PhD Scientific Days 2026

Dental Research

Fracture under Load: Aesthetic Indirect Restorations with Deep Margin Elevation

Name of the presenter

Theocharous, Michalis

Institute/workplace of the presenter

Center for Translational Medicine, Semmelweis University

Authors

Michalis Theocharous¹, Enikő Szabó¹, Beáta Kerémi¹, Darius-Valentin Sandu¹, Raika Ansaripour¹
1: Center for Translational Medicine, Semmelweis University

Text of the abstract

Introduction: Subgingival cavities pose many clinical challenges in dental practice. Deep margin elevation (DME) has been proposed as a minimally invasive alternative to surgical crown lengthening and orthodontic extrusion for elevating the subgingival margins to a more coronal level, using composite or resin-modified glass ionomer cement. It is important to address the relocation of subgingival margins while ensuring the marginal integrity of the indirect restorations remains maximal.
Aims: This systematic review aims to evaluate the effect of DME on microleakage in teeth restored with aesthetic posterior indirect restorations under in vitro conditions, and to identify the factors that influence this outcome.
Method: In accordance with PRISMA guidelines, a systematic search was conducted in PubMed, Embase, and Cochrane. Studies were assessed for eligibility, and after data extraction, a random-effects analysis was performed to evaluate the impact of DME on microleakage. To test whether the material and level of DME, the height of the proximal box in relation to the cementoenamel junction(CEJ), DME on one or both proximal sides, the type of tooth, or whether the tooth was root canal treated or not influenced fracture resistance, stepwise multivariate regression analysis was done.
Results: Performing DME did not have an influence on fracture resistance of restored teeth (p=0.684, CI=-79.06;119.57); however heterogeneity was high (I2=96%) among the studies. With regression analysis we identified the factors which affect fracture resistance. Restricted stable models included DME made with glass ionomer cement (est=-0.16, p<0.0001, CI=-0.2125;-0.1088), 2 mm distance of proximal cavity from CEJ of (est=-0.53, p<0.0001, CI=-0.7739;-0.2896), partial coverage restoration made from resin material (est=-0.18, p=0.04, CI=-0.3478;-0.0095), partial coverage restoration made from ceramic material (est=-0.16, p=0.0018, CI=-0.2635;-0.0604). Significance level was set at p<0.05.
Conclusion: Making DME in subgingival cavities does not negatively influence fracture resistance of restored teeth against masticatory load. DME can be made from glass ionomer cement or resin with a height of even 2 mm and covered by partial coverage resin or ceramic restorations.
Funding: This research received no external funding.