Deep Margin Elevation: A Literature Review

Abstract

A conservative approach for restoring deep proximal lesions is to apply an increment of composite resin over the preexisting cervical margin to relocate it coronally, the so-called “deep margin elevation” (DME). A literature search for research articles referring to DME published from January 1998 until November 2021 was conducted using MEDLINE (PubMed), Ovid, Scopus, Cochrane Library and Semantic Scholar databases applying preset inclusion and exclusion criteria. Elevation material and adhesive system employed for luting seem to be significant factors concerning the marginal adaptation of the restoration. This technique does not affect bond strength, fatigue behavior, fracture resistance, failure pattern or repairability. DME and subgingival restorations are compatible with periodontal health, given that they are well-polished and refined. The available literature is limited mainly to in vitro studies. Therefore, randomized clinical trials with extended follow-up periods are necessary to clarify all aspects of the technique and ascertain its validity in clinical practice. For the time being, DME should be applied with caution respecting three criteria: capability of field isolation, the perfect seal of the cervical margin provided by the matrix, and no invasion of the connective compartment of biological width.

Current Strategies to Control Recurrent and Residual Caries with Resin Composite Restorations: Operator- and Material-Related Factors

“…Self-etching bonding agents in deep non-enamel marginal locations are recommended rather than total-etch. Bonding agents with incorporated MDP and fluorides might be an advantageous option to impart antibacterial and MMPs’ inhibiting effects and enhance bond durability [ 125 , 188 ]. Partial indirect restorations with DME have good survival rates [ 103 , 189 , 190 ].…”

Quality of CAD-CAM inlays placed on aged resin-based composite restorations used as deep margin elevation: a laboratory study

“…to a supragingival position is frequently used as a more straightforward alternative to surgical crown lengthening or orthodontic or surgical extrusion [1][2][3]. This restorative approach, termed deep margin elevation (DME), facilitates the subsequent preparation, impression taking, isolation with rubber dam, and adhesive luting of an indirect restoration [1].…”

“…to a supragingival position is frequently used as a more straightforward alternative to surgical crown lengthening or orthodontic or surgical extrusion [1][2][3]. This restorative approach, termed deep margin elevation (DME), facilitates the subsequent preparation, impression taking, isolation with rubber dam, and adhesive luting of an indirect restoration [1]. According to the most recent review article, well-polished DME restorations made with proper isolation of the working field and not infringing on the supracrestal connective tissue attachment are compatible with periodontal health [1].…”

“…However, the number of clinical studies investigating DME is limited. Consequently, the available evidence on DME is largely based on laboratory studies [1]. The marginal quality of dental restorations is of paramount importance, as poor adaptation and defects promote the accumulation of biofilm, which may in turn cause periodontal disease, secondary caries, or both.…”

“…But the body of laboratory evidence on DME consists mostly of studies that did not expose RBC restorations used for DME to any form of aging before bonding an indirect restoration on top. A review published in 2022 included 16 in vitro studies assessing the marginal quality of indirect restorations in teeth with DME [1]. In 11 out of these 16 studies, indirect restorations were made immediately after DME, while two and three studies reported water storage periods of 1 week at 37 °C and 2 weeks at room temperature, respectively [1].…”