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| Title |
Deep Margin Elevation Is a Viable Alternative to Conventional Surgical Crown Lengthening on Teeth Affected by Extensive Carious Lesions |
| Clinical Question |
In patients in need of restorations on teeth with subgingival caries lesions (P), does the choice of deep margin elevation (I) or conventional surgical crown lengthening procedure (C) affect clinical outcomes (O)? |
| Clinical Bottom Line |
Deep margin elevation (DME) is a feasible method for restoring teeth with localized subgingival defects, potentially serving as an alternative to surgical crown lengthening (SCL). There are key factors to consider with DME to have a high success rate, such as effective isolation, careful execution of the bonding and buildup process, and thorough biofilm removal through patient-managed oral hygiene and professional maintenance. The randomized controlled trial and the systematic review support these statements; however, more evidence is needed to assess the long-term success rate of DME due to the lack of sufficient clinical trials evidence. DME can serve as an alternative treatment to SCL, which is significant both for patients who cannot undergo surgery due to health issues and for clinicians to be able to propose a less invasive treatment option with minimal adverse effect on periodontal health to patients. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 36602272 | Eggmann / 2022 | 278 patients in 38 included studies | Systematic review of randomized trials | | Key results | The overall survival rate for teeth with DME was 95.6% after a 10-year follow-up in a study that involved 120 patients. No instances of fractures, secondary caries, or endodontic complications were reported in a cohort study, which included data from 10 teeth with DME. Teeth included in the study had restorations that were rated ideal or satisfactory after an average follow-up of 14 years. One systematic review revealed that teeth restored with DME showed a better survival rate compared with teeth treated with SCL. | | #2) 38147139 | Farouk / 2023 | 19 patients with 19 extensive caries in need of marginal relocation | Randomized Controlled Trial | | Key results | The study suggests that both DME and SCL are effective in managing deeply located proximal margins after removal of extensive carious lesions. Teeth restored with DME showed statistically significant lower mean clinical attachment level than SCL group after 3, 6, 9 and 12 months (0.85mm versus 1.39mm, P=0.010) meaning that there was less periodontal disease progression in DME group. After 9 and 12 months, DME group showed statistically significant lower mean probing depth than the SCL group (2.1mm versus 2.61mm, P=0.033). Although the differences of clinical attachment level and probing depth in between the two groups were not clinically significant, clinicians can expect less periodontal impingements in teeth restored with DME. | |
| Evidence Search |
(deep margin elevation) AND (survival rate) AND (biological complications) AND (restorative complications) AND (patient’s satisfaction) |
Comments on
The Evidence |
The review performed by Eggmann et al. exhibited relatively strong review methodologies, utilizing both inclusion and exclusion criteria and their thorough research on multiple databases. Even though they assessed the risk of bias, more detailed reporting of the quality assessment would provide robustness of the evaluation. For the randomized controlled trial by Farouk et al., it was well designed with authorization from the ethical approval of institution where the study was conducted, and the participants were randomly allocated. |
| Applicability |
For carious lesions that extend further subgingivally, clinicians usually must perform surgical crown lengthening (SCL) to relocate the gingival margin apically or extract severely affected teeth. Deep margin elevation (DME) was introduced to better preserve teeth and limit the invasiveness of the surgical procedure. However, there is a lack of consensus on whether clinicians should bond subgingivally where isolation is considerably difficult to obtain. Based on the referenced studies, clinicians can confidently advocate performing DME on patients as a viable alternative to SCL due to satisfactory survival rate, lower invasiveness, and lower risk of long-term periodontal impingements. |
| Specialty/Discipline |
(Periodontics) (Prosthodontics) (Restorative Dentistry) |
| Keywords |
Deep Margin Elevation, Surgical Crown Lengthening, Periodontal Health, Restorative Complications
|
| ID# |
3572 |
| Date of submission: |
10/22/2024 |
| E-mail |
yamadas1@uthscsa.edu |
| Author |
Shuhei Yamada |
| Co-author(s) |
Rakan AlShammari |
| Co-author(s) e-mail |
alshammari@uthscsa.edu |
| Faculty mentor/Co-author |
Kyumin Whang, PhD |
| Faculty mentor/Co-author e-mail |
WHANG@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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