How do you manage deep caries lesions

with subgingival margins?

Deep Margin 1.png
Deep Margin 2.png

An adult patient presents with restoration loss on the mandibular right premolar. During clinical and radiographic examination, you diagnose a deep proximal carious lesion reaching beyond the CEJ with the proximal margin partially covered by overgrowing gingival tissue. The tooth is vital and there is no periapical radiolucency. 

What would be your most likely treatment approach for this case scenario?

* 1. Would you do crown lengthening?
* 2. Would you do a root canal?
* 3. How would you restore function?
* 4. How often do patients in your practice in a similar situation decide to extract the tooth rather than restore it?
* 5. A technique named as Coronal Marginal Relocation (CMR), Deep Margin Elevation (DME) or Proximal Box Elevation (PBE) could be used in the case scenario. Prior to today, had you been aware of this restorative dentistry technique?

* Pictures used by permission from Frese et al. Proximal box elevation with resin composite and the dogma of biological width: clinical R2-technique and critical review Oper Dent 39, 22-31. © Operative Dentistry, Inc. Transmission or reproduction of protected items beyond that allowed by fair use requires the written permission of Operative Dentistry, Inc.