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Musapoor N, Neshandar Asli H, Mokhtari S, Babaee Hemmati Y, Falahchai M. In Vitro Effect of the Length of Relocated Cervical Margin with Casting Post and Core, Prefabricated Fiber Post, and Polyethylene Fiber with a Composite Core on Fracture Resistance and Marginal Integrity. Int J Dent 2024; 2024:9274141. [PMID: 39229333 PMCID: PMC11371451 DOI: 10.1155/2024/9274141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/10/2024] [Accepted: 07/25/2024] [Indexed: 09/05/2024] Open
Abstract
Objective This study aimed to assess the effect of length of the relocated cervical margin with casting post and core (CP), prefabricated fiber post and composite core (PFP), and polyethylene fiber-reinforced composite (PEFRC) on fracture resistance and marginal integrity. Materials and Methods In this in vitro study, 70 sound human maxillary premolars were divided into seven groups according to the type of post and core system and length of the relocated cervical margin (n = 10): control (no preparation), PFP-3, PEFRC-3, CP-3 with 3 mm of cervical margin relocation (CMR), PFP-6, PEFRC-6, and CP-6 (with 6 mm of CMR). The samples were restored with zirconia crowns (except the control group). Epoxy resin replicas were fabricated before and after thermomechanical loading. Marginal integrity was assessed at the luting cement-core, core-tooth, and luting cement-enamel interfaces under a scanning electron microscope (SEM) (×200). Fracture resistance and failure mode were subsequently assessed. Data were analyzed by independent t-test, paired t-test, ANOVA, Tukey-Games Howell, Mann-Whitney, Kruskal-Wallis, Wilcoxon, Mann-Whitney with Bonferroni correction, and Fisher-Freeman-Halton tests (α = 0.05). Results The marginal integrity of the groups with 3 mm of CMR followed the following order: PEFRC > PFP > CP at all interfaces (P < 0.05). In 6-mm CMR groups, this order was CP < PFP = PEFRC at the luting cement-core and (CP < PEFRC) = PFP at the core-tooth interface. No significant difference was found in fracture resistance when comparing the 3-mm CMR groups with each other (P > 0.05). PFP-6 showed higher FR than CP-6 (P < 0.001). PEFRC-6 had no significant difference with PFP-6 and CP-6 (P > 0.05). In each post and core system, 3-mm CMR groups showed higher marginal integrity and fracture resistance (P < 0.05). Conclusion Increasing the length of the relocated cervical margin decreased the marginal integrity and fracture resistance of all three systems of CP, PFP, and PEFRC.
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Affiliation(s)
- Naghmeh Musapoor
- Department of ProsthodonticsDental Sciences Research CenterSchool of DentistryQazvin University of Medical Sciences, Qazvin, Iran
| | - Hamid Neshandar Asli
- Department of ProsthodonticsDental Sciences Research CenterSchool of DentistryGuilan University of Medical Sciences, Rasht, Iran
| | - Soroosh Mokhtari
- Department of ProsthodonticsDental Sciences Research CenterSchool of DentistryArak University of Medical Sciences, Arak, Iran
| | - Yasamin Babaee Hemmati
- Department of OrthodonticsDental Sciences Research CenterSchool of DentistryGuilan University of Medical Sciences, Rasht, Iran
| | - Mehran Falahchai
- Department of ProsthodonticsDental Sciences Research CenterSchool of DentistryGuilan University of Medical Sciences, Rasht, Iran
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Caussin E, Izart M, Ceinos R, Attal JP, Beres F, François P. Advanced Material Strategy for Restoring Damaged Endodontically Treated Teeth: A Comprehensive Review. MATERIALS (BASEL, SWITZERLAND) 2024; 17:3736. [PMID: 39124400 PMCID: PMC11313123 DOI: 10.3390/ma17153736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024]
Abstract
The restoration of endodontically treated teeth (ETT) remains a significant challenge in modern dentistry. These teeth often suffer from substantial structural damage due to both the original pathology and the invasive nature of endodontic procedures. Consequently, ETT are more susceptible to fractures compared to vital teeth, necessitating restorative strategies that can effectively restore both function and aesthetics while minimizing the risk of failure. In recent years, advances in adhesive dentistry and the development of high-strength ceramics have further expanded the restorative options for ETT. Bonded restorations have gained popularity as they preserve more tooth structure and enhance the overall strenght of the tooth-restoration complex. The choice of restorative material and technique is influenced by numerous factors, including the amount of remaining tooth structure, the functional requirements of the tooth, and the aesthetic demands of the patient. Despite the plethora of available materials and techniques, the optimal approach to restoring ETT remains a topic of ongoing research and debate. In this comprehensive review, the current state of and recent advances in restoring damaged endodontically treated teeth are explored. Numerous therapeutic options exist, involving a wide range of materials. This article aims to present the biomaterial advancements of the past decade and their applications, offering alternative approaches to treating damaged ETT with the goal of prolonging their retention on the dental arch and serving as a valuable resource for dental practitioners who face this issue daily.
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Affiliation(s)
- Elisa Caussin
- Faculty of Dental Surgery, University of Paris Cité, 75006 Paris, France
- Bretonneau Hospital, Assistance Publique des Hôpitaux de Paris, 75018 Paris, France
- URB2i, Université of Paris Cité, 92100 Montrouge, France
| | - Mathieu Izart
- Faculty of Dental Surgery, University of Paris Cité, 75006 Paris, France
- Bretonneau Hospital, Assistance Publique des Hôpitaux de Paris, 75018 Paris, France
| | - Romain Ceinos
- URB2i, Université of Paris Cité, 92100 Montrouge, France
- Faculty of Dental Surgery, Côte d’Azur University, 06000 Nice, France
| | - Jean-Pierre Attal
- Faculty of Dental Surgery, University of Paris Cité, 75006 Paris, France
- URB2i, Université of Paris Cité, 92100 Montrouge, France
- Charles Foix Hospital, Assistance Publique des Hôpitaux de Paris, 94200 Ivry-Sur-Seine, France
| | - Fleur Beres
- Faculty of Dental Surgery, University of Paris Cité, 75006 Paris, France
- Bretonneau Hospital, Assistance Publique des Hôpitaux de Paris, 75018 Paris, France
| | - Philippe François
- Faculty of Dental Surgery, University of Paris Cité, 75006 Paris, France
- Bretonneau Hospital, Assistance Publique des Hôpitaux de Paris, 75018 Paris, France
- URB2i, Université of Paris Cité, 92100 Montrouge, France
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Taylor A, Burns L. Deep margin elevation in restorative dentistry: A scoping review. J Dent 2024; 146:105066. [PMID: 38740249 DOI: 10.1016/j.jdent.2024.105066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES Deep margin elevation (DME) is a restorative approach offering the possibility of performing stepwise elevation of deep proximal cavities to create more favourable margins for direct or indirect restorations. The objectives of this scoping review were to explore what is known or unknown about DME by describing a wide ranging evidence base including peer reviewed literature and non-traditionally published information on the web. DATA Data were extracted from the included evidence in order to describe the following: the extent and nature of the evidence base; the situations which are appropriate for DME; the materials and techniques which are used; the outcomes which have been measured in empirical studies; the risks which have been reported; and the findings which have been reported in studies which compared DME to surgical crown lengthening. SOURCES This scoping review included a wide range of published evidence and extensive web searching for grey literature, including CPD, training and multimedia information. STUDY SELECTION The findings revealed a range of published literature as well as freely available, online information advising practitioners about DME. Most empirical evidence was based on in vitro studies, and there were few clinical studies comparing DME to crown lengthening. Online information included recent, multimedia sources. CONCLUSIONS DME is a technique that can be used with motivated patients with good oral hygiene if rubber dam isolation is achieved, if there is no invasion of the connective tissue space, and if a strict restorative protocol is adhered to. CLINICAL SIGNIFICANCE With phasing out of amalgam and adhesive dentistry increasing in popularity, DME addresses multiple clinical problems associated with sub-gingival margins prior to restoration.
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Affiliation(s)
- Anna Taylor
- The Treatment Centre, Tinner's Court, Back Quay, Truro, Cornwall TR1 2LL, UK
| | - Lorna Burns
- Peninsula Dental School, John Bull Building, Research Way, Plymouth, Devon PL6 8BU, UK.
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Sadeghnezhad P, Sarraf Shirazi A, Borouziniat A, Majidinia S, Soltaninezhad P, Nejat AH. Enhancing subgingival margin restoration: a comprehensive review and meta-analysis of deep margin elevation's impact on microleakage. Evid Based Dent 2024:10.1038/s41432-024-01028-0. [PMID: 38907025 DOI: 10.1038/s41432-024-01028-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/03/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION Restorative dentistry faces complex challenges with deep proximal surface destruction, requiring novel approaches like DME (Deep Margin Elevation). In order to achieve the best results while treating severe tooth damage, this study examines the advantages, disadvantages, and possible collaborations of different treatments. AIMS This systematic review investigates the efficacy of DME as an adjunctive procedure in restorative dentistry, specifically focusing on its impact on microleakage. METHODS The study adheres to PRISMA guidelines and employs the PICOS framework for eligibility criteria. 394 potentially qualifying studies were discovered and thorough literature search was carried out via databases. After applying inclusion criteria, 7 studies were included in the analysis. Articles were selected based on criteria that included indirect restoration and performing DME and were compared with indirect restorations without DME. Composite resin was used for DME. Other materials for DME performing, including GI and composite flow, were systematically reviewed. Data analysis was done by biostat software (α = 0.05). RESULTS The meta-analysis of selected studies reveals a statistically significant positive effect of DME on reduction of microleakage (p = 0.001). CONCLUSION The results of this study underscore the potential of DME in addressing subgingival margin challenges and provide valuable insights for restorative dentistry practices.
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Affiliation(s)
- Pegah Sadeghnezhad
- Dentist, School of Dentistry, Mashhad University of Medical Science, Mashhad, Iran
| | | | - Alireza Borouziniat
- Dental Research Center, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Majidinia
- Dental Materials Research Center, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Pouria Soltaninezhad
- Dentist, School of Dentistry, Mashhad University of Medical Science, Mashhad, Iran
| | - Amir Hossein Nejat
- Department of Prosthodontics, School of Dentistry, Louisiana State University Health Science Center, New Orleans, LA, USA
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Adel M, Hamdy A, Sabet A, Ebeid K. Effect of cervical margin relocation on marginal adaptation and microleakage of indirect ceramic restorations. J Prosthodont 2024; 33:374-381. [PMID: 37186493 DOI: 10.1111/jopr.13696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/23/2023] [Indexed: 05/17/2023] Open
Abstract
PURPOSE This study evaluated the effect of cervical margin relocation (CMR) with two different materials and contamination with hemostatic agents on the margin adaptation and microleakage of ceramic restorations. MATERIALS AND METHODS Mesial-occlusal-distal cavities were prepared in 60 human first molars and distributed to 3 groups (n = 20) according to the margin relocation procedure. The groups were: group F; flowable composite applied in two 2 mm increments, group B; bulk-fill flowable composite applied as a bulk increment of 4 mm thickness and group C (control); no CMR was done. Each group was subdivided into two subgroups (subgroup N; no hemostatic agent applied and subgroup H; hemostatic agent was applied). In all groups, ceramic inlays were prepared and cemented. The samples were subjected to thermocycling (10,000 cycles). The adaptation of the cervical margin was evaluated with scanning electron microscopy (200×). Samples were then assessed for microleakage analysis with the dye penetration method. Marginal adaptation data were normally distributed and analyzed using two-way ANOVA followed by Tukey's post hoc test. Ordinal microleakage score data were analyzed using cumulative link models followed by the analysis of deviance using Wald chi-square tests. RESULTS Both CMR and contamination with a hemostatic agent had significant effects on the margin adaptation of the cervical margin. Group C showed the highest adaptation with no significant difference from group F. The lowest adaptation was revealed in group B with a significant difference from group C. Subgroup N (in all groups) showed a statistically higher adaptation than subgroup H. Regarding microleakage assessment, CMR had no significant effect but hemostatic agent application showed a significantly higher microleakage score for all groups. CONCLUSIONS Both the CMR procedure and contamination with AlCl3 hemostatic agent had a negative effect on marginal adaptation. For microleakage assessment, only contamination with hemostatic agent negatively affected the microleakage with no effect on the margin relocation procedure.
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Affiliation(s)
- Marwa Adel
- Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Amina Hamdy
- Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Ahmed Sabet
- Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
- Department of Fixed Prosthodontics, Faculty of Dentistry, British University in Egypt, Cairo, Egypt
| | - Kamal Ebeid
- Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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Falahchai M, Musapoor N, Mokhtari S, Babaee Hemmati Y, Neshandar Asli H. Fracture resistance and failure mode of endodontically treated premolars reconstructed by different preparation approaches: Cervical margin relocation and crown lengthening with complete and partial ferrule with three different post and core systems. J Prosthodont 2023. [PMID: 37505114 DOI: 10.1111/jopr.13741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/14/2023] [Accepted: 07/23/2023] [Indexed: 07/29/2023] Open
Abstract
PURPOSE To assess the fracture resistance and failure mode of endodontically treated premolars reconstructed by different preparation approaches: cervical margin relocation (CMR) and crown lengthening (CL) with complete ferrule (CLF) and partial ferrule (CLPF) with three different post and core systems. MATERIALS AND METHODS In this in vitro study, 100 maxillary premolars were assigned to the following 10 groups according to their preparation approach and type of post and core system (n = 10): (I) control (intact teeth), (II) prefabricated fiber post (PFP) and composite core with CMR (PFP-CMR), (III) polyethylene fiber-reinforced composite (PEFRC) with CMR (PEFRC-CMR), (IV) casting post (CP) and core with CMR (CP-CMR), (V) PFP-CLPF, (VI) PEFRC-CLPF, (VII) CP-CLPF, (VIII) PFP-CLF, (IX) PEFRC-CLF, and (X) CP-CLF. After thermomechanical loading, the fracture resistance and failure mode were assessed. Data were analyzed statistically (α = 0.05). RESULTS In all post and core systems, the CLPF approach had lower fracture resistance than CMR (p < 0.05); CLF showed higher fracture resistance than CLPF only in the PFP system (p = 0.038). In PEFRC and CP systems, the difference between CLF and CLPF was not significant (p > 0.05). No significant difference was found in fracture resistance of different post and core systems with the same preparation approach (p > 0.05). CLPF showed the highest frequency of favorable, and CLF showed the highest frequency of unfavorable fractures. CONCLUSION CLPF yielded lower fracture resistance than CMR. The difference in fracture resistance was not significant between CLF and CMR but the frequency of unfavorable fractures was higher in CLF than in other groups.
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Affiliation(s)
- Mehran Falahchai
- Department of Prosthodontics, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
| | - Naghmeh Musapoor
- Department of Prosthodontics, School of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Soroosh Mokhtari
- Department of Prosthodontics, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
| | - Yasamin Babaee Hemmati
- Department of Orthodontics, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamid Neshandar Asli
- Department of Prosthodontics, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
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Al Aggan N, Nabih SM, Abd Al Hady AAA. Influence of the cervical margin relocation on stress distribution -. BRAZILIAN JOURNAL OF ORAL SCIENCES 2023; 22:e230356. [DOI: 10.20396/bjos.v22i00.8670356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Aim: Evaluate the influence of the cervical margin relocation (CMR) on stress distribution in the lower first molar restored with direct nano-ceramic composite (zenit). Methods: A 3D model of the lower first molar was modeled and used. Standardized mesio-occluso-distal (MOD) preparation consisted in two models used in this study with mesial subgingival margin in model II. (CMR) was applied in model II using flowable composite or resin glass ionomer (Riva). Both models were restored with nanoceramic composite and then subjected to six runs (2 for the model I and 4 for model II) with load (100N) as two load cases, one at (11º) and other at (45º) from the vertical axis. The stress distributions (FEA) in the final restoration and (CMR) material were analyzed using 3D models. Results: The two models recorded an equivalent Von Mises stress and Total deformation in the final restoration, regardless of the difference in the oblique angle incidence from (11º to 45º) or the type of the material used for (CMR) there was no significant difference in the (FEA) between the model with CMR (model II) and the model without CMR (model I). Conclusions: (CMR) technique seems to be biomechanically beneficial with high eccentric applied stress, (CMR) with resin glass ionomer or flowable composite resin in combination with nanoceramic composite improved the biomechanical behavior of (MOD) cavities extended below cement enamel junction (CMR) with high modulus elasticity material like (Riva) exhibits a more uniform stress distribution.
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Ismail HS, Azees PAA, Wang H, Ali AI, Mehesen RE, Mahmoud SH, Chen XD, Yeh CK, Garcia-Godoy F. Periodontopathic bacterial adhesion to different restorative materials used to elevate proximal subgingival margins. Eur J Oral Sci 2023; 131:e12909. [PMID: 36526586 DOI: 10.1111/eos.12909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
This study compared the periodontopathic bacterial adhesion to four restorative materials used for deep margin elevation at 2, 24, and 48-h after incubation. Discs were produced from four restorative materials: resin modified glass ionomer, glass hybrid, flowable bulk fill resin composite, and bioactive ionic resin. Root dentin was used as control. Specimens were coated with saliva and used to culture a biofilm comprised of three strains of periodontopathic bacteria; Porphyromonas gingivalis, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans. Bacterial adherence was assessed by colony count assay, crystal violet staining, and visualized using confocal laser scanning microscopy. Data were analyzed by two-way ANOVA followed by Tukey's post hoc tests. The adhesion values for the control specimens were significantly higher than for other materials, while those for the flowable bulk fill were significantly lower than for any other material within all evaluation assays. The 2-h incubation period showed the lowest adhesion values regardless of the group. The 48-h adhesion values were higher than the 24-h results in all groups except the flowable bulk fill. Microscopic imaging partially supported the findings of the measurements. In terms of periodontopathic bacterial adhesion, the tested flowable bulk fill may be preferable for subgingival use over other tested materials.
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Affiliation(s)
- Hoda S Ismail
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt.,Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Parveez Ahamed Abdul Azees
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Hanzhou Wang
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Ashraf I Ali
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Rabab El Mehesen
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Salah H Mahmoud
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt.,Conservative Dentistry Department, Faculty of Dentistry, Horus University, New-Damietta, Damietta, Egypt
| | - Xiao-Dong Chen
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Department of Biomedical Engineering, University of Texas at San Antonio, San Antonio, Texas, USA.,Research Service, South Texas Veterans Health Care System, Audie Murphy VA Medical Center, San Antonio, Texas, USA
| | - Chih-Ko Yeh
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Geriatric Research Education and Clinical Center Audie L. Murphy Division South Texas Veterans Health care system, San Antonio, Texas, USA
| | - Franklin Garcia-Godoy
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,The Forsyth Institute, Cambridge, Massachusetts, USA
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Eggmann F, Ayub JM, Conejo J, Blatz MB. Deep margin elevation-Present status and future directions. J ESTHET RESTOR DENT 2023; 35:26-47. [PMID: 36602272 DOI: 10.1111/jerd.13008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Deep margin elevation (DME) is a treatment approach to relocate the cervical margin of teeth with subgingival defects to a supragingival position with a direct restoration to facilitate rubber dam isolation, impression taking, and bonding of indirect restorations. This article provides an overview of the current scientific evidence on DME and future directions for research. OVERVIEW The review included 38 studies on DME, most conducted in vitro. These studies indicate that DME has no detrimental effect on the fracture resistance of restored teeth. Evidence on the impact of DME on marginal quality is conflicting, but most in vitro studies observed no negative effect. Clinical studies, most comprising small patient cohorts, demonstrated favorable restorative outcomes and suggest that DME restorations made with scrupulous care are compatible with periodontal health. Bleeding on probing may occur more frequently at sites with DME, though evidence on this is not unequivocal. CONCLUSIONS Current evidence, based largely on laboratory studies and limited clinical data, supports DME as a viable approach to restore teeth with localized subgingival defects. However, further clinical studies with long-term follow-ups are required to provide corroborative evidence. CLINICAL SIGNIFICANCE Current evidence suggests that DME is a viable approach to restore teeth with localized subgingival defects as a possible alternative to surgical crown lengthening. Proper working field isolation, meticulous care in the bonding and buildup procedure, and biofilm removal through patient-performed oral hygiene and professional maintenance care are crucial. As scant clinical trial-based evidence is available today, further research is needed to evaluate the long-term performance of DME restorations and their impact on periodontal health.
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Affiliation(s)
- Florin Eggmann
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Jose M Ayub
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julián Conejo
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Markus B Blatz
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Deep Margin Elevation: Current Concepts and Clinical Considerations: A Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101482. [PMID: 36295642 PMCID: PMC9610387 DOI: 10.3390/medicina58101482] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/05/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
Dietschi and Spreafico first proposed deep margin elevation (DME) in 1998 to address the multiple clinical problems associated with sub-gingival margins, where sub-gingival margins will be repositioned coronally using composite resin restorations. Given that dentistry is directing towards conservatism, its use is currently trending. Materials and Methods: a search was performed through PubMed, Scopus, and Google Scholar search engines to obtain relevant articles with no time restriction. Results: With biological width taken into consideration, well-defined and polished sub-gingival restorations are compatible with periodontal health. Marginal integrity in the DME technique seems to be affected by the type of adhesive, restoration, and incremental layering of the restoration. Regarding fracture resistance, DME has no significant effects. Conclusion: The DME technique seems to be a minimally invasive alternative to surgical crown lengthening (SCL) and orthodontic extrusion (OE) with respect to biological width. Well-controlled clinical trials are limited in this field; further long-term follow-up studies emphasizing the periodontal outcomes and prevention of complications are needed.
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Ismail HS, Ali AI, Mehesen RE, Garcia-Godoy F, Mahmoud SH. In vitro marginal and internal adaptation of four different base materials used to elevate proximal dentin gingival margins. J Clin Exp Dent 2022; 14:e550-e559. [PMID: 35912027 PMCID: PMC9328484 DOI: 10.4317/jced.59652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/06/2022] [Indexed: 11/22/2022] Open
Abstract
Background There is still debate about the most appropriate restorative material category to relocate the proximal deep cervical margins, thus, this study aimed to compare the marginal and internal adaptation of four base materials used for deep margin elevation, and to evaluate each base material/overlying composite interface.
Material and Methods Fifty six molars received class II cavities with dentin/cementum gingival margins. They were divided into four groups and their gingival margins were elevated using either; resin modified glass ionomer (RMGI), highly viscous conventional glass ionomer (HV-GIC), flowable bulk fill resin composite (Bulk Flow) and bioactive ionic resin (Activa). The rest of the cavities were completed with the same overlying composite. Half of each group was either; kept in sterile water for 1 week, or subjected to 18 months water storage and 15,000 thermal cycles. Base materials/gingival dentin interfaces were examined under a scanning electron microscope at different magnifications, and percentage of continuous margin (% CM) and maximum gap width (MGW) were analyzed, in addition to base materials/overlying composite interfaces evaluations. % CM values were statistically analyzed using Two-way analysis of variance, Tukey post hoc tests (at p<0.05) and Pearson’s correlation while MGW values were analyzed using Kruskal–Wallis, Mann–Whitney U tests and Spearmen correlation
Results Both Bulk Flow and Activa had better marginal integrity than RMGI and HV-GIC. All base materials were adversely affected by aging. All base materials/overlying composite interfaces were continuous and age defying.
Conclusions In terms of marginal integrity, Bulk Flow and Activa might be preferable for proximal dentin margin elevation under direct restoration compared to the other tested base materials. Key words:Deep proximal margin, interface analysis, marginal quality, open sandwich technique.
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Affiliation(s)
- Hoda S Ismail
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Ashraf I Ali
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Rabab El Mehesen
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Franklin Garcia-Godoy
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,The Forsyth Institute, Cambridge, MA, USA
| | - Salah H Mahmoud
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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Ismail HS, Ali AI, Mehesen RE, Juloski J, Garcia-Godoy F, Mahmoud SH. Deep proximal margin rebuilding with direct esthetic restorations: a systematic review of marginal adaptation and bond strength. Restor Dent Endod 2022; 47:e15. [PMID: 35692223 PMCID: PMC9160765 DOI: 10.5395/rde.2022.47.e15] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/25/2021] [Accepted: 08/08/2021] [Indexed: 11/25/2022] Open
Abstract
This review aimed to characterize the effect of direct restorative material types and adhesive protocols on marginal adaptation and the bond strength of the interface between the material and the proximal dentin/cementum. An electronic search of 3 databases (the National Library of Medicine [MEDLINE/PubMed], Scopus, and ScienceDirect) was conducted. Studies were included if they evaluated marginal adaptation or bond strength tests for proximal restorations under the cementoenamel junction. Only 16 studies met the inclusion criteria and were included in this review. These studies presented a high degree of heterogeneity in terms of the materials used and the methodologies and evaluation criteria of each test; therefore, only a descriptive analysis could be conducted. The included studies were individually evaluated for the risk of bias following predetermined criteria. To summarize the results of the included studies, the type of restorative material affected the test results, whereas the use of different adhesive protocols had an insignificant effect on the results. It could be concluded that various categories of resin-based composites could be a suitable choice for clinicians to elevate proximal dentin/cementum margins, rather than the open sandwich technique with resin-modified glass ionomers. Despite challenges in bonding to proximal dentin/cementum margins, different adhesive protocols provided comparable outcomes.
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Affiliation(s)
- Hoda S. Ismail
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Egypt
| | - Ashraf I. Ali
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Egypt
| | - Rabab El. Mehesen
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Egypt
| | - Jelena Juloski
- Clinic for Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Serbia
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Franklin Garcia-Godoy
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA
- The Forsyth Institute, Cambridge, MA, USA
| | - Salah H. Mahmoud
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Egypt
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Ismail HS, Ali AI, Garcia-Godoy F. Influence of Manual and Ultrasonic Scaling on Surface Roughness of Four Different Base Materials Used to Elevate Proximal Dentin-Cementum Gingival Margins: An In Vitro Study. Oper Dent 2022; 47:E106-E118. [PMID: 35405002 DOI: 10.2341/20-007-c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2021] [Indexed: 11/23/2022]
Abstract
AIM To evaluate and compare the effects of both manual and ultrasonic scaling on surface roughness of four different base materials, used for elevating dentin/cementum gingival margins of proximal cavities. METHODS AND MATERIALS Eighty human upper molars with compound Class II mesial cavities, with gingival margins 1 mm below the cemento-enamel junction (CEJ), were divided into four different groups according to the type of the base material used; resin-modified glass ionomer (RMGI), glass hybrid (HV-GIC), flowable bulk-fill resin composite (Bulk Flow) and bioactive ionic resin (Activa). This was followed by completing the restorations with the same resin composite. All materials were used according to the manufacturers' instructions. All groups were further subdivided into two subgroups according to the scaling technique: manual (hand) or ultrasonic. All restorative and scaling procedures were performed after fixation of specimens with acrylic beside neighboring teeth to simulate natural contact. The mean surface roughness (Ra, μm) of all specimens was measured quantitatively and qualitatively by a three-dimensional (3D) surface analyzer system at two stages; (1) after thermal cycling for 5000 cycles without scaling and (2) after scaling. Data were statistically analyzed using analysis of variance (ANOVA), Tukey post hoc tests, and paired sample t-tests (at α=0.05). RESULTS For baseline readings, the Bulk Flow group had the lowest Ra values, while HV-GIC group had the highest. RMGI and Activa groups had no statistical significant difference between their Ra values (p>0.05). For post scaling readings, hand scaling had significantly lower Ra values than ultrasonic scaling in all the material groups (p<0.05), except in the Bulk Flow group, where both scaling methods were not significantly different from each other (p>0.05). CONCLUSION Bulk Flow had the smoothest surfaces when cured against a matrix band compared with the other tested base materials. When hand and ultrasonic scaling methods were compared, the latter technique had more detrimental effect on the surface texture of the four tested base materials.
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Affiliation(s)
- H S Ismail
- *Hoda Ismail, assistant lecturer, Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - A I Ali
- Ashraf Ibrahim Ali, associate professor, Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura Egypt
| | - F Garcia-Godoy
- Franklin Garcia-Godoy, professor, Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA; adjunct professor, The Forsyth Institute, Cambridge, MA, USA
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Deep Margin Elevation: A Literature Review. Dent J (Basel) 2022; 10:dj10030048. [PMID: 35323250 PMCID: PMC8947734 DOI: 10.3390/dj10030048] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 01/02/2023] Open
Abstract
A conservative approach for restoring deep proximal lesions is to apply an increment of composite resin over the preexisting cervical margin to relocate it coronally, the so-called “deep margin elevation” (DME). A literature search for research articles referring to DME published from January 1998 until November 2021 was conducted using MEDLINE (PubMed), Ovid, Scopus, Cochrane Library and Semantic Scholar databases applying preset inclusion and exclusion criteria. Elevation material and adhesive system employed for luting seem to be significant factors concerning the marginal adaptation of the restoration. This technique does not affect bond strength, fatigue behavior, fracture resistance, failure pattern or repairability. DME and subgingival restorations are compatible with periodontal health, given that they are well-polished and refined. The available literature is limited mainly to in vitro studies. Therefore, randomized clinical trials with extended follow-up periods are necessary to clarify all aspects of the technique and ascertain its validity in clinical practice. For the time being, DME should be applied with caution respecting three criteria: capability of field isolation, the perfect seal of the cervical margin provided by the matrix, and no invasion of the connective compartment of biological width.
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Baldi A, Scattina A, Ferrero G, Comba A, Alovisi M, Pasqualini D, Peroni L, Muggeo M, Germanetti F, Scotti N. Highly-filled flowable composite in deep margin elevation: FEA study obtained from a microCT real model. Dent Mater 2022; 38:e94-e107. [DOI: 10.1016/j.dental.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/15/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022]
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Ismail HS, Morrow BR, Ali AI, Mehesen RE, Garcia-Godoy F, Mahmoud SH. Correlation between different methodologies used to evaluate the marginal adaptation of proximal dentin gingival margins elevated using a glass hybrid. RESTORATIVE DENTISTRY & ENDODONTICS 2022; 47:e36. [DOI: 10.5395/rde.2022.47.e36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/20/2022] [Accepted: 06/15/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Hoda S. Ismail
- Department of Operative Dentistry Faculty of Dentistry, Mansoura University, Mansoura, Egypt
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Brian R. Morrow
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ashraf I. Ali
- Department of Operative Dentistry Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Rabab El. Mehesen
- Department of Operative Dentistry Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Franklin Garcia-Godoy
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA
- Adjunct Faculty, The Forsyth Institute, Cambridge, MA, USA
| | - Salah H. Mahmoud
- Department of Operative Dentistry Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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Grassi EDA, de Andrade GS, Tribst JPM, Machry RV, Valandro LF, Ramos NDC, Bresciani E, Saavedra GDSFA. Fatigue behavior and stress distribution of molars restored with MOD inlays with and without deep margin elevation. Clin Oral Investig 2021; 26:2513-2526. [PMID: 34643807 DOI: 10.1007/s00784-021-04219-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study evaluated the effect of deep margin elevation (DME) and restorative materials (leucite-reinforced glass-ceramics [C] vs. indirect resin composite [R]) on the fatigue behavior and stress distribution of maxillary molars with 2-mm deep proximal margins restored with MOD inlay. METHODS Fifty-two extracted human third molars were randomly assigned into four groups (n = 13): C; DME + C; R; and DME + R. Inlays were fabricated in CAD-CAM and bonded to all teeth. The fatigue behavior was assessed with the stepwise stress test (10,000 cycles/step; step = 50 N; 20 Hz; initial load = 200 N). Fatigue failure loads and the number of cycles were analyzed with 2-way ANOVA and Tukey's test (p < 0.05) and Kaplan-Meier survival plots. The stress distribution was assessed with finite element analysis. The models were considered isotropic, linear, and homogeneous, and presented bonded contacts. A tripod axial load (400 N) was applied to the occlusal surface. The stress distribution was analyzed with the maximum principal stress criterion. RESULTS For fatigue, there was no difference for DME factor (p > 0.05). For the material factor, the load and number of cycles for failure were statistically higher in the R groups (p < 0.05). The finite element analysis showed that resin composite inlays concentrated more stress in the tooth structure, while ceramic inlays concentrated more stress in the restoration. Non-reparable failures were more frequent in the resin composite inlays groups. CONCLUSIONS DME was not negative for fatigue and biomechanical behaviors. Resin composite inlays were more resistant to the fatigue test, although the failure mode was more aggressive. CLINICAL SIGNIFICANCE DME does not impair mechanical behavior. Resin composite inlays failed at higher loads but with a more aggressive failure mode.
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Affiliation(s)
- Elisa Donaria Aboucauch Grassi
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), 777th Eng. Francisco José Longo Av., São José dos Campos, SP, 12245-000, Brazil
| | - Guilherme Schmitt de Andrade
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), 777th Eng. Francisco José Longo Av., São José dos Campos, SP, 12245-000, Brazil
| | - João Paulo Mendes Tribst
- Post-Graduate Program in Dentistry, University of Taubaté (UNITAU), 09th Rua Dos Operários St., Taubaté, SP, 12020-340, Brazil
| | - Renan Vaz Machry
- Graduate Program of Oral Science, Prosthodontics Unit, School of Dentistry, Federal University of Santa Maria (UFSM), Roraima Av, Santa Maria, RS, 100097105-340, Brazil
| | - Luiz Felipe Valandro
- Graduate Program of Oral Science, Prosthodontics Unit, School of Dentistry, Federal University of Santa Maria (UFSM), Roraima Av, Santa Maria, RS, 100097105-340, Brazil
| | - Nathalia de Carvalho Ramos
- School of Dentistry, São Francisco University (USF), 218th São Francisco de Assis Av., Bragança Paulista, SP, 12916-900, Brazil
| | - Eduardo Bresciani
- Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University (Unesp), 777th Eng. Francisco José Longo Av., São José dos Campos, SP, 12245-000, Brazil
| | - Guilherme de Siqueira Ferreira Anzaloni Saavedra
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), 777th Eng. Francisco José Longo Av., São José dos Campos, SP, 12245-000, Brazil.
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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. J Family Med Prim Care 2021; 10:1931-1937. [PMID: 34195127 PMCID: PMC8208217 DOI: 10.4103/jfmpc.jfmpc_1707_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/25/2020] [Accepted: 10/07/2020] [Indexed: 12/02/2022] Open
Abstract
Objectives: To evaluate Knowledge, Attitude, and Practice (KAP) regarding deep margin elevation (DME) among dental practitioners in Riyadh city. Materials and Methodology: A cross-sectional study that comprised a total number of 535 dental practitioners: 255 (47.7%) were males and 280 (52.3%) females. A self-constructed 21 close-ended self-administered questionnaire was utilized in the study. The data were entered and analyzed by Chi-square test and descriptive analysis using Statistical Package for the Social Sciences (SPSS) software. Results: Although the majority of the respondents have heard about DME, only 30.4% have utilized this technique in their clinical practice by having general practitioners and specialists utilize this technique more often than consultants. Among the participants, 65.4% of them have agreed that adhesion by bonding to deep cervical dentin is predictable and related to the success of the final restoration. Conclusion: The knowledge level of DME among the study participants was adequate. The findings of this study revealed that the total number of dentists who utilize the technique in restoring large subgingival defects of posterior teeth with proximal caries is very minimal. Thus, it is recommended that dental practitioners have this technique introduced in their dental clinics as an alternative to surgical crown lengthening. Although years of experience and dentist rank may influence the clinical decision, in-depth factorial analysis with a greater sample size is necessary.
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Affiliation(s)
| | - Weam M Banjar
- Office of Assistant Deputy for Planning and Organization Excellence, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Mada I Alawad
- Dental Intern, Riyadh Elm University, Riyadh, Saudi Arabia
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