Raise to restore: A case series on the clinical application of deep margin elevation

Objectives: Deep subgingival margins present challenges in isolation, impression accuracy, and restoration longevity. This study aimed to evaluate the clinical outcomes of deep margin elevation (DME) as a conservative alternative to surgical crown lengthening for restoring teeth with subgingival proximal margins. Methods: Four patients presenting with subgingival margins were treated using DME. Cases were categorized into three grades based on isolation feasibility and biological width involvement. Margin elevation was performed using direct composite build-up under rubber dam isolation, often following immediate dentin sealing. Indirect restorations were placed after radiographic confirmation. Follow-up periods ranged from 1 to 13 months. Results: Grade 1 and Grade 2 cases demonstrated successful margin elevation and placement of indirect restorations without periodontal complications. The Grade 3 case required surgical crown lengthening prior to restoration. All treated cases exhibited stable restorations, favorable marginal adaptation, and healthy periodontal responses during follow-up. Conclusions: Deep margin elevation is an effective minimally invasive technique for managing subgingival defects while preserving periodontal health and facilitating adhesive restorations. Appropriate case selection and isolation protocols are critical for long-term success.