What Is Deep Marginal Elevation?

Deep Marginal Elevation (DME) is a technique where a subgingival margin is sealed and elevated using composite resin. A curved Tofflemire matrix is used to adapt the material, elevating the margin to a more manageable supragingival level where proper rubber dam isolation and bonding can be achieved.

This technique is especially useful when:

1- The margin is below the CEJ.

2- You’re placing indirect restorations.

When Should You Perform DME?

If endodontic treatment is planned, DME should be done before access opening to ensure excellent isolation throughout the procedure.

Clinical Requirements for DME

Here’s a checklist of clinical tips for performing DME successfully:

1- Tissue Management: If the gingiva has overgrown, reduce it using a ThermaCut bur or dull round bur to expose the margin.

2- Secondary Isolation: Use Teflon tape as secondary isolation for deep Class II boxes.

3- Matrix Selection: Use a curved matrix band, not a standard one. Standard bands are suitable only for supragingival margins.

4-Matrices Modifications for Deep Marginal Elevation or Coronal Marginal Relocation: 

To enable matrices to move apically and offer better flare, several modifications have been developed. While commercial matrices like the Garrison Reel Matrix offer ideal adaptation, they can be expensive. Therefore, clinicians often modify traditional matrix bands to mimic the performance of premium systems.

One common approach is the Magne modification, which enables apical movement but does not significantly improve flaring unless a band with intense curvature is used. Another technique, known as the Gergis modification (wave cut), attempts to increase the curvature of the band to provide a contour closer to the Garrison system, offering better occlusal divergence—although it can be challenging to cut accurately. It’s also essential to shorten the matrix height to improve subgingival adaptation, but it should never be less than 2 mm. Ideally, the matrix height should exceed the desired elevation by 1 mm (e.g., for a 2 mm elevation, use a 3 mm matrix). Additionally, proper buccal and lingual support from adjacent tooth structures is crucial to prevent matrix instability or collapse. If isolation cannot be achieved with the modified matrix alone, surgical crown lengthening may be necessary. A common issue with modified matrices is tearing under pressure, although some clinicians observe that inverting the Tofflemire retainer—particularly with the Magne style—may help reduce this risk, potentially due to design-related factors.

5- No Tissue Interference: Make sure no gingiva or rubber dam sheet is trapped between the tooth and matrix.

6- Seal Access Before DME: If the tooth already has endo access, temporarily seal it with teflon to avoid etch/bond leakage.

7- Smooth the Margin: Use a fine finishing stone to smooth the margin before bonding.

8- Bonding Protocol: Always use a 3-step etch-and-rinse bonding system for better sealing and dentin bonding.

9- Composite Placement Technique

Don’t build the wall entirely. Elevate only 2–3 mm of the margin.

Use the Snowplow Technique: apply a thin uncured layer of flowable composite, followed by packable composite on top, then cure both together to improve adaptation.

10- Matrix-in-Matrix for Deep Margins: If the margin is extremely deep, insert a small piece of matrix vertically (matrix-in-matrix) before placing the main curved matrix band.

How to Perform DME: Step-by-Step

GIC vs Flowable Composite: Which Is Better?

Flowable Composite is preferred if you can maintain proper isolation during the procedure.

High-viscosity, fast-set GIC is better if moisture control is compromised.

Why GIC?

Higher viscosity improves adaptation.

What’s the Difference Between DME and DMA?

DME (Deep Marginal Elevation) involves elevating the margin using restorative material.

DMA is done first to allow DME to be performed properly. DMA often involves:

Soft tissue removal using ThermaCut or dull burs.

Final Clinical Tips

1- Always verify your isolation before starting.

2- Respect biological width during DMA and DME.

3- Choose your materials and matrices carefully depending on the depth and location of the lesion.

🔚 By mastering Deep Marginal Elevation and Acquisition, you ensure cleaner fields, better restorations, and more predictable results—especially in complex posterior cases.