The management of deep subgingival carious lesions presents significant challenges for achieving durable adhesive restorations due to limited access, moisture control, and proximity to periodontal tissues. Two main approaches are currently adopted to manage these cases: Deep Margin Elevation (DME) and Surgical Crown Lengthening (SCL). This systematic review (PROSPERO registration CRD420250654262) aimed to compare the performance and survival of restorations placed following DME versus SCL in teeth with deep subgingival margins. A comprehensive literature search was conducted in PubMed, B-ON, and the Cochrane Library for studies published between 2014 and 2025. Following PRISMA guidelines, six studies were included. Methodological quality and risk of bias were assessed using ROBINS-I, RoB 2, and the CARE guidelines. The available evidence indicates that both DME and SCL provide satisfactory periodontal stability, high restoration survival rates, and a low incidence of recurrent caries. DME emerged as a minimally invasive strategy that facilitates adhesive procedures by relocating deep margins to more accessible positions, potentially improving marginal integrity while preserving tooth structure and gingival architecture, particularly in patients with a thick gingival biotype. The choice between DME and SCL should be individualized. Further long-term clinical studies are required to clarify their impact on adhesive interface durability in subgingival environments.
Ceravolo et al. (Wed,) studied this question.