Introduction
Deep Margin Elevation (DME), also called cervical margin relocation (CMR) or proximal box elevation, is a minimally invasive adhesive technique that repositions subgingival restorative margins coronally. First described by Dietschi and Spreafico in 1998, it enables clinicians to restore teeth with deep margins without surgical crown lengthening or orthodontic extrusion.
In endodontic restorative workflows, DME simplifies isolation, improves adhesive performance, and provides a controlled foundation for indirect restorations. Success depends on matrix adaptation, tissue management, and moisture control - areas where the DME Wedge provides a clear advantage.
Challenges in Conventional DME
In traditional DME procedures, clinicians typically use a foil matrix and a separate wedge. This approach is often challenging:
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The wedge can distort the matrix, compromising marginal adaptation
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Achieving depth control is difficult, especially in narrow proximal boxes
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The interproximal rubber dam is frequently damaged during cavity preparation
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Maintaining isolation and haemostasis can be time-consuming
How the DME Wedge Solves These Limitations
The DME Wedge integrates the matrix and wedge functions into one device - simplifying the procedure and improving outcomes.
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Matrix and wedge in one tool
It eliminates the need for a foil matrix, as the DME Wedge itself acts as both the matrix and the wedge. Its contour adapts to the cervical margin while compressing gingival tissues to create a clear field. -
Gentle tissue management and haemostasis
Its soft, compressive material provides a tourniquet effect, displacing tissue and controlling minor bleeding - ideal for subgingival margins without the need for cords or pastes. -
Stable isolation and accurate adaptation
The wedge maintains pressure against the tooth and tissue, supporting the composite during incremental build-up. It holds position under the rubber dam without distortion, simplifying otherwise complex isolation. -
Predictable results in endodontic restorations
For restoratively driven endodontists, the DME Wedge provides a fast, reliable way to elevate deep margins - whether you plan to leave an open contact for later crown placement or to build a full proximal wall immediately.
Clinical Example: Deep Margin Elevation in an Endodontically Treated Maxillary Premolar
Case courtesy of Dr. Venkat Canakapalli - Root Canal Clinic - Tauranga (shared with permission).
Case Summary:
A maxillary premolar presented with a deep distal margin extending close to the alveolar crest following endodontic treatment. The DME Wedge was placed to laterally retract tissue and provide a stable surface against which the margin could be directly built up. Incremental composite placement elevated the margin to a supragingival level, after which a conventional matrix system was used to complete the restoration under ideal adhesive conditions.
Outcome:
Post-operative radiographs confirmed excellent marginal adaptation, contour, and seal - achieved with reduced chair time and simplified tissue management.
Practical Considerations
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Rubber dam use is strongly recommended for control and cleanliness - though the DME Wedge’s integrated seal makes isolation less demanding than traditional systems.
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DME should not be used if margins encroach into connective tissue or bone.
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Adequate haemostasis and respect for the biological width remain essential for periodontal health.
Conclusion
For endodontic restorative cases with deep margins, the DME Wedge is a practical innovation for restoratively driven clinicians. It saves time, simplifies isolation, and replaces two tools - the matrix and wedge - with one efficient solution.
By enabling predictable margin elevation and strong adhesive foundations, the DME Wedge helps clinicians restore structure conservatively while maintaining biological and restorative integrity.