Gingival margin elevation in severely damaged teeth: with 18-month follow-up case report
DOI:
https://doi.org/10.24265/kiru.2026.v23n2.08Keywords:
Root Caries; Conservative Treatment; Esthetics; Gingivitis; Composite ResinAbstract
Gingival margin elevation (GME) is a conservative procedure that relocating the subgingival margin to a more supragingival position using restorative materials. This report describes a clinical case in which a 1 mm flapless crown lengthening was performed, followed by GME with Filtek Supreme Flowable Restorative resin (3M ESPE, St. Paul, MN, USA) and Filtek Z350 XT composite resin (3M ESPE, St. Paul, MN, USA) as a pre-endodontic restoration. Subsequently; endodontic retreatments were completed and indirect partial coverage (onlays) were adhesive cemented on the structurally compromised lower right first and second molars. The case demostrates the clinical viability of GME in two multirooted teeth, with functional and aesthetic results satisfactorily maintained over an 18-month follow-up.
Downloads
References
Gavriil D, Kakka A, Myers P, O´Connor CJ. Pre-endodontic restoration of structurally compromised teeth: current concepts. Br Dent J. 2021;231(6):343–349. doi: 10.1038/s41415-021-3467-0.
Vertolli T, Martinsen B, Hanson C, Howard R, Kooistra S, Ye L. Effect of Deep Margin Elevation on CAD/CAM-Fabricated Ceramic Inlays. Oper Dent. 2020;45(6):608–617. doi:10.2341/18-315-L.
Bresser R, Carvalho M, Naves L, Melma H, Cune M, Gresnigt M. Biomechanical behavior of molars restored with direct and indirect restorations in combination with deep margin elevation. J Mech Behav Biomed Mater. 2024;152:106459. doi: 10.1016/j.jmbbm.2024.106459.
Bresser R, Gerdolle D, Van den Heijkant I, Sluiter-Pouwels L, Cune M, Gresnigt M. Up to 12 years clinical evaluation of 197 partial indirect restorations with deep margin elevation in the posterior region. J Dent. 2019,91:103227. doi: 10.1016/j.jdent.2019.103227.
Aldakheel M, Aldosary K, Alnafissah S, Alaamer R, Alqahtani A, Almuhtab N. Deep Margin Elevation: Current Concepts and Clinical Considerations: A Review. Medicina (Kaunas). 2022;58(10):1482. doi:10.3390/medicina58101482.
Felemban MF, Khattak O, Alsharari T, Alzahrani AH, Ganji KK, Iqbal A. Relationship between Deep Marginal Elevation and Periodontal Parameters: A Systematic Review. Medicina (Kaunas). Multidisciplinary Digital Publishing Institute; 2023;59(11):1948. doi:10.3390/medicina59111948.
Geo TD, Gupta S, Gupta SG, Rana K singh. Is Deep margin elevation a reliable tool for cervical margin relocation? – A comparative review. J Oral Biol Craniofac Res. 2024;14(1):33-38. doi: 10.1016/j.jobcr.2023.12.002.
Chun EP, de Andrade GS, Grassi EDA, Garaicoa J, Garaicoa-Pazmino C. Impact of Deep Margin Elevation Procedures Upon Periodontal Parameters: A Systematic Review. Eur J Prosthodont Restor Dent. 2023;31(1):10–21. doi:10.1922/EJPRD_2350Chun12.
Samartzi TK, Papalexopoulos D, Ntovas P, Rahiotis C, Blatz MB. Deep Margin Elevation: A Literature Review. Dent J. 2022;10(3):48. doi: 10.3390/dj10030048.
Frese C, Wolff D, Staehle HJ. Proximal box elevation with resin composite and the dogma of biological width: Clinical R2-technique and critical review. Oper Dent. 2014;39(1):22–31. doi: 10.2341/13-052-T.
Juloski J, Köken S, Ferrari M. Cervical margin relocation in indirect adhesive restorations: A literature review. J Prosthodont Res. 2018;62(3):273-280. doi: 10.1016/j.jpor.2017.09.005.
Dietschi D, Spreafico R. Current clinical concepts for adhesive cementation of tooth-colored posterior restorations. Pract Periodontics Aesthet Dent. 1998;10(1):47–54. PMID: 9582662.
Magne P, Spreafico RC. Deep Margin Elevation: A Paradigm Shift. Am J Esthet Dent. 2012;2(2):86-96.
Da Silva Gonçalves D, Cura M, Ceballos L, Fuentes MV. Influence of proximal box elevation on bond strength of composite inlays. Clin Oral Investig. 2017;21(1):247–54. doi: 10.1007/s00784-016-1782-7.
Mugri M, Sayed M, Nedumgottil B, Bhandi S, Raj A, Testarelli L, et al. Treatment Prognosis of Restored Teeth with Crown Lengthening vs. Deep Margin Elevation: A Systematic Review. Materials. 2021;14(21):6733. doi: 10.3390/ma14216733.
Eggmann F, Ayub J, Conejo J, Blatz M. Deep margin elevation—Present status and future directions. J Esthet Restor Dent. 2023;35(1), 26-47. doi: 10.1111/jerd.13008.
Elmorsy A, Ibrahim S, El-Nahass H, Zohairy A. 22 months follow-up of deep marginal acquisition with thermacut bur in management of deep subgingival interproximal carious lesions: a case report. BMC Oral Health. 2025;25(1):67. doi: 10.1186/s12903-024-05326-y.
Bresser R, Naves L, Van Der Made S, Cune M, Gresnigt M. Deep margin elevation A case report study. Int J Esthet Dent. 2023;18(2):142-160.
Prado T, Chun E, Augusto M, Bernardon P, Grassi E, Saavedra G, De Andrade, G. Biomechanical, operative and biological aspects of the cervical margin relocation: a case report. Braz Dent Sci. 2022;25(3):e3158. doi: 10.4322/bds.2022.e3158.
Ferrari M, Koken S, Grandini S, Ferrari Cagidiaco E, Joda T, Discepoli N. Influence of cervical margin relocation (CMR) on periodontal health: 12-month results of a controlled trial. J Dent. 2018;69:70-76. doi: 10.1016/j.jdent.2017.10.008.
Drebel D, Montenegro S. Elevação de margem gengival e restauração indireta em resina composta fresada. Rev Nav Odontol. 2024,51(2):33–42. doi: 10.69909/1983-7550-dme-4.
Gözetici-Çil B, Öztürk-Bozkurt F, Genç-Çalışkan G, Yılmaz B, Aksaka N, Özcan M. Clinical Performance of Posterior Indirect Resin Composite Restorations with the Proximal Box Elevation Technique: A Prospective Clinical Trial up to 3 Years. J Adhes Dent. 2024;26(1):19–30.
El-Ma’aita A, Radwan H, Al-Rabab’ah M. Deep Margin Elevation - A Retrospective Clinical Study. J Adhes Dent. 2024;26:117–124.
Haralur S, Alqahtani M, Alqahtani R, Shabab R, Hummadi K. Effect of Dentin-Disinfection Chemicals on Shear Bond Strength and Microhardness of Resin-Infiltrated Human Dentin in Different Adhesive Protocols. Medicina (B Aires). 2022;58(9):1244. doi:10.3390/medicina58091244.
Taylor A, Burns L. Deep margin elevation in restorative dentistry: A scoping review. J Dent. 2024;146:105066. doi: 10.1016/j.jdent.2024.105066.
Romano G, Modoni M, Ferraris F, Zakaraya A, Rasperini G. Supracrestal tissue esthetic management (STEM) technique and current approaches in restorative and surgical treatment of deep margins. The international journal of esthetic dentistry. Int J Esthet Dent. 2022;2:162–184.
Veneziani M. Adhesive restorations in the posterior area with subgingival cervical margins: new classification and differentiated treatment approach. Eur J Esthet Dent. 2010;5(1):50–76.
Lorca D, Tiffi C, Sarmiento R, Sarmiento J. In vitro comparison of marginal infiltration between a conventional resin and a bulk-fill resin, in the relocation of cervical margins technique. J Oral Res. 2023;12(1):1–11. doi: 10.17126/joralres.2023.001.
Baldi A, Rossi T, Comba A, Monticone L, Paolone G, Sannino I, et al. Three-Dimensional Internal Voids and Marginal Adaptation in Deep Margin Elevation Technique: Efficiency of Highly Filled Flowable Composites Sample preparation and test. J Adhes Dent. 2024;26:223–230. doi: 10.3290/j.jad.b5759489.
Ismail HS, Ali AI. Effect of different restorative systems and aging on marginal adaptation of resin composites to deep proximal margins. J Esthet Restor Dent. 2024;36(2):346–355. doi: 10.1111/jerd.13116.
Van Meerbeek B, Yoshihara K, Van Landuyt K, Yoshida Y, Peumans M. From Buonocore’s Pioneering Acid-Etch Technique to Self-Adhering Restoratives. A Status Perspective of Rapidly Advancing Dental Adhesive Technology. J Adhes Dent. 2020;22(1):7–34. doi: 10.3290/j.jad.a43994.
Alrabiah A, Alqudrah A, Aljabr N, Alzareei S, Asali W, Alajmi A, et al. Deep margin elevation: systematic review and meta-analysis of in-vitro studies. Ann Dent Spec. 2023;11(2):25–39. doi: 10.51847/UXGlOQCjFD.
Grassi E, de Andrade G, Tribst J, Machry R, Valandro L, Ramos N, Saavedra, G. Fatigue behavior and stress distribution of molars restored with MOD inlays with and without deep margin elevation. Clin Oral Investig. 2022;26(3):2513–2526. doi:10.1007/s00784-021-04219-6.
Ipek İ, Bilge K. The effect of different liquids on the surface roughness and color stability of single shade and nanohybrid resin composites: An AFM and SEM analysis. Microsc Res Tech. 2024;87(9):2063–2071. doi: 10.1002/jemt.24586
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Diego Fernando Casco Silva , Lidia Carolina López Bazán
This work is licensed under a Creative Commons Attribution 4.0 International License.
- Los autores/as conservarán sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación esta revista.
- Los autores/as podrán adoptar otros acuerdos de licencia no exclusiva de distribución de la versión de la obra publicada (p. ej.: depositarla en un archivo telemático institucional o publicarla en un volumen monográfico) siempre que se indique la publicación inicial en esta revista.
- Se permite y recomienda a los autores/as difundir su obra a través de Internet (p. ej.: en archivos telemáticos institucionales o en su página web) posterior al proceso de aprobación del manuscrito, lo cual puede producir intercambios interesantes y aumentar las citas de la obra publicada.
