Deep margin elevation a challenge? Steps to success in restoring subgingival margins.

Adhesive restorative dentistry involves performing a series of clinical steps which follow one another in a repetitive and predictable way. This paper aims to address all stages of treatment, starting from isolation technique with the rubber dam system , choosing a matrix system that fit all the individual requirements in difficult clinical cases and different ways to adapt them to deep margins in teeth with important structure loss.We will debate the Deep Margin Elevation technique , a procedure that involves placing a material to raise the restorative margin to an equigingival or supragingival location.Today this concept can be used in synergy with IDS (Immediate Dentin Sealing) to improve the bond and marginal seal of indirect adhesive restorations.

New generation composites are much improved in terms of C-Factor , mechanical resistance and resistance to bacterial contamination , which makes them a valuable choice for a long term predictability , even when used to directly restore teeth with significant structural loss or teeth that need cuspal coverage. New fiber reinforced composites, developed to replace dentin, represent an ideal under layer for conventional composites that replace enamel. Glass fibers particles stop the propagation to the tooth structure of the crack lines , thought to be the most common reason for the failure of large restorations.

Key words : Rubber dam isolation, matrix system, Deep Margin Elevation, Immediate Dentin Sealing, Fibers reinforced composites, Direct restorations,Indirect restorations.