(TC21) Deep Margin Elevation: An Alternative Restorative Approach to Treating Teeth with Deep Caries

Abstract: The practice of endodontics today demands a focused and committed approach to the restorative and periodontal aspects of treating endodontically involved teeth. The restoration of teeth presenting with interproximal caries that extend below the cemento-enamel junction presents an especially common and challenging situation for endodontists. Classically, these teeth have been treated with surgical crown lengthening or orthodontic extrusion prior to placing a definitive restoration. If the patient cannot afford the additional procedure, or if the procedure will compromise the attachment of the adjacent teeth, their only remaining option is extraction of the tooth. Alternatively, a procedure termed “deep margin elevation” or “cervical margin relocation” has been proposed. This concept involves relocating the margin coronally with a restorative material prior to placing an indirect restoration. Concerns regarding this approach include the possible violation of the “biologic width” and the breakdown of the integrity of the crown-restorative material interface. The successful application of this technique, however, could result in significant benefits to the patient such as cost savings, reduced treatment time and the avoidance of a surgical procedure. As such, the incorporation of deep margin elevation to our daily practice has the potential to maintain many teeth that may otherwise be extracted. This literature supported and case-based table clinic aims to challenge the dogma of “biologic width invasion” and presents deep margin elevation as an alternative approach to treating teeth with extensive interproximal caries. In addition, a recommended treatment protocol will be presented.