Deep Margin Elevation With Resin-modified Glass Ionomer in Posterior Adhesive Indirect Restorations Based on Biomimetic Principles: A Case Report

Abstract

A ceramic onlay restoration is a more conservative treatment than full-coverage crowns for endodontically treated teeth (ETT); thus, it helps preserve the tooth structure. Deep margin elevation (DME) is a method to relocate subgingival margins into a more coronal position with resin-modified glass ionomer (RMGI) or direct composite resin before the cementation of the indirect restoration. A 33-year-old male was referred to restore two ETT (teeth N. 46 and 47) with extensive coronal defects extending subgingivally between two teeth. Tooth N. 47 could not undergo a crown lengthening (CL) procedure due to its short root trunk. DME with RMGI was done for both teeth before preparation for ceramic onlays. In this case, by following the principles of biomimetic dentistry, we aimed to restore the tooth defect with a material that bore all functional stresses, in addition to achieving esthetic. It seems that DME in combination with ceramic onlay restoration can be a conservative method to restore ETT in the posterior region. The goal of considering the principles of biomimetic dentistry is to maintain the function of teeth using a good bond to hard tissue that unifies the tooth and its restoration hence distributing the stresses through the tooth as a unit with near-normal functional, biological, and esthetic features.

State of the art of biological thickness in deep margin restorations

“…As a final step, light curing is done [6,8,9,[17][18][19]21,23]. Glass ionomer modified with resin can also be used following the manufacturer's instructions and light curing (30 seconds) [21,24].  Excess material is removed to prepare the margins and composites to avoid the adherence of dental plaque [6][7][8][9]18,19,23,25].…”