Awareness and Practice of Deep Margin Elevation among Dental Practitioners in India: A Cross-Sectional Survey

Mythri Padaru; Preethesh Shetty; Namith Rai; Raksha Bhat

Authors

Mythri Padaru
Preethesh Shetty
Namith Rai
Raksha Bhat

Keywords:

Awareness, Dentistry, Education, Dental, Preventive Dentistry

Abstract

Objective: To evaluate knowledge, attitude and practice of deep margin elevation (DME) amongst dental practitioners in India, thereby increasing awareness. Material and Methods: A cross-sectional study was carried out among academicians, private practitioners, and post-graduate students, comprising 266 participants. Twenty-three close-ended web-based questionnaires were circulated through Google Forms. Data was analyzed using the Chi-square test, and descriptive analysis was performed using the Statistical Package for the Social Sciences software. Results: Although most respondents were aware of DME, only 27.4% claimed to have used this approach in daily practice. 60.4% reasoned out that DME was a technique-sensitive procedure. However, 50% of participants prefer to use DME as a substitute for surgical crown lengthening. There was a significant association between awareness regarding the term DME, knowledge of the procedure, and the study participants' cadre (p=0.024 and p=0.214, respectively). Conclusion: Knowledge, attitude, and practice of DME among dental practitioners in India are adequate. However, few dentists use this method to treat extensive subgingival decay in clinical practice. This can be attributed to the lack of literature on the subject and the perceived difficulties of the procedure. There is a need for more clinical research to understand the long-term prognosis of teeth restored using this technique and to encourage its usage in practice.

References

Splieth CH, Santamaria RM, Basner R, Schüler E, Schmoeckel J. 40-year longitudinal caries development in German Adolescents in the light of new caries measures. Caries Res 2019; 53(6):609-616. https://doi.org/10.1159/000501263

Pretty IA, Ekstrand KR. Detection and monitoring of early caries lesions: a review. Eur Arch Paediatr Dent 2016; 17(1):13-25. https://doi.org/10.1007/s40368-015-0208-6

Nasim I, Chaudhary M. Prevalence of proximal caries in the posterior teeth in patients visiting a dental college. J Complement Med Res 2020; 11(3):246-253. https://doi.org/10.5455/jcmr.2020.11.04.31

Veneziani M. Adhesive restorations in the posterior area with subgingival cervical margins: New classification and differentiated treatment approach. Eur J Esthet Dent 2010; 5(1):50-76.

Vertolli TJ, Martinsen BD, Hanson CM, Howard RS, Kooistra S, Ye L. Effect of deep margin elevation on CAD/CAM-fabricated ceramic inlays. Oper Dent 2020; 45(6):608-617. https://doi.org/10.2341/18-315-L

Eggmann F, Ayub JM, Conejo J, Blatz MB. Deep margin elevation - Present status and future directions. J Esthet Restor Dent 2023; 35(1):26-47. https://doi.org/10.1111/jerd.13008

Samartzi TK, Papalexopoulos D, Ntovas P, Rahiotis C, Blatz MB. Deep margin elevation: A literature review. Dent J 2022; 10(3):48. https://doi.org/10.3390/dj10030048

Lang NP, Lindhe J, editors. Clinical periodontology and implant dentistry. 2 Volume Set. 6th. ed. John Wiley & Sons; 2015.

Nugala B, Kumar BS, Sahitya S, Krishna PM. Biologic width and its importance in periodontal and restorative dentistry. J Conserv Dent 2012; 15(1):12-17. https://doi.org/10.4103/0972-0707.92599

Padbury A Jr, Eber R, Wang HL. Interactions between the gingiva and the margin of restorations. J Clin Periodontol 2003; 30(5):379-385. https://doi.org/10.1034/j.1600-051x.2003.01277.x

Planciunas L, Puriene A, Mackeviciene G. Surgical lengthening of the clinical tooth crown. Stomatologija 2006; 8(3):88-95.

Bach N, Baylard JF, Voyer R. Orthodontic extrusion: periodontal considerations and applications. J Can Dent Assoc 2004; 70(11):775-780.

Cordaro M, Staderini E, Torsello F, Grande NM, Turchi M, Cordaro M. Orthodontic extrusion vs. Surgical extrusion to rehabilitate severely damaged teeth: A literature review. Int J Environ Res Public Health 2021; 18(18):9530. https://doi.org/10.3390/ijerph18189530

Sarfati A, Tirlet G. Deep margin elevation versus crown lengthening: Biologic width revisited. Int J Esthet Dent 2018; 13(3):334-356.

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 2021; 14(21):6733. https://doi.org/10.3390/ma14216733

Ghezzi C, Brambilla G, Conti A, Dosoli R, Ceroni F, Ferrantino L. Cervical margin relocation: case series and new classification system. Int J Esthet Dent 2019; 14(3):272-284.

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(5):1931-1937. https://doi.org/10.4103/jfmpc.jfmpc_1707_20

Tyas MJ, Anusavice KJ, Frencken JE, Mount GJ. Minimal intervention dentistry--A review. FDI Commission Project 1-97. Int Dent J 2000; 50(1):1-12. https://doi.org/10.1111/j.1875-595x.2000.tb00540.x

Rayapudi J, Usha C. Knowledge, attitude and skills of dental practitioners of Puducherry on minimally invasive dentistry concepts: A questionnaire survey. J Conserv Dent 2018; 21(3):257-262. https://doi.org/10.4103/JCD.JCD_309_17

Alahmari NM, Adawi HA, Moaleem MMA, Alqahtani FM, Alshahrani FT, Aldhelai TA. Effects of the cervical marginal relocation technique on the marginal adaptation of lithium disilicate CAD/CAM ceramic crowns on premolars. J Contemp Dent Pract 2021; 22(8):900-906.

Bresser RA, van de Geer L, Gerdolle D, Schepke U, Cune MS, Gresnigt MMM. Influence of deep margin elevation and preparation design on the fracture strength of indirectly restored molars. J Mech Behav Biomed Mater 2020; 110:103950. https://doi.org/10.1016/j.jmbbm.2020.103950

Da Silva D, Ceballos L, Fuentes MV. Influence of the adhesive strategy in the sealing ability of resin composite inlays after deep margin elevation. J Clin Exp Dent 2021; 13(9):e886-e893. https://doi.org/10.4317/jced.58689

Frankenberger R, Hehn J, Hajtó J, Krämer N, Naumann M, Koch A, et al. Effect of proximal box elevation with resin composite on marginal quality of ceramic inlays in vitro. Clin Oral Investig 2013; 17(1):177-183. https://doi.org/10.1007/s00784-012-0677-5

Baldi A, Scattina A, Ferrero G, Comba A, Alovisi M, Pasqualini D, et al. Highly-filled flowable composite in deep margin elevation: FEA study obtained from a microCT real model. Dent Mater 2022; 38(4):e94-e107. https://doi.org/10.1016/j.dental.2021.10.005

Chen YC, Lin CL, Hou CH. Investigating inlay designs of class II cavity with deep margin elevation using finite element method. BMC Oral Health 2021; 21(1):264. https://doi.org/10.1186/s12903-021-01630-z

Grassi EDA, de Andrade GS, Tribst JPM, Machry RV, Valandro LF, Ramos NC, et al. Fatigue behavior and stress distribution of molars restored with MOD inlays with and without deep margin elevation. Clin Oral Investig 2022; 26(3):2513-2526. https://doi.org/10.1007/s00784-021-04219-6

Bertoldi C, Monari E, Cortellini P, Generali L, Lucchi A, Spinato S, et al. Clinical and histological reaction of periodontal tissues to subgingival resin composite restorations. Clin Oral Investig 2020; 24(2):1001-1011. https://doi.org/10.1007/s00784-019-02998-7

Bresser RA, Gerdolle D, van den Heijkant IA, Sluiter-Pouwels LMA, Cune MS, Gresnigt MMM. Up to 12 years clinical evaluation of 197 partial indirect restorations with deep margin elevation in the posterior region. J Dent 2019; 91:103227. https://doi.org/10.1016/j.jdent.2019.103227

Dietschi D, Spreafico R. Evidence-based concepts and procedures for bonded inlays and onlays. Part III. A case series with long-term clinical results and follow-up. Int J Esthet Dent 2019; 14(2):118-133.

Alhumaidan G, Alammar R, Al Asmari D, Alenezi A. Clinical performance of indirect restorations with cervical margin relocation in posterior teeth: A systematic review. Dentistry Review 2022; 2(1):100034. https://doi.org/10.1016/j.dentre.2022.100034

Miao C, Yang X, Wong MC, Zou J, Zhou X, Li C, et al. Rubber dam isolation for restorative treatment in dental patients. Cochrane Database Syst Rev 2021; 5(5):CD009858. https://doi.org/10.1002/14651858.CD009858.pub3

Ahmed SN, Donovan TE. Gingival displacement: Survey results of dentists' practice procedures. J Prosthet Dent 2015; 114(1):81-5.e1-2. https://doi.org/10.1016/j.prosdent.2014.11.015

Schuh PL, Wachtel H, Bolz W, Maischberger C, Schenk A, Kühn M. "Teflon tape technique": Synergy between isolation and lucidity. Quintessence Int 2019; 50(6):488-493. https://doi.org/10.3290/j.qi.a42483

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(2):e15. https://doi.org/10.5395/rde.2022.47.e15

Hahn B, Haubitz I, Krug R, Krastl G, Soliman S. Influence of matrix type on marginal gap formation of deep Class II bulk-fill composite restorations. Int J Environ Res Public Health 2022; 19(9):4961. https://doi.org/10.3390/ijerph19094961

Bailey O. Sectional matrix solutions: The distorted truth. Br Dent J 2021; 231(9):547-555. https://doi.org/10.1038/s41415-021-3608-5

Aldakheel M, Aldosary K, Alnafissah S, Alaamer R, Alqahtani A, Almuhtab N. Deep margin elevation: Current concepts and clinical considerations: A review. Medicina 2022; 58(10):1482. https://doi.org/10.3390/medicina58101482

Amesti-Garaizabal A, Agustín-Panadero R, Verdejo-Solá B, Fons-Font A, Fernández-Estevan L, Montiel-Company J, et al. Fracture resistance of partial indirect restorations made with CAD/CAM technology. A systematic review and meta-analysis. J Clin Med 2019; 8(11):1932. https://doi.org/10.3390/jcm8111932

Magne P. M-i-M for DME: Matrix-in-a-matrix technique for deep margin elevation. J Prosthet Dent 2021; 130(4):434-438. https://doi.org/10.1016/j.prosdent.2021.11.021

Dablanca-Blanco AB, Blanco-Carrión J, Martín-Biedma B, Varela-Patiño P, Bello-Castro A, Castelo-Baz P. Management of large class II lesions in molars: How to restore and when to perform surgical crown lengthening? Restor Dent Endod 2017; 42(3):240-252. https://doi.org/10.5395/rde.2017.42.3.240