deep margin elevation

Deep Margin Elevation (DME) is used to manage and restore teeth with subgingival (below the gum line) cavities or defects. The goal is to "elevate" the margin of the defect to a more accessible and visible position, making it easier to restore with a crown or filling.

Why Deep Margin Elevation is Used:

  1. Accessibility: When a cavity or defect is located below the gum line, it's challenging to properly clean, prepare, and restore the tooth. Elevating the margin simplifies this process.

  2. Preservation of Tooth Structure: DME allows for more conservative treatment, avoiding the need to remove healthy tooth structure to access the deep margin.

  3. Improved Bonding: Restorations are more effective when placed on enamel. DME brings the margin to a higher position where enamel is more likely to be present.

  4. Better Prognosis: By elevating the margin, the restoration is less likely to be affected by the surrounding soft tissues, reducing the risk of gum inflammation and ensuring a better long-term outcome.

The Procedure:

  1. Isolation: The tooth is isolated, often with a rubber dam, to keep the area dry and prevent contamination.

  2. Material Application: Resin composite is carefully placed and built up in the deep area, elevating the margin to a higher, more accessible position.

  3. Restoration: Once the margin is elevated, the tooth is restored using traditional methods, such as a crown or filling.

Deep Margin Elevation is particularly useful for treating teeth that would otherwise require more invasive procedures, such as crown lengthening surgery, to make the margin accessible.

  • Deep Margin Elevation (DME) is becoming increasingly common, particularly in certain clinical situations where it offers distinct advantages. While it may not yet be as widely practiced as more traditional techniques like crown lengthening, its use is growing due to its conservative approach and ability to preserve tooth structure.

    Patient Preferences: Many patients prefer less invasive treatments that involve shorter recovery times and less discomfort. DME offers an alternative to surgical procedures like crown lengthening, which can be more invasive and require longer healing periods.

  • Achieving a perfect seal at the interface between the elevated margin and the filling/crown can be challenging. If the seal is not adequate, bacteria can infiltrate, leading to secondary caries (new decay) or restoration failure.

    The procedure involves working close to or within the gum line, which can lead to irritation, inflammation, or gingival recession if not performed carefully.

    DME adds complexity to the filling/crown process, which can increase the time required for treatment and the overall cost.

  • Crown Lengthening Surgery

    Crown lengthening involves surgically removing a portion of the gum tissue and possibly some bone around the tooth to expose more of the tooth structure above the gum line.

    Orthodontic Extrusion (Forced Eruption)

    This technique uses orthodontic forces to gradually extrude (pull) the tooth coronally (towards the crown), thereby bringing the deep margin to a more accessible level.

    Subgingival (under gum) Restoration

    Directly placing a restoration at the deep margin without attempting to elevate it. This often involves careful management of the gingival tissues and using specific restorative materials that bond well to subgingival tooth surfaces.

    Extraction and Replacement

    In cases where the tooth is severely compromised, extraction followed by replacement (with a dental implant, bridge, or removable prosthesis) might be the best option.

    Apical Repositioning Flap

    A surgical technique where a flap of gum tissue is repositioned towards the tooth root, effectively exposing more tooth structure.