龈壁提升术操作流程与效果评价的研究进展

doi:10.13591/j.cnki.kqyx.2025.07.012

摘要/Abstract

摘要：

大范围深龋和龈下深边缘是口腔临床中的常见情形,随着材料学和粘接技术的发展,以及微创牙科学理念的普及,龈壁提升术由于其微创及修复周期短等特点逐渐进入医生视野中。尽管龈壁提升术有诸多优点,因其技术敏感性较高而未得以广泛应用。目前关于龈壁提升术研究主要集中于体外试验,缺乏高质量的临床随机对照研究,且尚无规范统一的操作流程可供参考。本文将从龈壁提升术的概念、操作流程和效果评价等方面作一综述。

关键词: 龈壁提升, 牙体缺损, 粘接修复

Abstract:

Deep proximal lesions with significant defects and subgingival margins exceeding cementoenamel junction are common clinical scenarios. With the development of materials and bonding dentistry, along with the popularization of the concept of minimally invasive dentistry, deep margin elevation is becoming an option for its minimal invasion and less time-consuming. Even though deep margin elevation seems a valuable technique, clinicians have not extensively applied it limited to its technical sensitivity. Current research is mainly in vitro and lacks high-quality clinical randomized controlled trails, or even standardized clinical process. This review summarizes the concept, procedure and clinical performance of deep margin elevation.

Key words: deep margin elevation, tooth defect, adhesive restoration

中图分类号:

R783.3

王鲁涛, 夏昕雨, 范佳燕, 王梁. 龈壁提升术操作流程与效果评价的研究进展[J]. 口腔医学, 2025, 45(7): 550-555.

WANG Lutao, XIA Xinyu, FAN Jiayan, WANG Liang. Advances in procedure and clinical performance of deep margin elevation[J]. Stomatology, 2025, 45(7): 550-555.

参考文献 72

[1]	Dietschi D, Spreafico R. Current clinical concepts for adhesive cementation of tooth-colored posterior restorations[J]. Pract Periodontics Aesthet Dent, 1998, 10(1): 47-54;quiz56. pmid: 9582662
[2]	Veneziani M. Adhesive restorations in the posterior area with subgingival cervical margins: New classification and differentiated treatment approach[J]. Eur J Esthet Dent, 2010, 5(1): 50-76. pmid: 20305873
[3]	Nugala B, Kumar BS, Sahitya S, et al. Biologic width and its importance in periodontal and restorative dentistry[J]. J Conserv Dent, 2012, 15(1): 12-17.
[4]	张婧秋, 何舒奇. 龈壁提升术对牙周组织影响的研究进展[J]. 口腔医学研究, 2023, 39(4): 295-299. doi: 10.13701/j.cnki.kqyxyj.2023.04.002
[5]	Alovisi M, Tempesta RM, Comba A, et al. Combined endo-restorative treatment of a traumatized central incisor: A five-year follow-up[J]. J Adhes Dent, 2020, 22(3): 249-254. doi: 10.3290/j.jad.a44548 pmid: 32435765
[6]	Samartzi TK, Papalexopoulos D, Ntovas P, et al. Deep margin elevation: A literature review[J]. Dent J, 2022, 10(3): 48.
[7]	Grubbs TD, Vargas M, Kolker J, et al. Efficacy of direct restorative materials in proximal box elevation on the margin quality and fracture resistance of molars restored with CAD/CAM onlays[J]. Oper Dent, 2020, 45(1): 52-61. doi: 10.2341/18-098-L pmid: 31084532
[8]	Eggmann F, Ayub JM, Conejo J, et al. Deep margin elevation-Present status and future directions[J]. J Esthet Restor Dent, 2023, 35(1): 26-47. doi: 10.1111/jerd.13008 pmid: 36602272
[9]	Farouk AT, Hassanein OES, Fahmy OI, et al. Biological evaluation of indirect restorations in endodontically treated posterior teeth with deeply located proximal margins following deep margin elevation versus surgical crown lengthening: A randomized controlled trial[J]. Clin Oral Investig, 2023, 28(1): 24.
[10]	Mugri MH, Sayed ME, Nedumgottil BM, et al. Treatment prognosis of restored teeth with crown lengthening vs. deep margin elevation: A systematic review[J]. Materials, 2021, 14(21): 6733.
[11]	Aldakheel M, Aldosary K, Alnafissah S, et al. Deep margin elevation: Current concepts and clinical considerations: A review[J]. Medicina, 2022, 58(10): 1482.
[12]	Juloski J, Köken S, Ferrari M. Cervical margin relocation in indirect adhesive restorations: A literature review[J]. J Prosthodont Res, 2018, 62(3): 273-280. doi: S1883-1958(17)30110-X pmid: 29153552
[13]	Samartzi TK, Papalexopoulos D, Sarafianou A, et al. Immediate dentin sealing: A literature review[J]. Clin Cosmet Investig Dent, 2021, 13: 233-256.
[14]	Roggendorf MJ, Krämer N, Dippold C, et al. Effect of proximal box elevation with resin composite on marginal quality of resin composite inlays in vitro[J]. J Dent, 2012, 40(12): 1068-1073. doi: 10.1016/j.jdent.2012.08.019 pmid: 22960537
[15]	Ilgenstein I, Zitzmann NU, Bühler J, et al. Influence of proximal box elevation on the marginal quality and fracture behavior of root-filled molars restored with CAD/CAM ceramic or composite onlays[J]. Clin Oral Investig, 2015, 19(5): 1021-1028.
[16]	Magne P, Spreafico RC. Deep margin elevation:A paradigm shift[J]. Amer J Esthet Dent, 2012, 2: 86-96.
[17]	Cavalcanti AN, Mitsui FH, Lima AF, et al. Evaluation of dentin hardness and bond strength at different walls of class Ⅱ preparations[J]. J Adhes Dent, 2010, 12(3): 183-188. doi: 10.3290/j.jad.a17524 pmid: 20157677
[18]	De Munck J, van Landuyt K, Peumans M, et al. A critical review of the durability of adhesion to tooth tissue: Methods and results[J]. J Dent Res, 2005, 84(2): 118-132. doi: 10.1177/154405910508400204 pmid: 15668328
[19]	Magne P. IDS: Immediate Dentin Sealing (IDS) for tooth preparations[J]. J Adhes Dent, 2014, 16(6): 594. doi: 10.3290/j.jad.a33324 pmid: 25564033
[20]	Juloski J, KÖken S, Ferrari M. No correlation between two methodological approaches applied to evaluate cervical margin relocation[J]. Dent Mater J, 2020, 39(4): 624-632. doi: 10.4012/dmj.2018-410 pmid: 32295986
[21]	Kielbassa AM, Philipp F. Restoring proximal cavities of molars using the proximal box elevation technique: Systematic review and report of a case[J]. Quintessence Int, 2015, 46(9): 751-764. doi: 10.3290/j.qi.a34459 pmid: 26159213
[22]	Dablanca-Blanco AB, Blanco-Carrión J, Martín-Biedma B, et al. Management of large class Ⅱ lesions in molars: How to restore and when to perform surgical crown lengthening?[J]. Restor Dent Endod, 2017, 42(3): 240-252. doi: 10.5395/rde.2017.42.3.240 pmid: 28808641
[23]	Ferrari M, Koken S, Grandini S, et al. Influence of cervical margin relocation (CMR) on periodontal health: 12-month results of a controlled trial[J]. J Dent, 2018, 69: 70-76. doi: S0300-5712(17)30260-9 pmid: 29061380
[24]	Bresser RA, Gerdolle D, van den Heijkant IA, et al. Up to 12 years clinical evaluation of 197 partial indirect restorations with deep margin elevation in the posterior region[J]. J Dent, 2019, 91: 103227.
[25]	Miao C, Yang XY, Wong MC, et al. Rubber dam isolation for restorative treatment in dental patients[J]. Cochrane Database Syst Rev, 2021, 5(5): CD009858.
[26]	冯琳, 岳林. 橡皮障隔离技术的临床应用[J]. 中华口腔医学杂志, 2019, 54(7): 498-502.
[27]	Heintze SD, Rousson V. Clinical effectiveness of direct class Ⅱ restorations: A meta-analysis[J]. J Adhes Dent, 2012, 14(5): 407-431.
[28]	Geo TD, Gupta S, Gupta SG, et al. Is Deep margin elevation a reliable tool for cervical margin relocation?: A comparative review[J]. J Oral Biol Craniofac Res, 2024, 14(1): 33-38. doi: 10.1016/j.jobcr.2023.12.002 pmid: 38481655
[29]	Magne P. M-i-M for DME: Matrix-in-a-matrix technique for deep margin elevation[J]. J Prosthet Dent, 2023, 130(4): 434-438.
[30]	Wolff D, Schick S, Staehle HJ, et al. Novel microscalpels for removing proximal composite resin overhangs on class Ⅱ restorations[J]. Oper Dent, 2017, 42(3): 297-307. doi: 10.2341/16-012-L pmid: 28467260
[31]	Soliman S, Krastl G, Winkler A, et al. Influence of the scalpel finishing technique on marginal gap formation in class Ⅱ resin composite restorations[J]. Oper Dent, 2023, 48(1): E12-E24.
[32]	Mannocci F, Bitter K, Sauro S, et al. Present status and future directions: The restoration of root filled teeth[J]. Int Endod J, 2022, 55(Suppl 4): 1059-1084.
[33]	Gavriil D, Kakka A, Myers P, et al. Pre-endodontic restoration of structurally compromised teeth: Current concepts[J]. Br Dent J, 2021, 231(6): 343-349.
[34]	Cardoso MV, de Almeida Neves A, Mine A, et al. Current aspects on bonding effectiveness and stability in adhesive dentistry[J]. Aust Dent J, 2011, 56(Suppl 1): 31-44.
[35]	Ismail HS, Ali AI, Mehesen RE, et al. Deep proximal margin rebuilding with direct esthetic restorations: A systematic review of marginal adaptation and bond strength[J]. Restor Dent Endod, 2022, 47(2): e15. doi: 10.5395/rde.2022.47.e15 pmid: 35692223
[36]	Rocca GT, Rizcalla N, Krejci I, et al. Evidence-based concepts and procedures for bonded inlays and onlays. Part Ⅱ. Guidelines for cavity preparation and restoration fabrication[J]. Int J Esthet Dent, 2015, 10(3): 392-413.
[37]	Burrer P, Dang H, Par M, et al. Effect of over-etching and prolonged application time of a universal adhesive on dentin bond strength[J]. Polymers, 2020, 12(12): 2902.
[38]	Ismail HS, Ali AI, Mehesen RE,et al. In vitro marginal and internal adaptation of four different base materials used to elevate proximal dentin gingival margins[J]. J Clin Exp Dent, 2022, 14(7): e550-e559.
[39]	Cavalheiro CP, Scherer H, Imparato JCP, et al. Use of flowable resin composite as an intermediate layer in class Ⅱ restorations: A systematic review and meta-analysis[J]. Clin Oral Investig, 2021, 25(10): 5629-5639.
[40]	Cieplik F, Hiller KA, Buchalla W, et al. Randomized clinical split-mouth study on a novel self-adhesive bulk-fill restorative vs. a conventional bulk-fill composite for restoration of class Ⅱ cavities - results after three years[J]. J Dent, 2022, 125: 104275.
[41]	Mente J, Hieber F, Sekundo C, et al. MTA matrix technique: Restoration of teeth with deep subgingival defects extending down to the osseous crest[J]. J Adhes Dent, 2022, 24: 269-278. doi: 10.3290/j.jad.b3146843 pmid: 35722937
[42]	Alhussein A, Alsahafi R, Wang XH, et al. Novel dental low-shrinkage-stress composite with antibacterial dimethylaminododecyl methacrylate monomer[J]. J Funct Biomater, 2023, 14(7): 335.
[43]	Frese C, Wolff D, Krüger T, et al. Biological evaluation of subgingivally placed direct resin composite materials[J]. J Oral Sci, 2018, 60(1): 89-96. doi: 10.2334/josnusd.16-0827 pmid: 29375100
[44]	Sun QN, Zhang LY, Bai RS, et al. Recent progress in antimicrobial strategies for resin-based restoratives[J]. Polymers, 2021, 13(10): 1590.
[45]	Bergeron C, Ballard C, Li YM, et al. A low-shrinkage, hydrophobic, degradation-resistant, antimicrobial dental composite using a fluorinated acrylate and an oxirane[J]. J Appl Biomater Funct Mater, 2022, 20: 22808000221087337.
[46]	Da Silva Gonçalves D, Cura M, Ceballos L, et al. Influence of proximal box elevation on bond strength of composite inlays[J]. Clin Oral Investig, 2017, 21(1): 247-254.
[47]	Mendes LT, Loomans BAC, Opdam NJM, et al. Silane coupling agents are beneficial for resin composite repair: A systematic review and meta-analysis of in vitro studies[J]. J Adhes Dent, 2020, 22(5): 443-453.
[48]	Qanungo A, Aras MA, Chitre V, et al. Immediate dentin sealing for indirect bonded restorations[J]. J Prosthodont Res, 2016, 60(4): 240-249. doi: S1883-1958(16)30021-4 pmid: 27131858
[49]	Thordrup M, Isidor F, Hörsted-Bindslev P. A prospective clinical study of indirect and direct composite and ceramic inlays: Ten-year results[J]. Quintessence Int, 2006, 37(2): 139-144. pmid: 16475376
[50]	Li H, Burrow MF, Tyas MJ. Nanoleakage patterns of four dentin bonding systems[J]. Dent Mater, 2000, 16(1): 48-56. pmid: 11203523
[51]	Spreafico R, Marchesi G, Turco G, et al. Evaluation of the in vitro effects of cervical marginal relocation using composite resins on the marginal quality of CAD/CAM crowns[J]. J Adhes Dent, 2016, 18(4): 355-362. doi: 10.3290/j.jad.a36514 pmid: 27419242
[52]	Frankenberger R, Hehn J, Hajtó J, et al. Effect of proximal box elevation with resin composite on marginal quality of ceramic inlays in vitro[J]. Clin Oral Investig, 2013, 17(1): 177-183.
[53]	Theisen CER, Amato J, Krastl G, et al. Quality of CAD-CAM inlays placed on aged resin-based composite restorations used as deep margin elevation: A laboratory study[J]. Clin Oral Investig, 2023, 27(6): 2691-2703.
[54]	Da Silva D, Ceballos L, Fuentes MV. Influence of the adhesive strategy in the sealing ability of resin composite inlays after deep margin elevation[J]. J Clin Exp Dent, 2021, 13(9): e886-e893.
[55]	Köken S, Juloski J, Sorrentino R, et al. Marginal sealing of relocated cervical margins of mesio-occluso-distal overlays[J]. J Oral Sci, 2018, 60(3): 460-468. doi: 10.2334/josnusd.17-0331 pmid: 29695671
[56]	Müller V, Friedl KH, Friedl K, et al. Influence of proximal box elevation technique on marginal integrity of adhesively luted Cerec inlays[J]. Clin Oral Investig, 2017, 21(2): 607-612.
[57]	Pereira LFO, Perucelli F, Souza EM, et al. Influence of cervical margin relocation with direct restorative materials on the marginal integrity of CAD-CAM composite inlays[J]. Am J Dent, 2022, 35(1): 30-36. pmid: 35316590
[58]	Sandoval MJ, Rocca GT, Krejci I, et al. In vitro evaluation of marginal and internal adaptation of class Ⅱ CAD/CAM ceramic restorations with different resinous bases and interface treatments[J]. Clin Oral Investig, 2015, 19(9): 2167-2177.
[59]	Scotti N, Baldi A, Vergano EA, et al. Tridimensional evaluation of the interfacial gap in deep cervical margin restorations: A micro-CT study[J]. Oper Dent, 2020, 45(5): E227-E236.
[60]	Eraslan Ö, Eraslan O, Eskitaşcıoğlu G, et al. Conservative restoration of severely damaged endodontically treated premolar teeth: A FEM study[J]. Clin Oral Investig, 2021, 15(3): 403-408.
[61]	Falahchai M, Musapoor N, Mokhtari S, et al. Fracture resistance and failure mode of endodontically treated premolars reconstructed by different preparation approaches: Cervical margin relocation and crown lengthening with complete and partial ferrule with three different post and core systems[J/OL]. J Prosthodont, (2023-07-28) [2024-07-12]. https://onlinelibrary.wiley.com/doi/10.1111/jopr.13741.
[62]	Zhang H, Li H, Cong Q, et al. Effect of proximal box elevation on fracture resistance and microleakage of premolars restored with ceramic endocrowns[J]. PLoS One, 2021, 16(5): e0252269.
[63]	Vertolli TJ, Martinsen BD, Hanson CM, et al. Effect of deep margin elevation on CAD/CAM-fabricated ceramic inlays[J]. Oper Dent, 2020, 45(6): 608-617.
[64]	Bresser RA, van de Geer L, Gerdolle D, et al. Influence of Deep Margin Elevation and preparation design on the fracture strength of indirectly restored molars[J]. J Mech Behav Biomed Mater, 2020, 110: 103950.
[65]	Muscholl C, Zamorska N, Schoilew K, et al. Retrospective clinical evaluation of subgingival composite resin restorations with deep-margin elevation[J]. J Adhes Dent, 2022, 24: 335-344. doi: 10.3290/j.jad.b3240665 pmid: 35983705
[66]	Schmidt JC, Sahrmann P, Weiger R, et al. Biologic width dimensions: A systematic review[J]. J Clin Periodontol, 2013, 40(5): 493-504. doi: 10.1111/jcpe.12078 pmid: 23461747
[67]	Padbury A Jr, Eber R, Wang HL. Interactions between the gingiva and the margin of restorations[J]. J Clin Periodontol, 2003, 30(5): 379-385. pmid: 12716328
[68]	Bertoldi C, Monari E, Cortellini P, et al. Clinical and histological reaction of periodontal tissues to subgingival resin composite restorations[J]. Clin Oral Investig, 2020, 24(2): 1001-1011.
[69]	Sarfati A, Tirlet G. Deep margin elevation versus crown lengthening: Biologic width revisited[J]. Int J Esthet Dent, 2018, 13(3): 334-356. pmid: 30073217
[70]	Gargiulo AW, Wentz FM, Orban B. Dimensions and relations of the dentogingival junction in humans[J]. J Periodontol, 1961, 32(3): 261-267.
[71]	Perez JR, Smukler H, Nunn ME. Clinical evaluation of the supraosseous gingivae before and after crown lengthening[J]. J Periodontol, 2007, 78(6): 1023-1030. doi: 10.1902/jop.2007.060485 pmid: 17539715
[72]	Ghezzi C, Brambilla G, Conti A, et al. Cervical margin relocation: Case series and new classification system[J]. Int J Esthet Dent, 2019, 14(3): 272-284. pmid: 31312813