Deep margin elevation, Systematic Review

Abstract

Introduction. Deep margin elevation (DME) is a less invasive alternative to coronal lengthening and orthodontic extrusion, offering lower cost and clinical time. DME involves elevating the margin of subgingival cavities to maintain periodontal health and prevent bacterial accumulation. Consider a minimum distance of 3 millimeters between the cavity and the osseous ridge. The choice of material and adhesive system plays an important role in marginal adaptation. Flowable resin composites excel in marginal adaptation, although they are not suitable for thermomechanical loading, suggesting preheated composites. Objective.  To analyze the marginal integrity and periodontal status of materials used for DME. Methodology. This study is a qualitative, cross-sectional systematic review following PRISMA guidelines. Multiple databases were searched extensively through July 2023 and inclusion criteria were applied that focused on studies incorporating the DME technique. A total of 692 articles were identified, of which 23 met the inclusion criteria and were analyzed in detail. Results. Addressing subgingival proximal caries lesions with DME to improve adaptation and periodontal health of surrounding tissues. Various materials used for DME are discussed, but lack of consensus on the choice of material and technique persists. Controversy is noted in studies evaluating the influence of SMD on marginal adaptation. In addition, the importance of maintaining an adequate distance between the restoration margin and the osseous ridge for periodontal health.