GINGIVAL MARGIN ELEVATION AND INDIRECT RESTORATION IN MILLED COMPOSITE RESIN IN TOOTH WITH SUBGINGIVAL MARGIN: CASE REPORT
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Published:
Oct 29, 2024
Keywords:
Composite resin, CAD-CAM, dental marginal adaptation, onlay dental, biomimetic
Main Article Content
Abstract
Currently, dentistry tends to be more conservative, preserving dental tissue. The use of direct restorations and indirect partial restorations in composite resin, associated with biomimetic protocols, are examples of minimally invasive procedures. Teeth with extensive cavities and subgingival marginal endings are challenges for clinical practice, and in the search for more conservative protocols, gingival margin elevation (GME) may be indicated. This work aims to demonstrate, through a clinical case, the importance of GME associated with the milled indirect restoration in composite resin, using the CAD-CAM system, in a tooth with a margin located beyond the cement-enamel junction (CEJ). The present case report described the restorative treatment of the upper left second premolar, which initially presented extensive caries under a composite resin restoration on the occlusal and mesial surfaces; and, after its removal, had the cervical margin of the mesial surface allocated subgingivally. The treatment option was composite resin GME, followed by endodontic treatment, sealing of the canal entrances, composite resin core build-up, and final restoration type onlay, also in composite resin, produced through the digitally assisted design and manufacturing system (CAD-CAM). The proposed treatment demonstrated that GME allows for the perfect adaptation of the restoration directly to the tooth, eliminating the need for clinical crown lengthening (CCL). Thus, an effective, quick treatment with lower comorbidity and reduced financial cost to the patient was achieved. After four months, the clinical and radiographic evaluation of the restoration showed good marginal adaptation, pleasant aesthetics, good polishing, and gingival health, with no signs of inflammation.
Article Details
How to Cite
Griebeler Carvalho Drebel, D. T., & Pizzini Montenegro, S. (2024). GINGIVAL MARGIN ELEVATION AND INDIRECT RESTORATION IN MILLED COMPOSITE RESIN IN TOOTH WITH SUBGINGIVAL MARGIN: CASE REPORT. Naval Dental Jounal, 51(2), 33-42. https://doi.org/10.69909/1983-7550-dme-4
Section
Case Reports
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
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22. Ferraris F. Posterior indirect adhesive restorations (PIAR): preparation designs and adhesthetics clinical protocol. Int J Esthet Dent. 2017;12(4):482–502.
23. 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.
24. Ghezzi C, Brambilla G, Conti A, Dosoli R, Ceroni F, Ferrantino L. Cervical margin relocation: case series and new classification system.
25. Fichera G, Mazzitelli C, Picciariello V, Maravic T, Josic U, Mazzoni A, et al. Structurally compromised teeth. Part II: A novel approach to peripheral build up procedures. Journal of Esthetic and Restorative Dentistry. 2024;36(1):20–31.
26. Milicich G, Rainey JT. Clinical presentations of stress distribution in teeth and the significance in operative dentistry. Pract Periodontics Aesthet Dent. setembro de 2000;12(7):695–700; quiz 702.
27. Urabe I, Nakajima S, Sano H, Tagami J. Physical properties of the dentin-enamel junction region. Am J Dent. junho de 2000;13(3):129–35.
28. Milicich G. The compression dome concept: the restorative implications. Gen Dent. 2017;65(5):55–60.
29. Macêdo B, Sousa V, Verde G, Martins I, Lima L. Influência de substâncias irrigadoras endodônticas na microdureza da dentina radicular - revisão integrativa. OCC. 2021;20(2). Disponível em: https://www.cro-pe.org.br/site/adm_syscomm/publicacao/foto/9eab4908c2ee625e1311b7a941b65edc.pdf
30. Saber SEDM, El-Askary FS. The Outcome of Immediate or Delayed Application of a Single-Step Self-Etch Adhesive to Coronal Dentin Following the Application of Different Endodontic Irrigants. Eur J Dent. abril de 2009;3(2):83–9.
31. Moghaddas MJ, Moosavi H, Ghavamnasiri M. Microleakage Evaluation of Adhesive Systems Following Pulp Chamber Irrigation with Sodium Hypochlorite. J Dent Res Dent Clin Dent Prospects. 2014;8(1):21–6.
32. Haralur SB, Alqahtani MM, Alqahtani RA, Shabab RM, Hummadi KA. Effect of Dentin-Disinfection Chemicals on Shear Bond Strength and Microhardness of Resin-Infiltrated Human Dentin in Different Adhesive Protocols. Medicina. setembro de 2022;58(9):1244.
33. 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 Oct;110:103950. doi: 10.1016/j.jmbbm.2020.103950. Epub 2020 Jul 6. PMID: 32957242.
34. Ozer F, Batu Eken Z, Hao J, Tuloglu N, Blatz MB. Effect of Immediate Dentin Sealing on the Bonding Performance of Indirect Restorations: A Systematic Review. Biomimetics (Basel). 17 de março de 2024;9(3):182.
35. Spreafico R, Marchesi G, Turco G, Frassetto A, Di Lenarda R, Mazzoni A, et al. Evaluation of the In Vitro Effects of Cervical Marginal Relocation Using Composite Resins on the Marginal Quality of CAD/CAM Crowns. J Adhes Dent. 2016;18(4):355–62.
36. Souza J, Fuentes MV, Baena E, Ceballos L. One-year clinical performance of lithium disilicate versus resin composite CAD/CAM onlays. Odontology. 1o de janeiro de 2021;109(1):259–70.
37. Elmoselhy HAS, Hassanien OES, Haridy MF, Salam El Baz MAE, Saber S. Two‑year clinical performance of indirect restorations fabricated from CAD/CAM nano hybrid composite versus lithium disilicate in mutilated vital teeth. A randomized controlled trial. BMC Oral Health. 17 de janeiro de 2024;24(1):101.
2. Suksawat N, Angwaravong O, Angwarawong T. Fracture resistance and fracture modes in endodontically treated maxillary premolars restored using different CAD-CAM onlays. J Prosthodont Res. 8 de abril de 2024;68(2):290–8.
3. Langoni A; Almeida G, Mota I, Dietrich L, Nascimento F, Viana H. Deep Margin Elevation: a restorative possibility to be considered. Research, Society and Development, [S. l.], v. 9, n. 11, p. e3799119863, 2020.
4. 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, 1482. https://doi.org/10.3390/medicina58101482.
5. Mugri, M.H.; Sayed, M.E.; Nedumgottil, B.M.; Bhandi, S.; Raj,A.T.; Testarelli, L.; Khurshid, Z.; Jain, S.; Patil, S. Treatment Prognosis of Restored Teeth with Crown Lengthening vs. Deep Margin Elevation: A Systematic Review. Materials 2021, 14, 6733. https:// doi.org/10.3390/ma14216733.
6. Samartzi, T.K.; Papalexopoulos, D.; Ntovas, P.; Rahiotis, C.; Blatz, M.B. Deep Margin Elevation: A Literature Review. Dent. J. 2022, 10, 48. https://doi.org/10.3390/dj10030048.
7. Felemban MF, Khattak O, Alsharari T, Alzahrani AH, Ganji KK, Iqbal A. Relationship between Deep Marginal Elevation and Periodontal Parameters: A Systematic Review. Medicina (Kaunas). 3 de novembro de 2023;59(11):1948.
8. El-Ma’aita AM, Radwan H, Al-Rabab’ah MA. Deep Margin Elevation - A Retrospective Clinical Study. J Adhes Dent. 15 de janeiro de 2024;26(1):117–24.
9. Dietschi D, Spreafico R. Current clinical concepts for adhesive cementation of tooth-colored posterior restorations. Pract Periodontics Aesthet Dent. 1998 Jan-Feb;10(1):47-54; quiz 56. PMID: 9582662.
10. Muscholl C, Zamorska N, Schoilew K, Sekundo C, Meller C, Büsch C, et al. Retrospective Clinical Evaluation of Subgingival Composite Resin Restorations with Deep-Margin Elevation. J Adhes Dent. 19 de agosto de 2022;24(1):335–44.
11. 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. dezembro de 2019;91:103227.
12. Sarfati A, Tirlet G. Deep margin elevation versus crown lengthening: biologic width revisited. Int J Esthet Dent. 2018;13(3):334–56.
13. Forster A, Braunitzer G, Tóth M, Szabó BP, Fráter M. In Vitro Fracture Resistance of Adhesively Restored Molar Teeth with Different MOD Cavity Dimensions. J Prosthodont. janeiro de 2019;28(1):e325–31.
14. 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 Mar 4;47(2):e15. doi: 10.5395/rde.2022.47.e15. PMID: 35692223; PMCID: PMC9160765.
15. Sinjari B, Santilli M, D’Addazio G, Rexhepi I, Gigante A, Caputi S, et al. Influence of Dentine Pre-Treatment by Sandblasting with Aluminum Oxide in Adhesive Restorations. An In Vitro Study. Materials (Basel). 7 de julho de 2020;13(13):3026.
16. Magne P. Immediate dentin sealing: a fundamental procedure for indirect bonded restorations. J Esthet Restor Dent. 2005;17(3):144–54; discussion 155.
17. Magne P, Kim TH, Cascione D, Donovan TE. Immediate dentin sealing improves bond strength of indirect restorations. Journal of Prosthetic Dentistry. 1o de dezembro de 2005;94(6):511–9.
18. de Carvalho MA, Lazari-Carvalho PC, Polonial IF, de Souza JB, Magne P. Significance of immediate dentin sealing and flowable resin coating reinforcement for unfilled/lightly filled adhesive systems. Journal of Esthetic and Restorative Dentistry. 2021;33(1):88–98.
19. Magne P, So WS, Cascione D. Immediate dentin sealing supports delayed restoration placement. J Prosthet Dent. setembro de 2007;98(3):166–74.
20. Murata T, Maseki T, Nara Y. Effect of immediate dentin sealing applications on bonding of CAD/CAM ceramic onlay restoration. Dent Mater J. 30 de novembro de 2018;37(6):928–39.
21. Bresser RA, Carvalho MA, Naves LZ, Melma H, Cune MS, Gresnigt MMM. Biomechanical behavior of molars restored with direct and indirect restorations in combination with deep margin elevation. J Mech Behav Biomed Mater. 2024 Apr;152:106459. doi: 10.1016/j.jmbbm.2024.106459. Epub 2024 Feb 12. PMID: 38394767.
22. Ferraris F. Posterior indirect adhesive restorations (PIAR): preparation designs and adhesthetics clinical protocol. Int J Esthet Dent. 2017;12(4):482–502.
23. 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.
24. Ghezzi C, Brambilla G, Conti A, Dosoli R, Ceroni F, Ferrantino L. Cervical margin relocation: case series and new classification system.
25. Fichera G, Mazzitelli C, Picciariello V, Maravic T, Josic U, Mazzoni A, et al. Structurally compromised teeth. Part II: A novel approach to peripheral build up procedures. Journal of Esthetic and Restorative Dentistry. 2024;36(1):20–31.
26. Milicich G, Rainey JT. Clinical presentations of stress distribution in teeth and the significance in operative dentistry. Pract Periodontics Aesthet Dent. setembro de 2000;12(7):695–700; quiz 702.
27. Urabe I, Nakajima S, Sano H, Tagami J. Physical properties of the dentin-enamel junction region. Am J Dent. junho de 2000;13(3):129–35.
28. Milicich G. The compression dome concept: the restorative implications. Gen Dent. 2017;65(5):55–60.
29. Macêdo B, Sousa V, Verde G, Martins I, Lima L. Influência de substâncias irrigadoras endodônticas na microdureza da dentina radicular - revisão integrativa. OCC. 2021;20(2). Disponível em: https://www.cro-pe.org.br/site/adm_syscomm/publicacao/foto/9eab4908c2ee625e1311b7a941b65edc.pdf
30. Saber SEDM, El-Askary FS. The Outcome of Immediate or Delayed Application of a Single-Step Self-Etch Adhesive to Coronal Dentin Following the Application of Different Endodontic Irrigants. Eur J Dent. abril de 2009;3(2):83–9.
31. Moghaddas MJ, Moosavi H, Ghavamnasiri M. Microleakage Evaluation of Adhesive Systems Following Pulp Chamber Irrigation with Sodium Hypochlorite. J Dent Res Dent Clin Dent Prospects. 2014;8(1):21–6.
32. Haralur SB, Alqahtani MM, Alqahtani RA, Shabab RM, Hummadi KA. Effect of Dentin-Disinfection Chemicals on Shear Bond Strength and Microhardness of Resin-Infiltrated Human Dentin in Different Adhesive Protocols. Medicina. setembro de 2022;58(9):1244.
33. 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 Oct;110:103950. doi: 10.1016/j.jmbbm.2020.103950. Epub 2020 Jul 6. PMID: 32957242.
34. Ozer F, Batu Eken Z, Hao J, Tuloglu N, Blatz MB. Effect of Immediate Dentin Sealing on the Bonding Performance of Indirect Restorations: A Systematic Review. Biomimetics (Basel). 17 de março de 2024;9(3):182.
35. Spreafico R, Marchesi G, Turco G, Frassetto A, Di Lenarda R, Mazzoni A, et al. Evaluation of the In Vitro Effects of Cervical Marginal Relocation Using Composite Resins on the Marginal Quality of CAD/CAM Crowns. J Adhes Dent. 2016;18(4):355–62.
36. Souza J, Fuentes MV, Baena E, Ceballos L. One-year clinical performance of lithium disilicate versus resin composite CAD/CAM onlays. Odontology. 1o de janeiro de 2021;109(1):259–70.
37. Elmoselhy HAS, Hassanien OES, Haridy MF, Salam El Baz MAE, Saber S. Two‑year clinical performance of indirect restorations fabricated from CAD/CAM nano hybrid composite versus lithium disilicate in mutilated vital teeth. A randomized controlled trial. BMC Oral Health. 17 de janeiro de 2024;24(1):101.