Is Deep margin elevation a reliable tool for cervical margin relocation? - A comparative review

Abstract

The permanence of deep subgingival restorations are questionable both functionally and biologically. Crown lengthening is one of the traditionally performing procedures to visualize and relocate the deep margins, but the limitations of the invasive surgical procedure are anatomical complications like exposure of root concavities or furcation, violation of biological width, post operative discomfort because of sutures or periodontal packs; and less patient compliance. Other than crown lengthening, researchers tried some other techniques like modified matrix adaptation technique, using retraction cord, making holes in matrix band and flowing resin modified glass ionomer cement (RMGIC) to the root or cervical caries, orthodontic extrusion. But most of these procedures are failed to give adequate clinical success. Deep margin elevation (DME) is one of the minimally invasive and successful procedure performing in deep subgingival caries. But the evidences and knowledge in this technique is limited among practitioners. This review is to evaluate the applicability of DME, the current clinical concepts, techniques and materials for DME; and a comparison with traditionally used various techniques for cervical margin relocation also concluding that currently available various clinical parameters with this technique.

Keywords: Cervical margin relocation; Crown lengthening; Deep margin elevation; Orthodontic extrusion; Proximal box elevation.

Graphical abstract

Fig. 1

Schematic illustration of DME technique A-Preoperative image showing subgingival caries B-Deep margin elevation and Gingival seat build-up C-Restoration D-Modified matrix band technique a- Deep subgingival caries b-Gingival seat build up with flowable composite c-Modified matrix band d-Wedge e-Immediate dentine seal f-Restoration with Bulk-fill composite.