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Polymer-based restorative outcomes following deep margin elevation: a systematic review and meta-analysis
Rim Bourgi1,2,3, Carlos Enrique Cuevas-Suárez4, Ahmed Tarek Farouk5
1Department of Restorative and Esthetic Dentistry, Faculty of Dental Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon.
Frontiers in Dental Medicine
|July 17, 2026
Summary
Deep margin elevation (DME) using adhesive polymer materials shows predictable outcomes for restoring teeth with deep margins. Different composite materials demonstrate similar clinical performance, supporting DME as a viable minimally invasive technique.
Area of Science:
- Restorative Dentistry
- Dental Materials Science
- Clinical Evidence Synthesis
Background:
- Deep margin elevation (DME) is a minimally invasive technique to manage subgingival margins for indirect restorations.
- The technique utilizes various resin-based polymeric materials, each with unique properties influencing clinical outcomes.
- Understanding the clinical relevance of material differences in DME is crucial for predictable restoration success.
Purpose of the Study:
- To systematically review and meta-analyze the clinical performance of indirect restorations following DME.
- To specifically evaluate the impact of different polymer-based restorative materials on DME outcomes.
Main Methods:
- Comprehensive literature search across multiple databases (PubMed/MEDLINE, Scopus, Web of Science, Scielo, Embase) up to March 2026.
- Inclusion of randomized clinical trials and prospective/retrospective studies on indirect restorations after DME.
- Assessment of primary outcomes (survival, success) and secondary outcomes (marginal adaptation, caries, sensitivity, periodontal health) using GRADE and risk of bias tools.
Main Results:
- Ten studies with 623 teeth showed high restoration survival rates (93-100%) over 6 months to 12 years.
- Resin-based composites (flowable, bulk-fill, injectable) exhibited comparable clinical performance regarding survival, marginal integrity, and periodontal stability.
- Modest increase in bleeding on probing observed, but probing depths and attachment levels remained stable; low certainty for secondary caries and sensitivity.
Conclusions:
- Adhesive polymer-based materials are supported by current evidence for predictable outcomes in DME.
- No significant superiority identified among different polymer materials, despite variations in composition and polymerization.
- Need for well-designed, long-term studies to elucidate the influence of polymer properties on clinical outcomes.
Keywords:
adhesive dentistrycervical margin relocationcomposite resindeep margin elevationdental polymersindirect restorationsrestoration survival
