Deep Margin Elevation in Endodontically Treated Posterior Teeth

This study aims to evaluate the periodontal response of proximal surfaces with deep margin elevation (DME) in endodontically treated posterior teeth restored with CAD/CAM systems. Deep subgingival margins present clinical challenges in terms of isolation, restoration, and long-term periodontal health. DME is a minimally invasive technique used to relocate subgingival margins coronally to a supragingival level, facilitating adhesive procedures and CAD/CAM restoration placement. However, the periodontal effects of DME remain unclear. In this prospective split-tooth clinical study, proximal surfaces treated with DME will be compared with control surfaces without DME within the same tooth. The primary outcome will be bleeding on probing (BOP), while secondary outcomes will include probing depth and plaque index. Clinical and radiographic evaluations will be performed at baseline and during follow-up. The results of this study are expected to provide clinical evidence regarding the periodontal impact of DME and support clinical decision-making in the restoration of endodontically treated posterior teeth.

Inclusion Criteria: * Patients aged between 18 and 65 years * Presence of at least one endodontically treated posterior tooth (premolar or molar) with extensive coronal structure loss * Teeth indicated for indirect CAD/CAM restoration * Presence of at least one proximal surface requiring deep margin elevation (subgingival margin) * Opposing proximal surface with supragingival or equigingival margin suitable as control * Good general health and ability to attend follow-up visits * Signed informed consent Exclusion Criteria: * Patients with poor oral hygiene or uncontrolled periodontal disease * Presence of active periodontal disease requiring treatment * Teeth with mobility greater than Grade I * Teeth with periapical pathology or unsuccessful endodontic treatment * Patients with systemic diseases affecting periodontal health (e.g., uncontrolled diabetes) * Pregnant or lactating women * Patients using medications affecting gingival tissues (e.g., immunosuppressants, calcium channel blockers) * Heavy smokers * Patients unable to comply with follow-up schedule