By: Michael Eid
Your first deep marginal elevation (DME) will test every bit of patience you have. The matrix won’t seal, saliva will creep in, and you’ll start questioning why a class 2 is becoming this difficult.
But once you understand why you’re doing it and how to do it right, DME becomes one of the most satisfying restorative skills you can master.
What Is Deep Marginal Elevation?
Deep Marginal Elevation (DME) – is when you raise a subgingival margin to a supragingival level using composite or glass ionomer before placing your final restoration.
Basically, you’re building a platform so that your final restoration can bond and seal properly — instead of trying to bond below the gumline where isolation is a nightmare.
Why It’s Done
- Better isolation: Easier to keep the area dry for bonding.
- Improved access: You can actually see and finish your margins.
- Healthier tissue: Keeps cement and materials away from the sulcus.
- Stronger seal: Bonds to composite are more reliable than trying to bond to dentin soaked in saliva and blood.
Different Approaches
1. Composite-Only DME
- Ideal when isolation is manageable and margins are just barely subgingival.
- Etch, bond, and incrementally build up composite until the margin is accessible.
- Use a sectional matrix (like Palodent or Garrison) with firm wedging.
Pro tip: Cure in small increments to avoid voids and shrinkage pulling away from the margin.
2. Glass Ionomer (GI) Base + Composite Overlay
- Best for deep boxes where moisture control is poor.
- GI can tolerate slight moisture and releases fluoride.
- Place GI just to lift the floor a bit, then overlay with composite for strength and esthetics.
Pro tip: Use resin-modified GI (like Fuji II LC) — it bonds better and sets faster.
3. Sandwich Technique
- Combine both: GI on the deepest floor, composite on top.
- The GI acts as a buffer and base, the composite seals and builds the height.
- Good compromise when isolation is questionable but strength is still a priority.
Tips to Make Your DME Actually Work
1. Matrix Mastery
- Sectional matrices are your friend, but make sure they’re sealed at the gingival margin.
- Use wedges that really push — plastic wedges won’t cut it, use a wooden wedge. The wood absorbs moisture and expands allowing for a better contour.
2. Manage Bleeding and Isolation
- Use retraction cord soaked in hemostatic (ViscoStat, Astringedent).
- Rubber dam if possible — but if not, dry angles, suction, and teflon barriers help.
- Remember: if you can’t see it or keep it dry, you can’t bond it.
Every DME you do teaches you how to isolate better, seal tighter, and think ahead. Master DME, and you’ll turn those “impossible” subgingival margins into clean, predictable restorations.
