Influence of cervical margin relocation (CMR) on periodontal health: 12-month results of a controlled trial
Ferrari Marco, Koken Serhat, Grandini Simone, Cagidiaco Edoardo Ferrari, Joda Tim, Discepoli Nicola. Influence of cervical margin relocation (CMR) on periodontal health: 12-month results of a controlled trial. Journal of Dentistry https://doi.org/10.1016/j.jdent.2017.10.008
The concept of Cervical Margin Relocation (CMR) consists on placing a base layer of direct resin composite to elevate supra- gingivally the proximal indirect bonded restorations. The aims of this clinical study were to evaluate 1. Bleeding on Probing (BoP) on posterior indirect restorations with one interproximal margin relocated cervically, and 2. possible correlation between depth of the interproximal margins and BoP.
CMR (Group1) and shoulder preparations (Group2) were performed in 35 posterior teeth and evaluated after 12 months (T12). Cavities’ margins were placed below the Cemento-Enamel-Junction (CEJ). CMR was applied in one interproximal box-slot preparation using G- Premio Bond, for dentin hybridization, and universal flow resin composite (GC Co. Tokyo, Japan). Pressed lithium disilicate crowns (LS2) (LiSi Press, GC Co. Tokyo, Japan) were made and placed with proprietary luting material. At baseline and after 12 months, clinical surrogate parameters were assessed; and measurements were recorded for the restorative margin position in relation to margo gingivae by probing, and radiographically, the distance from the bone crest was calculated (in mm). Statistical analysis was performed.
CMR was associated with statistically significant increased BoP scores compared to shoulder preparation at T12 (53.0% vs. 31.5% per site, respectively) (p=0.10). Gingival Index (GI) and Plaque Index (PI) were not statistically different between both groups. The linear distance between the bone crest and the restorative margin was 2mm in 13 out of 19 experimental sites of Group 1, and 6 out of 11 of Group 2.
Higher incidence of BoP can be expected around teeth treated with the concept of CMR and in coincidence with deep margins placed at or closer than 2 mm from the bone crest.
1. Clinical Significance
CMR is a clinically sensitive-technique, especially when performed on deep subgingival margins.
Old indirect restoration made with porcelain fused to metal in need to be replaced because secondary decay.
X-ray of the cavity after the old restoration was removed.
The cavity after decay removal. The application of a metal matrix protected the soft tissue, although after removing the matrix the tissue is slightly bleeding.
Under rubber dam and after adaptating metal matrix and wedge to the emergence profile of the tooth, the procedure of immediate dentin sealing and cervical margin relocation are perfomed: the first layer of flowable resin composite is already light-cured.
Complete build-up of the cavity.
Immediately after the build up, still under rubber dam, the final preparation was made.
The final preparation.
The traditional impression.
The final LiSi Press partial crown.
The crown after being luted under rubber dam.
Recall after 12 months; clinical and radiographic views.