Marginal ridge reconstruction at sever loss of dental hard tissues

Duboke aproksimalne karijesne lezije vrlo su učestale u svakodnevnom kliničkom radu. U modernoj stomatologiji cilj je osigurati trajnost direktne ili indirektne restauracije kod opsežno izgubljenih zubnih tkiva uz naglasak na estetiku nadomjestka. Uklanjanjem dubokih karijesnih lezija nastaje subgingivna preparacija koja seže ispod caklinsko-cementnog spojišta. Takav defekt teško je nadoknaditi jer je otežana vidljivost, održavanje suhog radnog polja, time i izrada odgovarajućeg direktnog ispuna, a kod indirektnih nadomjestaka otiskivanje preparacije i njihovo cementiranje. Kirurško produljenje kliničke krune zuba može biti jedno od rješenja kada se razina gingive kirurški spušta kako bi se omogućio pristup granici preparacije. Takav pristup ima i svoje nedostatke kao što su narušavanje biološke širine, gubitak pričvrstka, dentinska preosjetljivost i moguće eksponiranje furkacije korijena. Restaurativni postupak kojim bi se minimalno invazivno osiguralo podizanje ruba preparacije u jednoj posjeti uz pomoć kompozitnih smola naziva se nadoknada marginalnog grebena ili engl. deep margin elevation. Tehniku su prvi put opisali 1998. godine Dietschi i Spreafico. Uz pomoć posebno oblikovanih matrica osigurava se suho radno polje i inkrementima kompozita podiže granica preparacije 2 milimetra supragingivno. Uz primarnu prednost očuvanja zuba koji su često bili osuđeni na ekstrakciju zbog nemogućnost restauracije, tehnika ima nekoliko dodatnih prednosti kao što su smanjen broj komplikacija, mogućnost otiskivanja u istoj posjeti i minimalna invazivnost. U slučaju indirektne restauracije, nakon izrade marginalnog grebena kompozitom napravi se bite-wing snimka za procjenu rubnog zatvaranja te ako se procijeni da je rezultat zadovoljavajuć, slijedi otiskivanje, izrada nadomjestka i njegovo cementiranje.Deep carious lesions are very common in everyday clinical work. In modern dentistry, the goal is to ensure the permanence of direct or indirect restoration in extensively lost dental tissues, with the emphasis on the aesthetics of the restoration. Removal of the deep carious lesions results in subgingival preparation located below the enamel-cement joint. Such a defect is difficult to make up for because of the reduced visibility as well as the maintenance of a dry working field and thus complicating the making of the appropriate direct filling. Moreover, in the case of indirect replacements, it affects imprinting of the preparation and its cementation. Surgical lengthening of the clinical crown of the tooth may be one of the solutions when the level of the gingiva is surgically lowered to allow access to the border of the preparation. Such an approach also has its drawbacks such as disruption of biological width, loss of attachment, dentinal hypersensitivity, and possible exposure of root furcation. A minimally invasive restorative procedure that would ensure the raising of the preparation edge in one visit with the use of composite resins is called deep margin elevation. The technique was first described in 1998 by Dietschi and Spreafico. With the help of specially designed matrices, a dry working field is ensured and with the use of the composite increments the preparation limit is elevated by 2 milimeters supragingivally. In addition to the primary advantage of preserving teeth that are often doomed to extraction, the technique has several additional advantages such as reduced number of complications, the ability to make a dental impression in the same visit and minimal invasiveness. In the case of indirect restoration, after making a marginal ridge with the use of composite, a bite-wing image is made to assess the marginal closure. If the result is judged to be satisfactory, it is followed by making an impression, indirect restoration and cementation