University of Indonesia
Conservative Dentistry Department
Optimization of Post-Endodontic Restoration: Strategies for Handling Deep Subgingival Margin through DME and Crown Lengthening
Hariansyah Buana Putra
Dini Asrianti
University of Indonesia - Indonesia
Conservative Dentistry Department
(*) Corresponding Author
Background: Post-endodontic restoration with deep subgingival margins
beyond the cementoenamel junction (CEJ) is a challenge in itself. This
condition can cause difficulties in insulation with rubber dams, molding, and
restoration cementing. The subgingival margin is also at risk of triggering
gingival inflammation and invasion of biological width (BW) due to its proximity
to the alveolar bone. Surgical crown lengthening (CL) is often recommended to
restore the ideal distance of the BW, but the procedure is invasive. As a more
conservative alternative, Deep Margin Elevation (DME) allows elevation of the
subgingival to supragingiva margin to improve the integrity of the restoration
without invading the BW.
Case report: The first case on the interproximal teeth 24 and 25 (Bone
Sounding: 1mm) was performed CL by the Periodontics department prior to
crown preparation, after previously undergoing endodontic and post fiber
treatment in the Dental Conservation department. The second case was in 36
previously treated teeth (Bone Sounding: 2mm) with deep subgingival margins,
DME was performed using a high-filler composite resin prior to onlay
restoration. Both procedures were carried out at RSKGM FKG UI.
Conclusion: Proper indication for CL and DME at the deep subgingival margin
can improve the optimization of periodontal health and the integrity of postendodontic restoration.
beyond the cementoenamel junction (CEJ) is a challenge in itself. This
condition can cause difficulties in insulation with rubber dams, molding, and
restoration cementing. The subgingival margin is also at risk of triggering
gingival inflammation and invasion of biological width (BW) due to its proximity
to the alveolar bone. Surgical crown lengthening (CL) is often recommended to
restore the ideal distance of the BW, but the procedure is invasive. As a more
conservative alternative, Deep Margin Elevation (DME) allows elevation of the
subgingival to supragingiva margin to improve the integrity of the restoration
without invading the BW.
Case report: The first case on the interproximal teeth 24 and 25 (Bone
Sounding: 1mm) was performed CL by the Periodontics department prior to
crown preparation, after previously undergoing endodontic and post fiber
treatment in the Dental Conservation department. The second case was in 36
previously treated teeth (Bone Sounding: 2mm) with deep subgingival margins,
DME was performed using a high-filler composite resin prior to onlay
restoration. Both procedures were carried out at RSKGM FKG UI.
Conclusion: Proper indication for CL and DME at the deep subgingival margin
can improve the optimization of periodontal health and the integrity of postendodontic restoration.
Keywords: Crown Lengthening, Deep Margin Elevation
- Aldakheel M, Aldosary K, Alnafissah S, Alaamer R, Alqahtani A, Almuhtab N. Deep Margin Elevation:
- Current Concepts and Clinical Considerations: A Review. Medicine. 2022 Oct 18; 58(10):1482.
- Samartzi TK, Papalexopoulos D, Ntovas P, Rahiotis C, Blatz MB. Deep Margin Elevation: A Literature
- Review. Dentistry Journal. 2022 Mar 14; 10(3):48.
- Binalrimal SR, Banjar WM, Alyousef SH, Alawad MI, Alawad GI. Assessment of knowledge, attitude,
- and practice regarding Deep Margin Elevation (DME) among dental practitioners in Riyadh, Saudi
- Arabia. Journal of Family Medicine and Primary Care. May 2021; 10(5):1931–7.
- Juloski J, Köken S, Ferrari M. Cervical margin relocation in indirect adhesive restorations: A literature
- review. Journal of Prosthodontic Research. 2018 Jul; 62(3):273– 80.
- Ferrari M, Koken S, Grandini S, Ferrari Cagidiaco E, Joda T, Discepoli N. Influence of cervical margin
- relocation (CMR) on periodontal health: 12-month results of a controlled trial. Journal of Dentistry. Feb.
- ; 69:70–6.
- Felemban MF, Khattak O, Alsharari T, Alzahrani AH, Ganji KK, Iqbal A. Relationship between Deep
- Marginal Elevation and Periodontal Parameters: A Systematic Review. Medicine. 2023 Nov 3;
- (11):1948.
- Sarfati A, Tirlet G. Deep margin elevation versus crown lengthening: biologic width revisited. CLINICAL
- RESEARCH. 2018;
- Grossman LI. Grossman's endodontic practice. 14th edition. Gopikrishna V, editor. Gurgaon: Wolters
- Kluwer Health (India); 2021.
- Eggmann, F.; Job, J.M.; Conejo, J.; Blatz,M.B. Deep margin elevation-Present status and future
- directions. J. Esthet. Restaurant. Dent. 2023, 35, 26–47.
- Pilalas, I.; Tsalikis, L.; Tatakis, D.N. Pre- restorative crown lengthening surgery outcomes: A systematic
- review. J. Clin. Periodontal. 2016, 43, 1094–1108.
- Bresser RA, Naves LZ, van der Made SAM, Cune MS, Gresnigt MMM. Deep margin elevation. A case
- report study. Int J Esthet Dent. 2023 May 11; 18(2):142-160. PMID: 37166769.
- ijed_2023_02_s0142.pdf.
- Vertolli T, Martinsen B, Hanson C, Howard R, Kooistra S, Ye L. Effect of Deep Margin Elevation on
- CAD/CAM-Fabricated Ceramic Inlays. Operative Dentistry. 2020 Nov 1; 45(6):608–17.
- Mugri MH, Sayed ME, Nedumgottil BM, Bhandi S, Raj AT, Testarelli L, et al. Treatment Prognosis of
- Restored Teeth with Crown Lengthening vs. Deep Margin Elevation: A Systematic Review. Materials.
- Nov 8; 14(21):6733.
- Alizadeh Oskoee P, Dibazar S. Deep margin elevation; Indications and periodontal considerations. J
- Adv Periodontal Implant Dent. 2024 Nov 6; 16(2):91–3.
- Ceddia M, Lamberti L, Trentadue B. FEA Comparison of the Mechanical Behavior of Three Dental
- Crown Materials: Enamel, Ceramic, and Zirconia. Materials. 2024 Jan 30; 17(3):673.
- Alsadon O, Patrick D, Johnson A, Pollington S, Wood D. Fracture resistance of zirconia- composite
- veneered crowns in comparison with zirconia-porcelain crowns. Dental Materials Journal. 2017;
- (3):289–95.
- Carvalho MAD, Lazari PC, Gresnigt M, Del Bel Cury AA, Magne P. Current options concerning the
- endodontically-treated teeth restoration with the adhesive approach. Oral Arm Res [Internet]. 2018 Oct
- [cited 2025 May 2025 6]; 32 (suppl1).
- Zardoni JLC, Cepeda MAAN, Padilla EER, Garza MAG, Casas FDM, Guajardo NAR, et al. Deep margin
- elevation, State of the art and future directions. Int J Appl Dent Sci. 2023 Jan 1; 9(1):295–8.
- Srimaneepong V, Heboyan A, Zafar MS, Khurshid Z, Marya A, Fernandes GVO, et al. Fixed Prosthetic
- Restorations and Periodontal Health: A Narrative Review. JFB. 2022 Feb 1; 13(1):15.
- Castelo-Baz P, Argibay-Lorenzo O, Muñoz F, Martin-Biedma B, Darriba IL, Miguéns-Vila R, et al.
- Periodontal response to a tricalcium silicate material or resin composite placed in close contact to the
- supracrestal tissue attachment: a histomorphometric comparative study. Clin Oral Invest. 2021 Oct;
- (10):5743–53.
- Magne P. M-i-M for DME: matrix-in-a- matrix technique for deep margin elevation. The Journal of
- Prosthetic Dentistry. Oct 2023; 130(4):434–8.
- Da Silva D, Ceballos L, Fuentes M. Influence of the adhesive strategy in the sealing ability of resin
- composite inlays after deep margin elevation. J Clin Exp Dent. 2021; E886–93.
- Zhang H, Li H, Cong Q, Zhang Z, Du A, Wang Y. Effect of proximal box elevation on fracture resistance
- and microleakage of premolars restored with ceramic endocrowns. Kielbassa AM, editor. PLoS ONE.
- May 26; 16(5):e0252269.
