Quality of Marginal Seal at the Root Dentine- Margin Elevation Material Interface in Proximal Box Elevation Technique for Adhesive Indirect Aesthetic Restorations- A Systematic Review

Abstract

Introduction: A subgingivally extending proximal carious defect can be adequately restored with an adhesive indirect aesthetic restoration only when the proximal margins can be raised coronal to the Cementoenamel Junction (CEJ) using various Margin Elevation Materials (MEM). This approach is commonly referred to as the Proximal Box Elevation (PBE) technique. However, there is a lack of evidence in the literature regarding the quality of the marginal seal at the root dentine- MEM interface when using PBE technique. Aim: The purpose of this systematic review was to summarise the available evidence on the the quality of the marginal seal at the root dentine- MEM when using the PBE technique during the placement of adhesive indirect aesthetic restorations. Materials and Methods: Comprehensive electronic search was performed in PubMed Central, Cochrane Library and Google Scholar from their inception to January 2021 at the Department of Conservative Dentistry and Endodontics, Sri Ramachandra Institute of Higher Education and Research (SRIHER) between May 2020 to January 2021. Full text articles published in english language which have performed an indirect restoration with and without PBE technique were included in the review. A total of 249 articles were screened initially in the review. The main keywords used were: “PBE”, “Cervical Margin Relocation (CMR)”, “Deep Margin Elevation (DME)” and “coronal margin relocation”. The review protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias assessment of the included studies was performed independently. Results: A total of 9 in-vitro studies were included in the present systematic review. Resin based composites of different viscosities seemed to perform adequately as MEM. It may be prudent to perform the margin elevation in multiple layers. Self etch adhesives had a better marginal seal than the total etch adhesives. Regarding the effect of indirect restoration on the marginal seal at the root dentine- MEM interface, there was no conclusive evidence. PBE may provide a congenial environment for predictable and efficient bonding of indirect adhesive aesthetic restorations. Conclusion: Based on the moderate quality of evidence from the included articles in this systematic review, it can be concluded that while performing a PBE technique, the quality of marginal seal at root dentine- MEM interface is satisfactory under in-vitro conditions.