Deep Margin Elevation: Next-Level Adhesive Dentistry to Avoid Surgical Crown Lengthening

Surgical crown lengthening (SCL) is the treatment of choice to ensure healthy tissues when subgingival tooth defects encroach on the biologic width.1 However, restorative techniques employing adhesive dentistry may provide viable alternatives to or complement SCL in select cases without the repercussions of surgical bone removal and open interproximal spaces. One such clinical technique, deep margin elevation (DME), employs a direct restoration to relocate the cervical margin of small subgingival defects of posterior teeth supragingivally. The "elevated" margin simplifies impression-making and bonding of indirect restorations, especially inlays and onlays. Recent scientific systematic literature reviews indicate favorable clinical outcomes and suggest that DME restorations made with scrupulous care have high success rates and are compatible with periodontal health. Optimal working field isolation, meticulous placement of matrices, proper bonding and buildup procedure, as well as regular maintenance and follow-up are essential for success. This article provides an overview of this approach.