Restoring proximal cavities of molars using the proximal box elevation technique: Systematic review and report of a case

Objective: For decades, dental restorative treatment of large and deep cavities of posterior teeth has been adequately ensured by amalgam or by indirect gold restorations; with the continuing advancements in material technology and clinical techniques, alternative and more esthetic types of restorations have become feasible. Proximal box elevation (PBE) using composite resins has been advocated for relocating subgingival cavity outlines; treatment success and effects of PBE require documentation. Data Sources: An electronic search was performed on several literature databases to identify relevant articles published in indexed journals until April 2015. Method and Materials: The authors independently screened the relevant papers found (PBE with composite resins). Results: This paper compiles the current knowledge about PBE (which is predominantly based on laboratory research, in particular with a focus on microleakage and marginal adaptation), revealing that flowable composites allow for a stepwise elevation of proximal cavity floors, thus simplifying treatment of deep lesions, and broadening the restorative spectrum. A case report revealing an advanced caries lesion and demonstrating the clinical application of the PBE technique together with an indirect computer-aided design/computer-assisted manufacture (CAD/CAM) all-ceramic restoration is presented, assuring the practitioner's familiarity with effective placement techniques. Conclusion: PBE represents a promising two-step treatment regimen, simultaneously encompassing the benefits of immediate dentin sealing and facilitating direct or indirect adhesive restorations of cavities with margins located beneath the gingival tissues. However, high-quality randomized clinical trials are required to confirm the laboratory outcomes. Keywords: advanced caries lesion, caries diagnosis, CEREC, gingivitis, margin relocation, open-sandwich restoration, proximal box elevation, proximal margin elevation technique