Deep Margin Elevation: A Literature Review.

Theodora Kalliopi Samartzi,Dimokritos Papalexopoulos,Markus B Blatz,Christos Rahiotis,Panagiotis Ntovas

doi:10.3390/dj10030048

Theodora Kalliopi Samartzi, Dimokritos Papalexopoulos + Show 3 more

Open Access

https://doi.org/10.3390/dj10030048

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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.

Highlights

The dental clinician has consistently challenged the restoration of deep proximal lesions since they are usually associated with significant defects with subgingival margins exceeding cementoenamel junction (CEJ) [1,2]
A search in the literature was conducted for evidence-based research articles referring to deep margin elevation” (DME) published from January 1998 until November 2021 using MEDLINE (PubMed), Ovid, Scopus, Cochrane Library and Semantic Scholar databases
Most of the studies focused on technique description, the microleakage/marginal adaptation, and the mechanical performance of the final restoration after the application of DME and its compatibility with periodontal tissues

Summary

Introduction

The dental clinician has consistently challenged the restoration of deep proximal lesions since they are usually associated with significant defects with subgingival margins exceeding cementoenamel junction (CEJ) [1,2]. In this clinical scenario, indirect restorations are preferable since they provide better esthetic, anatomic form, physical and mechanical properties, and reduced polymerization shrinkage due to their extraoral fabrication that permits the relief of residual stresses [3–7]. The techniques mentioned above may cause further attachment loss and exposure of root concavities and furcations to the oral environment, dentin hypersensitivity, and unfavorable crown to root ratio as well as compromised esthetics This process may often delay the delivery of the final restoration [1,9–11]

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