Effect of Deep Margin Elevation on the Pulpal and Periodontal Health of Teeth: A Systematic Review
To systematically evaluate the clinical performance of deep margin elevation (DME) technique in terms of pulpal and periodontal health of teeth. An exploratory search was performed in PubMed, Scopus, Embase, Web of Science, and Google Scholar up to September 2023 by two authors independently. This systematic review was performed in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Systematic Reviews (PRISMA-SR) and registered with PROSPERO-CRD42022382082. A custom-designed spreadsheet was used to extract the data. The quality of each study was evaluated by means of the Joanna Briggs Institute (JBI) risk of bias (ROB) tool specific for each study design. A total of 5363 articles was obtained through an electronic database search, the grey literature, and a hand search. 2814 duplicates were removed, and an additional 2535 articles were also removed, as they did not meet the eligibility criteria. Following the screening of titles and abstracts, 16 articles were selected for full text reading, from which 10 articles were included for final qualitative analysis. DME was predominantly done with resin-based composite or glass ionomer cement (GIC). Parameters like periodontal pocket depth and bleeding on probing were within normal limits in all teeth with DME. Only one study checked the histological outcome and concluded that DME had no negative effect on the periodontium. Most of the studies used indirect restoration (composite/lithium disilicate/Emax) over the DME layer. The follow-up period ranged between 6 months and 12 years. The level of evidence of this review is low, but DME was successful in all teeth, without any deleterious effect on pulp and periodontium.SUMMARY
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Illustration of the deep marginal elevation procedure. Abbreviations: GIC, glass ionomer cement.
PRISMA flow chart of the study selection. Based on a figure from Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. (2021) The PRISMA 2020 statement: An updated guideline for reporting systematic reviews British Medical Journal 327(71). doi:10.1136/bmj.n71. Licensed under CC BY 4.0 For more information, visit http://www.prisma-statement.org/.
Type of clinical studies included.
Type of matrix used.
Bonding strategy followed in performing the deep marginal elevation procedure.
Type of restorative material used to perform the deep marginal elevation.
Technique and number of layers placed to perform the deep marginal elevation.
Type of final restoration given above the deep marginal elevation layer.
An illustration of deep marginal elevation procedure in a Class II cavity in which snowplow technique is demonstrated with matrix and wedge placement.
Risk of bias charts using the Joanna Briggs Institute (JBI) tool for different study designs: (A) Low risk of bias for case reports; (B) Moderate risk of bias for case series; (C) Moderate risk of bias for cohort study; (D) Moderate risk of bias for randomized clinical trial.
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