Deep Margin Elevation (DME)

Categories: Prosthodontics;
Deep Margin Elevation (DME)

A lively Dentaltown thread kicked off by one dentist asking whether DME is anything more than “throwing a greater curve band on and filling the tooth.” Responses revealed how opinions vary with experience and philosophy.

Some voiced skepticism, calling DME a “crutch” or “MacGyver-esque” when used improperly. Isolation challenges, dual-leakage margins (tooth/composite and composite/crown), and potential caries under a crown were common concerns.

Yet experienced practitioners pushed back, noting that a small, well-isolated composite elevation far from occlusal stress can be highly predictable. Compared to surgical crown lengthening, DME can better preserve ferrule and tissue. They framed it as smart adaptation, not sloppy shortcuts.

Technique precision matters
One commenter likened dismissing DME to belittling Immediate Dentin Sealing: technically correct but misses nuance. Protocols highlighted include rubber dam, Teflon, specialized bands (like the Belknap band), wedges, and sectional rings. These tools allow precise, clean subgingival bonding.

Evidence and clinical support
Clinical success stories span 9 to 12 years, including a 95.9% survival rate in nearly 200 cases (Dietschi/Spreafico) and favorable periodontal outcomes (Magne/Spreafico; Sarfati and Tirlet). Posts from biomimetic dentists advocate using the right bonding agents (such as Clearfil Majesty Flow) and layering strategies, cautioned only for tech-savvy clinicians.

Clinical indications and case selection
DME is typically used when surgical crown lengthening isn’t ideal, especially near implants. Patient selection is critical: use small composite rises on one to two walls, ensure remaining ferrule, and inform patients about the risks. One dentist capped DME cases at under five percent of crowns, with the rest managed via traditional crown lengthening or laser troughing.

Biologic width and periodontal health
Opponents worry about biologic width violations, but recent histologic work shows that well-polished, sealed composites near the bone do not harm tissue if placed meticulously. Protocols emphasize judgment: perform DME only when you can isolate to at least the sulcus (Grade I per Veneziani classification). Otherwise, traditional surgical or laser exposure may be safer.

Professional and legal concerns
Discussion touched on whether using DME invites board scrutiny. Ultimately, when done appropriately and documented, DME isn’t ethically or legally unsound. Boards generally care more about informed consent, rationale, and record-keeping than technique labels.

Final takeaways
DME can be a conservative, viable alternative to crown lengthening, especially when: Isolation is perfect, you’re using trusted bonding systems and composites, you follow a careful protocol, and you select patients and cases judiciously. It’s not a one-size-fits-all shortcut. Done poorly, it’s a weak link. Done well, it can save structure, support tissue health, and avoid surgery. Conclusion DME isn’t just a buzzword. With careful technique, good materials, proper case selection, and clear consent, it stands as a minimally invasive, biomimetic option that complements, not replaces, traditional crown prep strategies. What truly matters is not the label but the quality of execution.


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