Management of deep gingival margins in class II cavity

Deep gingival margins in class II cavity is one of the main challenges that faces the dentist during placing amalgam or composite restoration, also during pre-endodontic build up for completion of endodontic treatment.

Management of deep subgingival margins is critical for the long term success of restoration.

The deep gingival margins can be in the form of gingival hyperplasia in which the gingiva grows over the tooth and covers part of it or after the excavation of the caries we found that the gingival proximal margin is subgingivally (inaccessible).

Management of deep gingival margins

• Deep margin acquisition.
• Deep margin elevation

Deep Margin Acquisition is the procedure that we can do to define or reach the sub-gingival margin (to be seen by your eyes) to isolate it and to restore it to a supra-gingival one.

To convert the sub-gingival margin into a supra-gingival one that is called Deep margin elevation / Deep margin Extension / Cervical margin relocation.

Types of Deep margins

1- Grade 1

• Subgingival margin without violation of the biological width, so that the margin easy to locate and east to restore.

2- Grade 2

• Sub-gingival margin without violation of the biological width with but it is difficult to locate and to restore as well.

3- Grade 3

• Sub-gingival margin which violates the biological width also difficult to restore and locate.

- We can differentiate between grade 2 and 3 by bone sounding.

- Bone sounding is a procedure which is done by placement of periodontal probe in the gingival sulcus and pierce it until you reach to the bone level, then you measure the distance between the base of the sulcus and the bone level.

- If the distance between them is less than 2 mm then it is grade 3 we cannot do deep margin elevation we should do surgical crown lengthening.

-If the distance between them is 2 mm or more then it is grade 1 or 2 we can do deep margin elevation in this case.

Management of Grade 1 deep margin

we can do soft tissue retraction by

• Pre-wedging
• Teflon
• Rubber Dam Inversion
• Retraction cord

Management of Grade 2 deep margin

we can do soft tissue trimming by

• Mechanical trimming by (Small Round Bur or by Therma-cut burs)
• Surgical blade
• Electro-surgery
• Laser (produces bloodless field)

Management of Grade 3 deep margin

we can do hard tissue trimming by

• Surgical crown lengthening

Inspired by Dr.Ahmed Alhakim

Management of deep gingival margins in class II cavity (Arabic)