27 May 2023

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Deep margin elevation: a literature review

By Lorenzo Breschi and Carlo D’Alessandro

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The management of teeth with subgingival defects is a great challenge in clinical practice. In this regard, Dietschi and Spreafico in 1998 proposed the deep margin elevation (DME) technique to solve the problems associated with subgingival restorations.

DME consists of relocating coronally the cervical margin of teeth with subgingival defects to a supragingival position with a direct restoration to facilitate rubber dam isolation, marginal integrity and bonding strength. As a result of this conservative approach, DME has been suggested as a viable alternative to more invasive procedures such as crown lengthening or surgical extrusion.

The interest toward the DME technique has increased over the past years and several clinical and laboratory studies have been proposed to validate this approach. In this regard, Eggmann et al. provided an overview of the current treatment protocols and scientific evidence on DME and outline future directions for research.

Materials and methods

Published articles were selected from six databases using the following search string: “deep margin elevation” OR “proximal box elevation” OR “cervical margin relocation” OR “coronal margin relocation.” Both in vivo and in vitro studies were considered. The risk of bias of each included study was assessed.

Results

Researchers included a total of 38 articles in the review process, with a predominance of laboratory studies. Results of the studies indicated that DME has no negative impact on the fracture resistance of the restored teeth. Regarding the marginal quality of the restorations, discordant results were observed among the studies. Even though clinical trials shown good periodontal response after DME, the number of patients included was too small, therefore requesting further investigations. 

Conclusion

Supported by current evidence, from many laboratory studies and only few clinical investigations, the authors concluded that DME can be recommended as a feasible treatment for restoring teeth with subgingival defects and as an alternative to a surgical approach. Crucial factors for success include proper field isolation, meticulous observance of the bonding and build-up procedures and maintenance of a good oral hygiene with regular follow-up visits. Further research and clinical trials are essential to validate this evidence and assess the long-term outcome of DME restorations.

Eggmann F, Ayub JM, Conejo J, Blatz MB. "Deep margin elevation-Present status and future directions." J Esthet Restor Dent. 2023 Jan;35(1):26-47. DOI: 10.1111/jerd.13008