Decision tree protocol for demineralized gingival margin extension in class II composite cavity preparations

• Main Authors: Shelyn Akari Yamakami, Shaan Sehgal, Russell Haywood Taylor, Hiroe Ohyama
• Format: Article
• Language: English
• Published: Elsevier 2021-07-01
• Series: Journal of Dental Sciences
• Subjects: Clinical protocols; Decision trees; Dental cavity preparation; Dental marginal adaptation; Operative dentistry
• Online Access: http://www.sciencedirect.com/science/article/pii/S1991790221000258

Summary: This study proposed the development of a protocol for class-II preparations with demineralized gingival margins for the improvement of the longevity of restorations. Evidence sources such as location/color/surface hardness/width of demineralized gingival margin with enamel/demineralized enamel (DE)/dentin/cementum were reviewed based on methodological studies and systematic reviews. A decision tree protocol was developed with criteria (i) lesion location: demineralized gingival margins in enamel must be removed, but if close to cementoenamel-junction, color should be evaluated. (ii) Color: yellow/brown lesions must be removed, but if white/opaque, then the surface hardness should be evaluated. (iii) Surface hardness: soft/demineralized gingival margin must be removed, but if adequately hard, width should be evaluated. (iv) Width: lesions less than half-enamel thickness and impenetrable by an explorer, remineralization is possible and the lesion does not need to be removed. A decision tree protocol was set up with the current available literature. Further continued investigations will be needed for the appropriate protocol updates.