As part of this process the clinician can carry out DME and place the definitive pre-endodontic composite restoration. This includes removing any existing restorations and caries, and checking that a well-sealed restoration can be placed. It is important to assess if a tooth is restorable prior to carrying out endodontic treatment. **Crowns and photography by Dr Vishal Patel When should we carry out DME for teeth requiring endodontic treatment? DME using the definitive zirconia crowns. The teeth were root treated and restored using a fibre post and composite core. A restorability assessment was carried out – a modified matrix band was used to achieve a good seal for the pre-endodontic restoration. Wedges, teflon tape, and light cured rubber dam materials (such as Opaldam) are also useful to help achieve a good seal.įigure 3: Extensively carious UL5 and UL6. Regular matrix bands can also be adapted on one side to help the band sit deeper. Special matrix systems have been developed for this purpose. The main challenge for DME is adapting the matrix band to the base of the restoration (Figure 3). DME should only be used if a good seal can be achieved. Moisture control is required for a shorter period of time and a matrix system helps achieve this. It is easier to place a direct restoration subgingivally. **Onlay restorative work by Dr Sanna Ajaz** Why is it easier to use a direct technique to elevate the margin? The one-year review radiograph shows the lesion is healing and the margins are sound. The preparation extended to sound tooth tissue in all areas except distally, where it would have been difficult to take an accurate impression. The distal margin was subgingival and the onlay margin was left on the composite restoration (DME). A gold onlay was cemented with Fuji Plus cement. The patient was referred back to her restorative dentist (Dr Sanna Ajaz) for a cuspal coverage restoration. Figure 2: Root canal treatment and composite core LL6. However, accurate subgingival impression taking still poses a challenge (Figure 2). These are less technique sensitive, do not require strict isolation and can be removed after the cement has hardened. The patient was referred back to her restorative dentist (Dr Vishal Patel) for a cuspal coverage restoration c) Onlay preparation distal margin left on the composite core d) Rubber dam isolation prior to cementation e) Teflon tape used to isolate the adjacent teeth f) Onlay cemented using a resin cement g) Excess cement cleared, cured and margins cleaned with a scalpel h) Finished result **Onlay and photography by Dr Vishal Patel is less important when using traditional cements (zinc phosphate or GIC) for non-bonded indirect restorations. Relocating the margin more coronally can help eliminate many of these problems.ĭME allows placement of a rubber dam during the cementation procedure, which can offer more predictable long term results (Figure 1).įigure 1: Root canal retreatment and E.max onlay LR6 a) Preoperative radiograph b) Root canal retreatment and composite core placed. This can compromise the seal and risk leakage of the restoration long term. Excess resin cement also needs removing prior to curing, which takes time and has a risk of bleeding when carried out subgingivally. However, they require excellent moisture control during the adhesive cementation procedure. Indirect bonded restorations are often chosen because they are aesthetic and conservative to preserve more tooth tissue. Why do we use DME?ĭeep subgingival margins are particularly difficult to manage with indirect restorations. What is deep margin elevation (DME)?Ī direct restoration is used to raise the cavity margin to an equigingival or supragingival location. It gained significant popularity following the paper ‘ Deep margin elevation: a paradigm shift’ by Pascal Magne and Roberto Spreafico in 2012. The concept of deep margin elevation was first presented by Dietschi and Spreafico in 1998. We regularly encounter this situation when restoring endodontically-treated teeth. Subgingival margins are a common clinical challenge. In this month’s instalment of the endo expert, Kreena Patel discusses a case using deep margin elevation (DME). The endo expert – saving compromised teeth part one: endodontics and deep margin elevation
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