Fig. 1

Case of a  28 years old patient referring pain in the left lower jaw when chewing.

Both sensibility testing and bleeding on probing were positive, 

Pocket probing depth of the element was ≤ 5 mm circumferentially except for the disto lingual aspect (6 mm).

A: lateral view

B: occlusal view

Fig. 2

Peri-apical X-Ray

The distance between the lower margin of the decayed tissue and the inter proximal bone peak among the elements 3.6 and 3.7, is evident.

Fig. 3

Pocket probing depth in the disto-lingual aspect of the element 3.6 (6 mm).

It is evident the bleeding on probing that could be referred to the loss of the hard tissue of the above mentioned tooth and the food impaction.

Fig. 4

Before assessing the correct therapy for the patient, the clinician must remove entirely the decayed tissue from the most apical portion of the cavity, in order to understand which would have been the bone probing dimension in the distal aspect of the tooth. 

If this results to be higher than 1.5 mm, (in the light of the recent definitions of the supra-crystal tissues attachment from the AAP and EFP Consensus), it is possible to precede to the restorative therapy without performing any of the crown-lengthening techniques.

The video describes step by step the passages

Fig. 5

Once the operative field is properly isolated (in this clinical case with 2 different clamps on the elements 3.6 and 3.7), the rubber dam must be heated into the sulcus in order to evince the most apical aspect of the cavity margin. 

The video describes step by step the passages

Fig. 6

A clinical occlusal picture of the reconstruction after the concluding adhesive passages and the cervical margin relocation techniques (before finishing and polishing).

The materials used were: 

  • 37% ortho-phosphoric acid  (Dentoetch, Itena Clinical) 
  • primer and bonding  (QuickBond, Itena Clinical) (applied as suggested by the manufacturer) 
  • Nano - filled composite dual cure material(Dentocore Body, Itena Clinical) for the CMR technique.
  • several layers of reflectys composite (Itena Clinical) for the restoration
  • brown stain into the sulcus
Fig. 7

Occlusal view of the reconstruction before removing the rubber dam

Fig. 8

Products used for the restoration

Fig. 9

Post operative peri-apical X-ray.


Based on author knowledge and experience, the nano - filled composite dual cure material (Dentocore Body, Itena Clinical) may be used for the cervical margin restoration technique. 

(ITENA CLINICAL) and ITENA Clinical's Reflectys Universal Restorative Composite seem to be perfect to achieve a strong structure and obtain an aesthetic satisfactory result.

However high-quality clinical trials are needed and , in clinical cases in which   

 It’s highly recommended to make the right diagnosis and the correct treatment plan before starting 


  1. D. Dietschi, R. Spreafico, Adhesive metal-free restorations: current concepts for the esthetic treatment of posterior teeth, Quintessence 2 (1997) 60–77. 
  2. D. Dietschi, R. Spreafico, Current clinical concepts for adhesive cementation of toothcolored posterior restorations, Pract. Periodontics Aesthet. Dent. 10 (1998) 47–54. 
  3. Ercoli, C., & Caton, J. G. (2018). Dental prostheses and tooth-related factors. Journal of Clinical Periodontology, 45(5S), S207–S218.
  4. Veneziani M. Adhesive restorations in the posterior area with subgingival cervical margins: new classification and differentiated treatment approach. Eur J Esthet Dent. 2010 Spring;5(1):50-76.
  5. Discepoli N, Marruganti C, Santoro F, Mirra R, Fiorino F, Medaglini D, Pozzi G, Ferrari M, Grandini S. Impact of interproximal composite restorations on periodontal tissue health: Clinical and cytokine profiles from a pre-post quasi-experimental study. J Periodontol. 2022 Jun;93(6):911-923. Olsburg S. Graduation thesis. Geneva: Geneva University, 2000. 
  6. Estafan D, Estafan A. Flow- able composite: a microleak- age study. J Dent Res 1998;77:938-942. 
  7. Vacek JS, Gehr ME, Asad DA, Richardson AC, Giambarresi LI. The dimen- sions of the human dento- gingival junction. Int J Peri- odontics Restorative Dent 1994;14:154-165.
  8. De Sanctis M, Clementini M. Flap approaches in plastic periodontal and implant surgery: crit- ical elements in design and execution. (2014). Journal of Clinical Periodontology. 2014. 41(s15), S108–S122.