Non-Cochrane · intervention · PM42466197
Polymer-based restorative outcomes following deep margin elevation: a systematic review and meta-analysis.
Bourgi Rim, Cuevas-Suárez Carlos Enrique, Farouk Ahmed Tarek, et al. · Frontiers in dental medicine · 2026 · PubMed · doi:10.3389/fdmed.2026.1854285
Findings
Population Patients receiving indirect restorations in permanent posterior teeth with deep proximal margins
8 findings
| Deep margin elevation (adhesive resin-based material) followed by indirect restoration | Indirect restoration with supragingival (non-elevated) margin | Fracture or debonding of restoration > 6 months | RD 0.02 [-0.01, 0.06] GRADE not reported 3 studies · 338 participants |
| Deep margin elevation (adhesive resin-based material) followed by indirect restoration | Indirect restoration with supragingival (non-elevated) margin | Gingival inflammation and bleeding | RD 0.12 [0.06, 0.18] Moderate Downgraded: risk of bias, imprecision 6 studies · 684 participants |
| Deep margin elevation (adhesive resin-based material) followed by indirect restoration | Indirect restoration with supragingival (non-elevated) margin | Fracture or debonding of restoration All follow-up | RD 0.02 [-0.01, 0.05] Moderate Downgraded: risk of bias, imprecision 3 studies · 438 participants |
| Deep margin elevation (adhesive resin-based material) followed by indirect restoration | Indirect restoration with supragingival (non-elevated) margin | Secondary caries All follow-up | RD 0.00 [-0.03, 0.02] Low Downgraded: risk of bias, imprecision 4 studies · 476 participants |
| Deep margin elevation (adhesive resin-based material) followed by indirect restoration | Indirect restoration with supragingival (non-elevated) margin | Gingival inflammation and bleeding > 6 months | RD 0.17 [0.10, 0.25] GRADE not reported 6 studies · 487 participants |
| Deep margin elevation (adhesive resin-based material) followed by indirect restoration | Indirect restoration with supragingival (non-elevated) margin | Secondary caries > 6 months | RD -0.01 [-0.03, 0.02] GRADE not reported 4 studies · 357 participants |
| Deep margin elevation (adhesive resin-based material) followed by indirect restoration | Indirect restoration with supragingival (non-elevated) margin | Secondary caries < 6 months | RD 0.00 [-0.05, 0.05] GRADE not reported 2 studies · 119 participants |
| Deep margin elevation (adhesive resin-based material) followed by indirect restoration | Indirect restoration with supragingival (non-elevated) margin | Gingival inflammation and bleeding < 6 months | RD 0.00 [-0.09, 0.09] GRADE not reported 3 studies · 197 participants |
Included primary studies 10
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Adson 2026 Clinical evaluation of deep margin elevation in CAD/CAM indirect restorations: A 24-month follow-up study. PMID:41643925 | 2026 | this review only | not stated | not extracted yet |
| Aksaka 2025 Periodontal status of indirect resin composite restorations with proximal box elevation: 3-year clinical results. PMID:41317197 | 2025 | this review only | not stated | not extracted yet |
| Bresser 2019 Up to 12 years clinical evaluation of 197 partial indirect restorations with deep margin elevation in the posterior region. PMID:31697971 | 2019 | this review only | not stated | not extracted yet |
| El-Ma'aita 2024 Deep Margin Elevation - A Retrospective Clinical Study. PMID:38602235 | 2024 | this review only | not stated | not extracted yet |
| Farouk 2023 Biological evaluation of indirect restorations in endodontically treated posterior teeth with deeply located proximal margins following… PMID:38147139 | 2023 | this review only | not stated | not extracted yet |
| Ferrari 2018 Influence of cervical margin relocation (CMR) on periodontal health: 12-month results of a controlled trial. PMID:29061380 | 2018 | this review only | not stated | not extracted yet |
| Gozetici-Cil 2024 Clinical Performance of Posterior Indirect Resin Composite Restorations with the Proximal Box Elevation Technique: A Prospective Clinical… PMID:38276889 | 2024 | this review only | not stated | not extracted yet |
| Hausdorfer 2024 Periodontal health in teeth treated with deep-margin-elevation and CAD/CAM partial lithium disilicate restorations-a prospective… PMID:39613879 | 2024 | this review only | not stated | not extracted yet |
| Hausdorfer 2025 Two-year evaluation of periodontal parameters following deep-margin-elevation and CAD/CAM partial lithium disilicate restorations - a… PMID:40532278 | 2025 | this review only | not stated | not extracted yet |
| Roshdy 2026 Effect of deep margin elevation with different injectable materials on performance of CAD/CAM-Fabricated nanoceramic-resin onlays: 3-year… PMID:41498943 | 2026 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients receiving indirect restorations in permanent teeth | 10 clinical studies, about 623 teeth, posterior teeth with deep proximal subgingival margins |
| Intervention | Deep margin elevation with adhesive materials (conventional, flowable, bulk-fill composites, RMGIC) followed by an indirect restoration | DME with flowable, bulk-fill, injectable composites or RMGIC before lithium disilicate, ceramic or resin composite partial indirect restorations (n=10) |
| Comparison | Indirect restorations placed supragingival | Supragingival or equigingival margins, conventional subgingival margins, surgical crown lengthening, natural proximal surfaces |
| Outcomes | Restoration survival and marginal adaptation (primary); secondary caries, postoperative sensitivity, periodontal parameters (probing depth, BoP, attachment level), biological or technical complications | Fracture/debonding (3 studies pooled), secondary caries (4 pooled), gingival inflammation/bleeding (6 pooled); survival, marginal adaptation and sensitivity narrative |
| Study designs | RCTs, controlled clinical trials, prospective or retrospective cohort studies | 2 RCTs, 8 non-randomized prospective/retrospective studies (n=10) |
| Timing | Minimum follow-up 6 months | 6 months to 12 years |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Partial Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: No · NRSI: No | NRSI: No · RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |