Deep Margin Elevation: The “Superhero” Technique to Save Your Tooth

Have you ever been told that a cavity is “too deep” under the gumline and that you might need gum surgery or even an extraction? It sounds scary, especially if you are traveling or living abroad here in Quito. But don’t panic just yet. There is a modern, conservative solution that can often save the day: Deep margin elevation (DME)

This technique AKA cervical margin repositioning, cervical margin relocation or proximal box elevation, is a game-changer in restorative dentistry. Instead of cutting away your gums or bone, we use advanced bonding materials to raise the level of the cavity to a point where it is easy to fix. It is specific to cases where the damage goes below the gum line.

In this article, we will explain exactly what DME is, why it is critical for saving natural teeth, and how we perform it here at Asiri. If you are looking for an honest, minimally invasive option, this guide is for you.

Key Points

• Saves Natural Structure: DME allows us to restore a tooth that might otherwise require aggressive gum surgery or extraction.
• Minimally Invasive: It is a non-surgical approach that focuses on raising the “margin” of the cavity using special bonding techniques.
• Better Bond Quality: By moving the workspace above the gum, we ensure your final crown or inlay bonds perfectly and lasts longer.

What is Deep Margin Elevation?

Deep Margin Elevation (DME) is a procedure used when a cavity or tooth fracture extends deep below the gum tissue (subgingival). In the past, dentists could not properly clean or glue a restoration in that wet, deep area.

With DME, we place a specialized band around the tooth and use a biocompatible resin composite to build the floor of the cavity up. Effectively, we “elevate” the deep edge until it sits above the gum line (supragingival).

Once the margin is elevated, the rest of the restoration (like a filling, inlay, onlay, or crown) becomes a standard, predictable procedure. It turns a “complex, risky” tooth into a “treatable” one without the need for scalpels or sutures.

Why is it Important?

For a dental restoration to last, it must be bonded to dry, clean tooth structure. If a cavity is deep under the gum, it is impossible to keep it dry because of saliva and gum fluid. If we try to glue a crown there, it will likely fail, leak, or cause infection.

DME solves this isolation problem. By raising the margin, we protect your gum health and ensure the final ceramic piece fits perfectly. For our patients who value “Dental Peace,” this avoids the trauma and long healing times of gum surgery.

According to studies, the DME technique seems to be a minimally invasive alternative to Surgical Crown Lengthening (SCL) and Orthoidontic Extrusion(OE) with respect to biological width in terms of time, cost, and patient comfort. ¹

The Procedure

• Pain-Free Anesthesia: We start by ensuring you are completely numb because, at Asiri, “pain is not an option”.
• Deep Isolation: We place a rubber dam and a special metal matrix band that slides deep between the tooth and gum to seal off fluids.
• Immediate Sealing: We apply a bonding agent to seal the dentin immediately, protecting the nerve and reducing sensitivity.
• Elevation Layering: We carefully place layers of composite material to build the tooth structure up to the gum level.
• Final Preparation: Once elevated, we refine the shape so it is ready for your final crown or inlay scan.

Benefits of Deep Margin Elevation

1. Non-Surgical: Avoids the pain and recovery time of surgical crown lengthening (cutting bone and gum).
2. Cost-Effective: Usually more affordable than surgery plus an implant.
3. Tooth Preservation: Keeps your natural root system intact, which is always better than an artificial implant.
4. Efficiency: Can often be done in a single visit before the final mold, respecting your time as a traveler or busy professional.

Risks and Potential Complications

• Gum Irritation: Temporary inflammation may occur immediately after the procedure but heals quickly with good hygiene.
• Technical Sensitivity: It requires a skilled dentist; if the isolation isn’t perfect, the bond can fail.
• Not for Every Tooth: If the cavity is too deep (violating the bone level), surgery might still be the only option.

Alternatives to Deep Margin Elevation

• Surgical Crown Lengthening (SCL): A minor surgery where bone and gum are removed to expose the tooth.
• Orthodontic Extrusion OE: Using braces to slowly pull the tooth up out of the gum (takes months).
• Extraction: Removing the tooth entirely and replacing it with an implant or bridge.

Frequently Asked Questions

• Is the procedure painful? No. We use local anesthesia, so you won’t feel a thing. You might feel slight pressure when we place the matrix band.
• How long does it take? The elevation itself usually takes about 30 to 45 minutes, depending on the difficulty.
• Can I eat right after? Yes, once the numbness wears off. The material is hardened instantly with a special light.
• Will it look natural? Absolutely. The material is tooth-colored and will be hidden under your final restoration.
• I am only in Quito for a week. Can I get this done? Yes. DME is perfect for dental tourism because it speeds up the process compared to waiting for gums to heal after surgery.

Key Terms

• Subgingival: Located below the gum line; an area that is difficult to clean and keep dry.
• Supragingival: Located above the gum line; the ideal position for dental margins to ensure easy cleaning.
• Resin Composite: A tooth-colored mixture of plastic and glass used to restore decayed teeth.
• Rubber Dam: A protective sheet used to isolate the tooth, keeping it dry and safe from bacteria during treatment.
• Matrix Band: A thin metal strip placed around the tooth to give shape and support to the filling material.

Conclusion

Deep Margin Elevation is a testament to how far dentistry has come. It allows us to save teeth that were once considered “hopeless” with a conservative, gentle approach. At Centro Odontológico Asiri, our goal is always your long-term health and your peace of mind.

We are honest and responsible; we will recommend DME only if it is truly the best option for you. If you have been told you need gum surgery, come see us for a second opinion.

Would you like us to evaluate if your tooth can be saved with this technique? Book your appointment online today.

References

1. Aldakheel M, Aldosary K, Alnafissah S, Alaamer R, Alqahtani A, Almuhtab N. Deep Margin Elevation: Current Concepts and Clinical Considerations: A Review. Medicina (Kaunas). 2022 Oct 18;58(10):1482. doi: 10.3390/medicina58101482. PMID: 36295642; PMCID: PMC9610387. ↩︎

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