Deep Margin Elevation in Posterior composite Part I

Deep margin elevation in posterior teeth.

Article info.

Keywords:

-        Deep caries.

-        Deep margin elevation.

-        Split dam.

-        Soft tissue management.

 

Abstract

 

·       Deep margin elevation is a conservative (Minimally invasive) technique used in deep proximal caries to relocate sub-gingival margins more coronal (supra-gingival) using different materials to facilitate (isolation, Matrixing), enhance marginal integrity, improve bonding strength and restoration durability.  

·       It could be a less invasive alternative to more invasive techniques like Crown lengthening and surgical extrusion. Deep margin could be restored by either Direct or Indirect restorations. Depending on the ability of (Isolation of the margin) & (The remaining tooth structure).

·       In case there is a massive loss of the tooth structure and cannot be restored by direct restoration, the tooth should be restored by Indirect Restoration.

·       It may be very challenging to restore the tooth with indirect restoration because of the cavity preparation, impression taking, the adhesive-bonding procedure, and proper moisture control may be interfered. 

·       These challenges are usually overcome by crown lengthening procedure.

 

Case Scenario:

 

Ø  In this case scenario you will see a fully detailed steps of restoring a tooth with deep caries by (Direct restoration).

 

 

 Fig.1 & Fig.2

A middle age female patient presented to our clinic complaining from pain related to lower left area, after clinical and radiographic examination we found a very deep decay located distally and approximating the pulp in the lower left second premolar (LL5), immediately we made a decision to start removing of the caries and prepare the cavity for build up , So after  local anesthesia application, split dam was done as pre isolating method before the final isolation (for better visualization and soft tissue retraction). 

Fig.3

After complete removal of all the carious tissues and removal of the inflamed soft tissue using (Thermacut bur), the split dam was removed then soft tissue clamp (44) was placed to retract the soft tissue then the final dam isolation, followed by sealing of the margin using Teflon material. 

Fig.4

After sealing the margin completely with Teflon material, obturation with gutta percha was done and the cavity was treated with air abrasion.

 

 

Fig.5&Fig.6

After completion of the root canal obturation, matrix was selected using BIOCLEAR EVOLVE probe to make sure that it is perfectly seal the margin then placing of the matrix (Evolve matrix black, size 7) takes place and provide a well contoured proximal contact.

Hint: The matrix was stabilized with flowable composite to prevent its movement from the correct position.

Fig.7 & Fig.8

After seating the matrix very well, normal steps of the direct composite restoration were done (acid etch, dual bonding technique, flowable composite “without curing” and then using of a bulk fill composite to complete the composite overlay by injection molding technique).

 

Case done by Dr/ Abdelrahman Ahmed Tawfik.

Article by Dr/ Amira Mohamed 

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