Margin Leakage in Restorative Dentistry
Marginal leakage around composite restorations and traditional crowns is not only a cosmetic concern, but a pathological concern as well. Staining around margins shows the gap between a tooth and the restorative material, which allows bacteria to enter under the restoration and fails to support the surrounding tooth structure, increasing a tooth’s risk of cuspal fracture from vertical and horizontal cracks. Biomimetic dentistry uses immediate dentin sealing and resin coating to create a margin smaller than a bacteria, mimicking the strength of the dentin-enamel junction and eliminating leaking margins while protecting the tooth’s health long-term.
Staining is visible around the margin of this traditional composite restoration. Initial case photo by Dr. Davey Alleman, DMD.
What is margin leakage?
Margin leakage is visible as dark staining around the area where a restoration and the natural tooth structure meet. This staining is caused by bacteria, as a result of the food and drinks we consume, entering the space between a tooth and the restoration. The dark margin shows how bacteria is given a chance to thrive because the tooth was restored but not sealed.
Peripheral rim fractures are visible, caused by the poorly bonded restoration not supporting the remaining tooth structure and increasing its risk of fracture. The cracks create a pathway for bacteria to enter under the restoration. Case by Dr. Davey Alleman, DMD.
Negative impacts of a leaking margin
In addition to looking visually unappealing, dark staining around margins means bacteria is flourishing under the restoration and could result in cavities. Cavities can cause sensitivity, expose the tooth to crack formation and put the pulp at risk of necrosis.
Using biomimetic techniques from the Six Lessons Approach, these teeth were restored by Dr. Davey Alleman, DMD. The bond between the tooth and restorative material is now so small that a bacteria cannot enter.
Closing the margin with biomimetic restorative dentistry
To stop bacteria from entering, make the gap smaller than the size of a bacteria. This is accomplished with the advanced adhesive principles of biomimetic restorative dentistry. When paired with techniques that reduce C-factor stresses and account for the Hierarchy of Bondability, certain dental bonding agents are able to bond to dentin at the nanometer level, mimicking the strength at which a natural tooth is bonded to itself.
This case by Dr. David Alleman, DDS shows a tooth restored using biomimetic dentistry after eight years and again after 20 years. The margin is clean and the restoration is still fully bonded.
Dr. David Alleman created his Six Lessons Approach to Biomimetic Restorative Dentistry to give doctors everywhere the complete set of protocols to restore a tooth from start to finish in a way that mimics the form and function of a natural tooth. Get trained in these proven techniques at Alleman Center biomimetic dentistry training programs.
Watch this Six Lessons Approach Podcast episode by Dr. David Alleman to learn more about the causes of dental failures, like margin leakage.
