Deep Margin Elevation: Current Evidence and a Critical Approach to Clinical Protocols—A Narrative Review

Deep margin elevation (DME) is a widely adopted technique for managing subgingival cervical proximal margins by repositioning them to a supragingival location. This approach enhances access, visibility, and control in these anatomically challenging areas. This narrative review aimed to evaluate current evidence on the indications, materials, clinical protocols, and outcomes of DME. A structured search was conducted in PubMed, the Cochrane Library and Scopus up to February 2025, using keywords such as “deep margin elevation”, “proximal box elevation” and “subgingival margin.” Clinical studies, in vitro investigations, relevant reviews and reports in English were included. A total of 59 articles were selected based on eligibility criteria. The hypothesis was that DME can serve as a reliable alternative to surgical crown lengthening in appropriate cases. A variety of materials have been investigated for use as the intermediate layer, with composite resins of varying viscosities and filler compositions being preferred due to their favorable long-term mechanical properties. DME may reduce the need for surgical intervention while maintaining periodontal health; however further randomized clinical trials are needed to clarify the material selection, establish long-term outcomes, and standardize clinical protocols. Understanding the indications, limitations, and protocol of DME is critical for achieving biologically sound and predictably functional restorations.