makes for ideal cosmetic dentistry results. Being able to correct or fix any issues that might arise are just as important.

Cosmetic Dentistry Case Example

Patient came to the dentist with a  list of things she did not like about her teeth. She did not like spaces between teeth, wanted whiter teeth, and also had a badly decayed tooth in the upper molar area.

Step 1 – Fully explain your wants and needs. You and your cosmetic dentist need open lines of communication. An agreement should be reached about what can and cannot be done based on time, budget, and  function.

Step 2 -Full treatment planning records need to be taken. Pre operative x-rays, study models, and digital photographs. These are essential for a good cosmetic dentistry outcome.

Before Cosmetic Dentistry Marielaina Perrone DDS

Cosmetic Dentistry – Before

Step 3 – Options for treatment should be presented. Discuss options and develop an agreed upon treatment plan. In the pictured case, the mouth was healthy (except for decayed molar) and free of periodontal disease. Patient was shown what the final treatment could look like. Such visual cues can be very helpful in decision making. In this case the treatment plan decided upon included:

-Removal of an extremely decayed molar, and replacement with a dental implant.

-Porcelain Veneers to correct shape, size, color, and spacing of the front six upper teeth.

-Teeth Whitening – This will allow the patient to whiten the teeth to a more desirable color, so that the new porcelain veneers, and implant crown can be matched to a more visually appearing, cosmetic color.

Step 4 – Patient has badly decayed molar removed and is referred to periodontist for implant consultation and placement. Following placement of dental implant patient will wait 4-6 months for healing and bone strengthening to occur before final porcelain crown can be placed.

Step 5 – Begin Teeth Whitening. This procedure can either be done in office (in one hour), or the patient can complete teeth whitening at home over the course of 2-4 weeks. This step is important as the final porcelain veneers and porcelain crown will be fabricated to match the new, lighter, final shade following teeth whitening.

Step 6 – Following teeth whitening, porcelain veneers procedure can begin. Porcelain veneers (also referred to as porcelain laminates) are super thin, custom fabricated

After Cosmetic Dentistry Marielaina Perrone DDS

After Cosmetic Dentistry

shells of tooth colored porcelain designed to cover the front surface of teeth to improve your smile’s overall aesthetic appearance. These shells are adhesively bonded to the front of the teeth changing their color, shape, width, and/or length. At end of this appointment patient will be sent home in temporary veneers while the laboratory can fabricate the custom porcelain veneers.

Step 7 – Placement and bonding of final veneers. This is a critical step in this case as the porcelain veneers must not only line up properly to close gaps but also be the right color and shape.

Step 8 – Placement of porcelain crown following healing of the dental implant.

Step 9 – Happy Smile!

Cosmetic Dentistry Conclusion

There you have the steps involved in a typical cosmetic dentistry case. Sometimes there are extra visits if any issues arise but if planned for properly the patient should know exactly what to expect in terms of the cosmetic dentistry treatment schedule as well as finances. Cosmetic dentistry can transform an ordinary smile into one that makes the patient smile bright for a long time to come.

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Marielaina Perrone
2551 N. Green Valley Pkwy #A405 HendersonNV89014 USA 
 • 702-458-2929

The use of dental implants in dentistry has been a very successful procedure. Most studies show that dental implants have a success rate of around 96-98% when placed properly. Dental implants have become a highly reliable procedure for the replacement of lost teeth. This means, almost all patients who undergo the procedure for dental

Dental Implants Marielaina Perrone DDS

implants with a highly competent surgeon, will have success. What about the other 2-4%? What can go wrong?

Success of dental implants is related to the dentist or surgeons skill, quality and quantity of the bone available at the site, quality of materials used, the patient’s healing ability, and maintenance of good oral hygiene.

Possible Dental Implants Complications

-Failed Integration of Dental Implants - This occurs when the bone does not grow and fuse between the threads of the implant. This fusion of bone to dental implant is called osseointegration. If this does not occur, the dental implants will not function properly,will become uncomfortable, become loose, or come out completely. To reduce this risk, your dental surgeon will evaluate the quality and density of the jaw bone prior to surgery. This will help to only place dental implants in areas where there is a highly predictable success rate. If osseointegration does not take place, the dental implants can be removed, and surgery can be attempted again once the area has fully healed.

-Infection –  This is the most common complication of dental implant surgery. The surrounding bone and gums can get infected during the surgical procedure. This can happen due to non-sterile technique, a contaminated implant, poor healing ability(diabetic, smoker, osteoporosis medications), pre-existing infection. The most likely time for this to occur would be during the surgical placement of the dental implant into the bone. Implant infection is a condition referred to as peri-implantitis. Peri-implantitis is characterized by inflammation or swelling of the tissues surrounding the implant area. Peri-implantitis can also present as a secondary infection later on is a form of periodontal disease that can lead to inflammation, bone loss and implant failure if not treated quickly and properly. Although implant infections are usually caused by the presence of bacteria during or immediately after the oral surgery for the placement of the dental implants, an implant infection can occur months or years after surgery.

-Post Surgical Bleeding - Some bleeding following surgery is normal and should be expected for about 1-2 days. Biting gently on a gauze pad placed over the surgery area for 30 minutes should normally stop the bleeding. Excessive bleeding is not normal and you should notify your dentist immediately if you have concerns about your dental implants.

-Damage To Surrounding Tissues - Dental implant complications related with surgical errors affecting adjacent teeth, nerves or sinus are directly correlated with the experience and skills of the dentist or surgeon. An experienced and skilled implant dentist is able to identify potential problems by examining x-rays or CT scan (computer tomography), design the proper surgical plan for ideal location and angle, and execute it successfully without complications. Even with the most skilled implant dentist there is always a possibility of dental implant complications. The complications can be limited by choosing an implant dentist with the skills and experience necessary to handle any complications if they arise.

The following areas could be damaged:

1Surrounding Teeth - During the placement of dental implants, the dentist may damage the crown or the roots of adjacent teeth. Root canal therapy may be needed to repair the injured teeth. The dentist must carefully review the x-rays or CT-scan

Dental Implants Marielaina Perrone DDSbefore drilling because the teeth are not always in ideal positions. A skilled implant dentist will be prepared for any changes necessary.

2. Nerve Damage - While rare, this is a complication of implant surgery in the lower jaw (mandible). There is a nerve (inferior alveolar nerve) that runs through the lower jawbone that can be injured during dental implants placement. Nerve injury may cause pain, numbness or painful tingling in teeth, gums, lips, tongue or chin. Similar symptoms may occur if the implant is placed right on top of the nerve, causing severe pain when chewing down. If the nerve fails to heal and the symptoms persist, the dental implant will likely need to be removed. X-rays and CT scans can help the implant dentist to identify the exact location of the nerve and minimize the possibility of nerve damage.

3. Perforation into Sinus - This occurs during placement of dental implants in the upper jaw. This occurs during implant placement, when an implant is placed into the sinus cavity. With proper planning, the bone around the sinus can be grafted and lifted (sinus augmentation) to allow for the necessary length of the dental implants. To prevent this implant complication, the dentist must check carefully the CT scans and proceed with ‘sinus augmentation’ if needed to provide sufficient bone for successful implant placement.

4. Bone Fracture - Jaw fracture is another possible complication of dental implants placement. If there is not enough bone or bone density, the jaw can fracture under the pressure during the surgical placement of the dental implants (during drilling or implant insertion).

5. Inflammation - Inflammation and swelling of the surrounding tissues is the immediate symptom of implant infection. Improper placement or size of the abutment and crown restoration, that puts under pressure and traumatizes the soft tissues around or beneath it, may also cause dental implants complications. Dental implant inflammation triggers an inflammatory response from the body’s immune system that attacks gum tissues and surrounding bone. This can result in bone loss around the dental implant and if left untreated the dental implants will become loose and will need to be removed. The dentist has to eliminate the inflammation as soon as possible to prevent further bone loss that can cause dental implants failure. The inflammation can be treated by antibiotics and cleaning if caused by implant infection, or by removing or adjusting the defective restoration if caused by trauma.

Other reasons for failure of Dental Implants

-Rejection – An extremely rare complication but it has been noted in the research literature. The dental implants can sometimes be viewed as a foreign body.

-Unusable Dental Implants – An implant that has successfully integrated with bone, but the area or extreme angle of placement deem it unrestorable.

Dental Implants Conclusion

Implant dentistry has come a long way. It has become an almost routine procedure. Understand, that just because it is done often does not make it a simple procedure thatDental Implants Marielaina Perrone DDS anyone can do. Implant surgery is an intricate and comprehensive process that involves several stages. Treatment consults, treatment planning, and treatment procedures (which can include multiple surgeries) need to be undertaken with extreme care. General dentists DO NOT have the same training as surgeons, and are generally better at restoring the implants after surgical placement. As with all types of surgery, there are risks involved during both the actual dental implants procedure as well as during the recovery period. While most dental implant complications are quite minor, it is important to be aware of them prior to surgery. These complications can be minimized by choosing an implant dentist with the skill and knowledge to overcome any challenges that may come your way before, during, or after surgery. Choose your surgeon based on skill level and not price, and you will be much more likely to have a long term success.

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What many people don’t realize, is that a tooth has nerves and blood vessels just like the rest of our body. A tooth is “vital” or alive. There are reasons why a tooth can become non vital, or dead. ItCosmetic Dentist Marielaina Perrone DDS is not always easy to tell, and sometimes can be quite painful.

A dead tooth is simply a tooth that no longer has access to nutrients and blood flow. Our teeth are composed of three layers: the enamel, the dentin and the nerve or “pulp”. A healthy tooth has living cells and tissue inside.This living tissue plays a role in the development of the teeth. The nerve is the part of the tooth that can sense temperature, when you drink or eat something really cold or hot. It can also sense how hard you are biting into something, and feel pain.

All the blood vessels and nerve fibers are located in the pulp and this means that when the pulp is dead, then the tooth is dies as well. What can happen if a tooth becomes non vital, and why does it die?

What Causes a Tooth To Die?

The two main causes are:

-Tooth Decay - Tooth decay or a bacterial infection, when left untreated, will begin to invade deeper into the tooth eventually penetrating through enamel and into the second layer, the dentin. When the decay or infection reaches deep inside the tooth, the cells of the pulp try to fight it off by triggering the inflammatory process. This includes action by the white blood cells. Pus develops when some of the white blood cells die during the battle against the infection. If the infection is not treated at this stage, all the white blood cells will die and the blood flow will stop completely.When this occurs, tooth sensitivity is usually the first sign of trouble and this sensitivity will eventually reach the pulp and results in a severe toothache.

-Dental Trauma – This can occur from traumatic injuries, falls, severe grinding and clenching, biting into very hard objects, and sometimes idiopathic internal resorption (a tooth self destructs from the inside out for no apparent reason) . When dental trauma occurs, the blood supply can be severed immediately, resulting in the pulp dying off. Sometimes it is a slow progressive breakdown as teeth wear and crack from bad oral habits. Prevention is the key whenever possible. This is why sports mouth guards are recommended for all contact sports activities. Nightguards are recommended for clenchers and grinders. Extremely hard foods should be avoided such as popcorn kernels, corn nuts, and the mouth should not be used in place of tools such as scissors or a bottle opener.

Signs and Symptoms

It can be very difficult to identify a dead tooth just by looking at it and that is another reason why it’s important to visit a dentist regularly. It is possible to have no symptoms when a tooth becomes non vital. However, a non-vital tooth may exhibit some a tell tale symptom like turning darker. This discoloration is usually the dead pulp becoming visible. Another sign of a non-vital tooth is an unexplained swelling, or a raised white pimple like area. These signs are normally a result of a periodontal abscess, caused by periodontal disease or injury, which can rupture and produce an infection in the gums and mouth. A dead tooth will eventually become loose due to the destruction of surrounding bone by the infection process. It can also produce a foul odor and even more severe pain.

Cosmetic Dentist Marielaina Perrone DDSTreatment Of A Dead Tooth

Many patients will ask, “If the tooth is dead why not just leave it alone?”.Simply put, the dead tissue in the pulp chamber will become a breeding ground for bacteria. If left untreated, an abscess can occur along with pain and discomfort. There are usually two options for treatment of a non vital tooth:

-Extraction – A tooth extraction can be performed if the tooth is not savable, or it can be chosen due to finances becoming an issue. A tooth extraction is usually the least expensive option but it can also can leave other issues on the long term horizon (such as tooth shifting, cosmetic and functional issues). Once extracted, tooth replacement can be done using a dental implant, a fixed bridge, or a removable denture.

-Root Canal Therapy -  This procedure is performed when a patient chooses to save the tooth. Root canal therapy allows the dentist to clean out the dead tissue and infection, ridding of the decayed part of the pulp. This will allow the dentist to rebuild on the sterile tooth to return full form and function. With today’s modern technology, root canal therapy can be a painless and comfortable experience and, if done early, can save a tooth by preventing further infection and subsequent tooth loss. The procedure usually begins with anesthesia to prevent any pain, then a dentist will make an opening for the cleaning instrument to penetrate the affected inner parts of the tooth. The infection is cleaned out and the opening is then closed with a filling. The tooth can then be bleached to turn it whiter or a veneer or a crown can be placed over the tooth to make it look natural.

How To Prevent A Tooth Becoming Non-Vital

Maintaining a proper dental hygiene regimen including brushing and flossing regularly can prevent the buildup of food and bacteria that gets trapped between teeth and gums, which can cause infection and tooth decay leading to dead teeth. Regular visits to the dentist are also very important, since your dentist will be able to identify and diagnose early signs of tooth issues. There are other early signs that you can recognize on your own that include sensitivity to heat or cold, pain when chewing or biting down, slight discolorations, bad breath, gum swelling and facial swelling. Saving a dead tooth depends on early detection and early treatment. Do not ignore the signs and symptoms – get it checked out to decrease your chances of infection and tooth loss.

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Many people think it is okay for some gum bleeding during brushing or flossing but that is simply not true. Bleeding gums equal unhealthy gums. Periodontal disease canBleeding Gums Marielaina Perrone DDS creep up silently attacking your gums and bone in your mouth. This is especially important with recent studies showing periodontal disease being linked to systemic diseases like stroke, heart disease, and diabetes.

In most cases, inflamed, swollen and bleeding gums are a sign of gingivitis. However,  there are a number of other factors that could be causing your gum problems. Whatever the cause of sore, painful gums, there are steps you can take to minimize gum damage and discomfort. Some people avoid dental cleanings at home or in the dental office because it always makes them bleed. What they need to understand is, that the only reason they are bleeding is because they have become inflamed. Once you have your teeth cleaned and are taught proper oral hygiene techniques, it takes about 2 weeks of bleeding gums before they heal and stop bleeding. You just have to put up with some soreness and tough it out to get results. Once your gums have healed you will be amazed how good they feel, and how the bleeding just stops.

Reasons For Gum Inflammation and Bleeding

-Poor dental hygiene

-Open mouth breathing

-Medication causing tissue overgrowth, or poor healing

-Acid reflux (GERD)

-Poor nutrition

-Systemic Disease

Other Factors That Cause Bleeding Gums

Chemotherapy

Chemotherapy has many side effects. One of those side effects can include painful, swollen, and bleeding gums. Another gum issue from chemotherapy is stomatitis. This

Bleeding Gums Marielaina Perrone DDS

causes the development of painful sores and ulcers on the gums and throughout the mouth.

Tobacco use

Smoking or using other tobacco products can be very damaging to your gum tissue, and people who smoke are much more likely to develop periodontal disease than those who do not. Smokers often find that their smoking habit gives you a number of gum problems from sensitive gums that bleed to painful sores in your mouth.

Hormone Irregularities

Some women find that they experience gum problems during menstruation or pregnancy (and even menopause). The hormonal increase during puberty can elevate blood flow to the gums, making them red, swollen, and sensitive. For women with menstrual gingivitis, the gums become red, swollen, and have an increased likelihood to bleed shortly before each menstrual period. These problems typically subside after menstruation begins. Pregnancy gingivitis typically starts in the second or third month of pregnancy and continues through the eighth month, causing sore, swollen, and bleeding gums. The use of birth control products (oral and injectables) may cause similar gum problems. Though uncommon, some women going through menopause may find that their gums become extremely dry and therefore sore and more likely to bleed.

 Gum Damage From Brushing and Flossing

The most common cause of bleeding gums is not following proper techniques when flossing and brushing. This allows harmful bacteria to accumulate, and can lead to damage to your gums. The gingival tissue in the mouth can be strengthened considerably with proper hygiene. Normal brushing and flossing of healthy, pink, firm gum tissue does not elicit bleeding.

Whether you choose a manual or electric toothbrush, choose one with soft nylon bristles that have blunted ends. Even though you can find brushes with medium or hard bristles, they may damage the enamel on your teeth or cause gum recession.

When you brush, make sure you use gentle, circular motions to massage and clean the teeth and gums. While many people use a back-and-forth motion, this motion canBleeding Gums Marielaina Perrone DDS actually irritate and damage your gums, making them sore and more likely to recede.

We all know the importance of flossing every day to help remove plaque from places where your toothbrush cannot reach. Make sure that you have been taught to properly floss and brush by a professional.Be gentle and thorough when you brush and when you floss. Floss between your teeth by carefully sliding it up and down, following the curve of each tooth, and do not use a shoeshine or slicing motion.

Stages Of Periodontal Disease

Recent studies show 50-75% of American adults over the age of 35 suffer from some form of periodontal disease. The majority with periodontal disease have the earliest form, called gingivitis (reversible with treatment), about 10-15% of the population has the much more advanced type of periodontal disease known as periodontitis (controllable but not reversible).

Poor oral hygiene leads to a build up of bacteria and plaque in the mouth around teeth. This build up of bacteria may cause your gums to become inflamed, which results in red, swollen, or bleeding gums. Most people with gingivitis do not notice any symptoms initially. If you diagnose gingivitis early, it can be reversed and healed with proper oral hygiene maintenance. Gingivitis, if left untreated, can and will progress, and ultimately lead to tooth loss.

Signs and Symptoms of Periodontal Disease

-Formation of deep pockets between teeth and gums

-Gums that bleed during and after toothbrushing or during flossing.

-Loose teeth

-Shifting of teeth or changes in the way your teeth bite together

-Persistent bad breath (halitosis) or a foul taste in the mouth

-Receding Gums

Bleeding Gums Marielaina Perrone DDS

-Red, swollen, or tender gums

As gingivitis progresses, it develops into periodontitis. This a condition in which the gums and bone that hold the teeth in place can begin to break down. The bacteria on the

teeth release toxic substances that harm your gums and cause them to become infected. The infection and the inflammation that result when your body attacks the bacteria can break down your gums and the bone in your jaw supporting the teeth. You may experience exceptionally swollen, painful gums that are likely to bleed. If left untreated, periodontitis can lead to tooth loss.

Tips To Prevent Bleeding Gums

-Visit dentist regularly.  This should include dental examinations, x-rays, and professional cleanings.

-Brush Twice a Day and follow proper brushing technique. If you’re not sure what to do, ask your dentist or dental hygienist for a quick lesson at your next visit.

-Floss daily. Flossing takes but a minute or two a day to do but the effects are far reaching in terms of keeping you gums healthy.

-Eat a well-balanced nutritious diet.

-Stay Hydrated by Drinking plenty of water.

-Do Not Smoke!

-Relax. Being stressed out raises levels of the stress hormone cortisol, increasing the likelihood of inflammation throughout your body, including in your gums.

Conclusion

Maintaining healthy teeth and gums is not a difficult job. It just requires knowing the proper techniques, creating daily habits, and visiting your dentist on a regular basis for check ups and professional cleanings. In the long run it will be well worth it as you save your teeth for a lifetime!

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