Deep Margin Elevation: Current Evidence and a Critical Approach to Clinical Protocols—A Narrative Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear authors,

Thank you very much for your work and the review regarding a relevant topic in restorative dentistry. DME is an interesting topic. Please follow the instructions for authors of “Adhesives”

Please adjust the title to a more specific aim of your review and give the kind the kind of review also in the title. This would increase reader´s interest in your research.

Abstract: Please give detailed information about the search strategy and the databases used. Material and Methos are missing. Please also give more information about the results of your search and the included studies. Please give a clear aim and hypothesis of your work also in the abstract. A clinical conclusion including the results of your literature search should be included.

Keywords: Please adjust the keywords to a clear aim. Thank you. The key words should be formatted ifollwing the requirements of the journal.

Introduction: Deep margin elevation is an interesting topic in the field. However, your review should follow a clear aim and hypothesis. Please add and clarify the aim regarding your used search strategy.

Material and Methods: Please give detailed information about the established Pico question resulting in your search strategy. I recommend adjusting the search strings and clarifying the search and adjust this section to the title aim and entire manuscript. “proximal box elevation” was not used as search string. Please explain. Furthermore, please explain in the discussion section why Web of Science was not used as database. Please add.

Conclusion: Please give a clear conclusion based on the results of your literature search, The actual conclusion could be more specific. Thank you.

Author Response

For Narrative Review

Response to Reviewer 1

Summary: Thank you for your insightful comments and suggestions. 

Comment 1: "Please adjust the title to a more specific aim of your review and give the kind the kind of review also in the title"

Response 1: Thank you for your comments. We revisited the review's title and added a clear statement regarding the kind of review. 

Comment 2: Please give detailed information about the search strategy and the databases used. Material and Methos are missing. Please also give more information about the results of your search and the included studies. Please give a clear aim and hypothesis of your work also in the abstract. A clinical conclusion including the results of your literature search should be included.

Response 2: In Page 1/ Lines 13-19, we added the Materials and Methods of the review, as well as the clear aim and hypothesis of the study. In Page 1/Lines 22-24 we added a clinical conclusion based on the included literature.

Comment 3: Keywords: Please adjust the keywords to a clear aim. Thank you. The key words should be formatted ifollwing the requirements of the journal.

Response 3: Thank you for your comment. The keywords have been revised to better reflect the aim of the review and have been formatted according to the journal’s guidelines.

Comment 4:Introduction: Deep margin elevation is an interesting topic in the field. However, your review should follow a clear aim and hypothesis. Please add and clarify the aim regarding your used search strategy.

Response 4: In Page 2/ Lines 56-61, we added the clear aim and search strategy of the review. 

Comment 5:Material and Methods: Please give detailed information about the established Pico question resulting in your search strategy. I recommend adjusting the search strings and clarifying the search and adjust this section to the title aim and entire manuscript. “proximal box elevation” was not used as search string. Please explain. Furthermore, please explain in the discussion section why Web of Science was not used as database. Please add.

Response 5: Thank you for pointing it out. In Page 2/ Lines 68-82, we clearly stated the PICO question of our search and we connected our search strategy to the aim of the review. We also elaborated on why Web of Science was not included. Proximal box elevation was in fact included in the key words. 

Comment 6: Conclusion: Please give a clear conclusion based on the results of your literature search, The actual conclusion could be more specific. Thank you.

Response 6: We sought to extract clinically relevant recommendations from the available literature and to determine more specifically whether our hypothesis was supported by the evidence. Page 25/ Lines 431-442.

We would like to thank you again and we are open to new assessments and comments.
Best regards,
The authors of the manuscript.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Introduction

• Considering already published reviews on deep margin elevation procedures, the rationale of this review should be explained more in the introduction section, outlining existing gaps in the literature.

Materials and methods:

• It is not clear if there were any exclusion criteria.
• What was the rationale for the inclusion of review articles in this study?

Results:

• The authors mentioned that 309 and 33 research items were identified in PubMed and the Cochrane Library, while 1499 were identified in the Scopus database. If all the items of PubMed and Cochrane Library (309 + 33) were duplicated in Scopus (1499), how come the research items after removal of the duplicates are 427? Please explain.
•  
• The included items should have been summarized, providing adequate details, considering the study's characteristics (materials used, techniques, aging, groups, investigations, etc) and the study's outcome, in two separate tables.
• The clinical images with figures 4, 5, 7, and 9 should be labeled, indicating the details of the procedure.
• Figure 8 has no caption.

Conclusion:

"Minor violations of the junctional epithelium are generally tolerated, but extension into connective tissue must be avoided." The authors should specify precisely what is meant by minor and extensive violations of the junctional epithelium.

Author Response

For Narrative Review

Response to Reviewer 2

Summary: The authors sincerely thank you for your thorough review of our manuscript. Please find below the detailed responses to your observations and suggestions.

Comment 1: 

Introduction

• Considering already published reviews on deep margin elevation procedures, the rationale of this review should be explained more in the introduction section, outlining existing gaps in the literature.

Response 1: 

Page 2/ Lines 56-66: Thank you for pointing this out. We have added a clear statement of the aim as well as the scope of this review, explaining the limitations of current literature on the topic. 

Comment 2: 

Materials and methods:

• It is not clear if there were any exclusion criteria.
• What was the rationale for the inclusion of review articles in this study?

Response 2: 

Page 3 / Lines 83-89: We have added a paragraph clearly stating inclusion & exclusion criteria of the review. 

Comment 3: 

Results:

• The authors mentioned that 309 and 33 research items were identified in PubMed and the Cochrane Library, while 1499 were identified in the Scopus database. If all the items of PubMed and Cochrane Library (309 + 33) were duplicated in Scopus (1499), how come the research items after removal of the duplicates are 427? Please explain.

Response 4: 

Thank you for your insightful comment. The observed discrepancy arises from the fact that while Scopus indexed a large number of search results, the majority of these were irrelevant to dentistry despite inclusion of appropriate key words. Therefore, in addition to removing duplicates, we excluded evidently irrelevant studies prior to screening based on abstract. We also stated clearer exclusion criteria in further stages.

This has now been clearly stated  in the updated PRISMA flow diagram. Page 3/Figure 1

Comment 5: 

• The included items should have been summarized, providing adequate details, considering the study's characteristics (materials used, techniques, aging, groups, investigations, etc) and the study's outcome, in two separate tables.

Response 5: 

We have added 5 tables (one for each type of study) including key information on each of the included studies (author, date, type of study, materials/methods, aging simulation / means of evaluation, groups compared, main outcome). Page 10-17 / Tables 1-5.

Comment 6: 

• The clinical images with figures 4, 5, 7, and 9 should be labeled, indicating the details of the procedure.

Response 6: 

Thank you for your observation. Labels have been added , guiding the readers through each step of the depicted procedures. 

Comment 7: 

• Figure 8 has no caption.

Response 7: 

A caption has been added to Figure 8. 

Comment 8:

Conclusion:

"Minor violations of the junctional epithelium are generally tolerated, but extension into connective tissue must be avoided." The authors should specify precisely what is meant by minor and extensive violations of the junctional epithelium.

Response 8: 

Thank you for your comment. We agree that greater precision was needed. A quantitive clarification has been added to the conclusion. Page 25  / Lines 433-437.

Comment 9: 

The English could be improved to more clearly express the research.

Response 9:

Thank you for your comment regarding the language quality. While we respectfully disagree with the extent of the initial assessment, we have reviewed and revised the entire manuscript thoroughly, to ensure clarity and meet the journal's standards. We trust that  the revised manuscript meets the expected level of fluency. 

We would like to thank you again and we are open to new assessments and comments.
Best regards,
The authors of the manuscript.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The abstract (lines 9-19) summarizes the topic well but does not provide specific data from the reviewed studies. Adding key numerical outcomes would strengthen it.

 

Lines 73-91 describe the literature search but do not specify the exact number (only reffers to te graph)

 

The review does not critically discuss potential biases or limitations of included studies (for examplee small sample sizes,

 

Terms like STA (supracrestal tissue attachment) are introduced but sometimes not defined immediately or consistently used (lines 133-137). Explain what it is at the first use and later just follow that short form

 

The review focuses on technical and biological aspects but does not discuss patient comfort, satisfaction, or cost-effectiveness. Also disadventages after tooth extraction as an alternative could be added (alveolar ridge collapse when tooth is extracted when no socket shield or SPOT technique is performed).

 

Its small suggestions - authors did a great job in significant problem

Author Response

For Narrative Review

Response to Reviewer 3

Summary: Thank you for taking the time to review this manuscript. Please find below our detailed revisions. 

Comment 1:

The abstract (lines 9-19) summarizes the topic well but does not provide specific data from the reviewed studies. Adding key numerical outcomes would strengthen it.

Response 1: 

Thank you for your observation. We agree that adding key information from the search results would enhance the abstract. We have thus revised it accordingly. Page 1/ Lines 16-18. 

Comment 2: 

Lines 73-91 describe the literature search but do not specify the exact number (only reffers to te graph)

Response 2: 

Thank you for your comment, we agree that further clarification of the search results would increase transparency of our methodology. We have added a paragraph analysing the distribution of included  studies. Page 4/ Lines 105-109.

Comment 3: 

The review does not critically discuss potential biases or limitations of included studies (for examplee small sample sizes,

 Response 3:

We agree with your observation.  We have added a paragraph discussing key limitations of the included studies. Page 4/ Lines 110-117

Comment 4: 

Terms like STA (supracrestal tissue attachment) are introduced but sometimes not defined immediately or consistently used (lines 133-137). Explain what it is at the first use and later just follow that short form

Response 4: Thank you for your observation. This issue has been dealt with throughout the manuscript. 

Comment 5:

The review focuses on technical and biological aspects but does not discuss patient comfort, satisfaction, or cost-effectiveness. Also disadventages after tooth extraction as an alternative could be added (alveolar ridge collapse when tooth is extracted when no socket shield or SPOT technique is performed).

Response 5:

Thank for your comment. We agree that the implications of tooth extraction should be briefly mentioned. We have added a paragraph discussing decision-making in such scenarios and the importance of maintaing the natural tooth structure. Page 24 / Lines 397-400.

Once again thank you for your helpful comments. 

Kind regards, 

The authors of the manuscript.

 

Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

DRAFT_adhesives-3645646-peer-review-v1

Deep Margin Elevation: current evidence and a critical approach to clinical protocols  

Overall Assessment

This work addresses a pertinent clinical issue. The article provides an extensive and up-to-date review of the Deep Margin Elevation (DME) technique, covering its foundational principles, clinical applications, materials used, periodontal response, and success rates. The structure is logical, clear, and didactic, with significant educational value. However, the review is marred by notable methodological flaws, as well as graphical and analytical issues that compromise its scientific rigor.

 

To better understand this article, I suggest reviewing the writing and the specific aspects commented on below.

 Comment 1 – Title

The title is clear and appropriately targeted. The abstract summarizes the objectives and main conclusions.

Comment 2 - Abstract

The abstract could include more specific results and a brief synthesis of the main limitations found in the literature.

Comment 3 – Keywords

It is not usual or standard practice in academic writing to place keywords between quotation marks. Quotation marks can interfere with indexing in databases.

Correct Keywords: deep margin elevation, proximal box relocation, subgingival margins, dental caries

Comment 4 –  Introduction

The introduction provides a solid clinical and historical foundation for the discussion of DME and demonstrates the authors' familiarity with the topic. However, due to its length, lack of methodological framing, and vague objectives, it falls short in clearly defining the purpose and scope of the review. It is informative, but would benefit from greater focus, structure, and critical framing to enhance its academic rigor and reader engagement.

Correct use of updated terms like supracrestal tissue attachment (STA) instead of biologic width shows alignment with contemporary periodontal standards.

BUT:

1. Excessive length and redundancy, with the same challenges of subgingival margins being repeated unnecessarily, which reduces clarity and conciseness.
2. There is no explicit statement of aims or research questions. The introduction does not clarify whether this is a narrative, systematic, or scoping review.
3. Although the topic is justified clinically, the introduction fails to clearly define what is missing in the existing literature (e.g., limited long-term studies, lack of standardized protocols).
4. The transitions between topics are occasionally abrupt, and related ideas could be grouped more logically (e.g., drawbacks of traditional techniques vs. benefits of DME).
5. Clearly state the review type and define the objectives at the end of the introduction.
6. Briefly mention the methodology (databases, criteria, timeframe) to establish credibility.
7. Identify the main gaps in the current literature that the review aims to address.
8. Improve flow and coherence by grouping related concepts more effectively.

Comment 5 –  Methodology

The methodology reflects a structured approach typical of a narrative review, incorporating a targeted search strategy across major databases (PubMed, Cochrane, Scopus) and using relevant keywords combined with Boolean operators. Inclusion and exclusion criteria are appropriately defined, and the time frame (1998–2024) aligns with the development timeline of the DME technique.

BUT:

1. The use of a PRISMA-style flowchart helps visualize the selection process, though it may give the impression of a systematic review.
2. The review lacks key methodological elements expected in systematic work, such as AMSTAR, ROBINS-I, or GRADE tools.
3. There is no formal critical appraisal of included studies, no evidence stratification, and no mention of multiple reviewers involved in screening, which reduces transparency and introduces potential bias.
4. The grouping of heterogeneous study types—clinical, in vitro, case reports, and opinion articles—without clarification of how their findings were synthesized or weighted further weakens the analytical framework.
5. To improve, the authors should clearly state the narrative nature of the review, explain how evidence was interpreted based on study type, and describe the synthesis method used (e.g., thematic, by outcome). Even without formal scoring tools, discussing the relative strength of evidence would enhance the interpretability of results.
6. Clarifying whether the review process involved more than one reviewer would also strengthen its methodological credibility. The process for removing duplicates, extracting data, and resolving disagreements is not described, which reduces methodological rigor.
7. While the methodology is acceptable for a narrative review, it risks being misinterpreted as systematic due to structural elements like the PRISMA diagram. Greater clarity regarding review type, evidence interpretation, and synthesis would reinforce the article’s scientific transparency.

8. Search Timeline vs. References

   The authors state that the literature search was conducted up to December 2024; however, several references cited in the manuscript are from 2025, including works marked as "in press" or already assigned to 2025 volumes (e.g., reference [5]). This discrepancy raises concerns about the transparency and consistency of the search process.

   While it is plausible that the authors included early access or pre-publication material, this should be explicitly clarified in the methodology section. For example, it would be appropriate to state whether articles "ahead of print" or with DOIs assigned in 2025 were included after the formal search cutoff. If the inclusion of post-2024 references was intentional, the search period should be adjusted accordingly (e.g., “up to February 2025”).

   Without this clarification, readers may question the completeness and reproducibility of the review. Transparent reporting of the search timeline and selection criteria is particularly important for reviews aiming to guide clinical practice or synthesize current evidence.

Comment 6 –  Discussion

The discussion provides a rich, multifaceted overview of Deep Margin Elevation, integrating mechanical, clinical, and periodontal perspectives. However, it suffers from fragmentation, redundancy, and a lack of critical synthesis across evidence types. Strengthening the structure, prioritizing evidence, and highlighting future research avenues would substantially enhance the scientific impact and clinical value of the discussion.

Items to reconsider:

1. Despite covering many topics, the discussion lacks a clear narrative hierarchy. Findings are presented in a segmented fashion without integrating the strength or quality of evidence behind each conclusion. There is no attempt to summarize “what is well supported” vs. “what remains uncertain.” Suggestion: Organize the discussion thematically or based on clinical relevance, ranking findings by evidence strength.
2. In vitro findings, case reports, and clinical trials are discussed in the same terms, without clear distinction in evidentiary weight. This can be misleading, especially in areas like periodontal response or long-term failure rates. Suggestion: Clearly distinguish insights based on clinical studies vs. in vitro or theoretical models.
3. Some arguments are repeated across subsections (e.g., the importance of respecting the supracrestal tissue attachment or the impact of isolation), which could have been consolidated for conciseness and clarity. Suggestion: Avoid repeating clinical advice unless supported by new evidence or context.
4. Although alternatives like crown lengthening and orthodontic extrusion are mentioned, their limitations are briefly reviewed without a critical or evidence-based comparison to DME in terms of patient-centered outcomes, healing time, or cost-effectiveness.

Suggestion: Include a comparative analysis of DME vs. alternative techniques using literature data.

1. While limitations are acknowledged, the discussion does not sufficiently elaborate on future research needs. For instance, more emphasis could be placed on the need for randomized clinical trials, standardized outcome measures, or evaluation of DME in anterior esthetic zones. Suggestion: Dedicate a specific subsection to future directions and research priorities.
2. The discussion would benefit from a final summarizing paragraph that clearly states the practical implications and the main evidence-based conclusions drawn from the review. Suggestion: Conclude the discussion with a concise synthesis of key clinical takeaways.

 Comment 7 –  Conclusions

Appropriate but somewhat generic. It lacks clinically actionable recommendations based on levels of evidence or strength of recommendation.

Suggestion: Deep Margin Elevation (DME) offers a minimally invasive solution for managing subgingival margins, enhancing isolation and adhesive control in posterior restorations. When performed with proper case selection, maintaining at least 2 mm distance from the alveolar crest and using appropriate materials and adhesive protocols, DME shows promising clinical potential. High-filled flowable or preheated composites are the most supported materials. Despite encouraging short-term outcomes, the current evidence is limited by heterogeneity and a lack of long-term clinical trials. Further research is needed to confirm the biological compatibility and long-term success of DME, particularly in complex or anterior cases.

 Comment 8 – References

They are comprehensive and updated by 2025,  and include relevant and recent articles.

There are some inconsistencies in formatting and lack of complete data for in-press studies. Standardize references according to Adhesives journal.

Example:

1. Sadeghnezhad P; Sarraf Shirazi A; Borouziniat A; Majidinia S; Soltaninezhad P; Nejat AH. Enhancing subgingival margin restoration: a comprehensive review and meta-analysis of deep margin elevation's impact on microleakage. Evid Based Dent https://doi.org/10.1038/s41432-024-01028-0
2. Aldakheel M; Aldosary K; Alnafissah S; Alaamer R; Alqahtani A; Almuhtab N. Deep margin elevation: current concepts and clinical considerations: a review. Medicina (Kaunas) 2022, 58, 1482. https://doi.org/10.3390/medicina58101482
3. Palma PJ; Neto MA; Messias A; Amaro AM. Microtensile bond strength of composite restorations: direct vs. semi-direct technique using the same adhesive system. J Compos Sci 2025, 9, 203. https://doi.org/10.3390/jcs9050203

Comment 9 – Figure captions

Figure 1 –  PRISMA instead of Prisma

Figure 2 - ??

 

Final Suggestions:

• Improve figures and visual data presentation.
• Expand discussion on knowledge gaps and practical clinical implications.

Author Response

For Narrative Review

Response to Reviewer 4

Summary: Thank you for taking the time to review this manuscript. Your comments were insightful and enhanced our review's transparency and structure. Please find below  the detailed revisions of the manuscript based on your comments.

Comment 2: The abstract could include more specific results and a brief synthesis of the main limitations found in the literature.

Response 2: Thank you for pointing this out. In Page 1/Lines 13-19 & 22-25, we added a description of the search strategy, the aim of this review, as well as a brief presentation of limitations found in available literature.

Comment 3: It is not usual or standard practice in academic writing to place keywords between quotation marks. Quotation marks can interfere with indexing in databases.

Correct Keywords: deep margin elevation, proximal box relocation, subgingival margins, dental caries

Response 3: Thank you for your comment. We placed the keywords accordingly.

Comment 4.1,2: Introduction. 

1. Excessive length and redundancy, with the same challenges of subgingival margins being repeated unnecessarily, which reduces clarity and conciseness.
2. There is no explicit statement of aims or research questions. The introduction does not clarify whether this is a narrative, systematic, or scoping review.
3. Although the topic is justified clinically, the introduction fails to clearly define what is missing in the existing literature (e.g., limited long-term studies, lack of standardized protocols).

Response 4.1,2,3: The Introduction (Pages 1-2/Lines 32-66) was reconstructed in order to be more concise. Repetitive content regarding challenges of sungingival margins has been minimized (Page 1/Lines 33-37). In Page 2/ Lines 56-66, we have added a clear statement of the kind of the review, the aim of this study, and the limitations found in the available literature.

Comment 4.4,5,6,7,8: 

4.The transitions between topics are occasionally abrupt, and related ideas could be grouped more logically (e.g., drawbacks of traditional techniques vs. benefits of DME)

5.Clearly state the review type and define the objectives at the end of the introduction.

6.Briefly mention the methodology (databases, criteria, timeframe) to establish credibility.

7.Identify the main gaps in the current literature that the review aims to address.

8.Improve flow and coherence by grouping related concepts more effectively.

 Response 4.4,5,6,7,8: 

Thank you for your insightful feedback. We tried to follow a more logical structure in the Introduction. Challenges by subgingival margins --> Traditional Solutions and their issues --> Development of DME & its benefits & limitations in current literature  --> Scope ,  Aim of current review & Brief presentation of Methodology.

Comment 5.3,4: 

3.There is no formal critical appraisal of included studies, no evidence stratification, and no mention of multiple reviewers involved in screening, which reduces transparency and introduces potential bias.

4.The grouping of heterogeneous study types—clinical, in vitro, case reports, and opinion articles—without clarification of how their findings were synthesized or weighted further weakens the analytical framework.

Response 5.3,4: 

In Page 3 / Lines 91-99, we incorporated a paragraph describing the process of studies selection. Furthermore, in Lines 110-117 we added a paragraph discussing the nature of the included studies, and the limitations of their methodology. 

Comment 5.5,6,7,8:

1. To improve, the authors should clearly state the narrative nature of the review, explain how evidence was interpreted based on study type, and describe the synthesis method used (e.g., thematic, by outcome). Even without formal scoring tools, discussing the relative strength of evidence would enhance the interpretability of results.
2. Clarifying whether the review process involved more than one reviewer would also strengthen its methodological credibility. The process for removing duplicates, extracting data, and resolving disagreements is not described, which reduces methodological rigor.
3. While the methodology is acceptable for a narrative review, it risks being misinterpreted as systematic due to structural elements like the PRISMA diagram. Greater clarity regarding review type, evidence interpretation, and synthesis would reinforce the article’s scientific transparency.

4. The authors state that the literature search was conducted up to December 2024; however, several references cited in the manuscript are from 2025, including works marked as "in press" or already assigned to 2025 volumes (e.g., reference [5]). This discrepancy raises concerns about the transparency and consistency of the search process.

   While it is plausible that the authors included early access or pre-publication material, this should be explicitly clarified in the methodology section. For example, it would be appropriate to state whether articles "ahead of print" or with DOIs assigned in 2025 were included after the formal search cutoff. If the inclusion of post-2024 references was intentional, the search period should be adjusted accordingly (e.g., “up to February 2025”).

   Without this clarification, readers may question the completeness and reproducibility of the review. Transparent reporting of the search timeline and selection criteria is particularly important for reviews aiming to guide clinical practice or synthesize current evidence.

Response 5.5,6,7,8: 

In the updated Materials & Methods, we clearly state the review type, the selection process, and the number of reviewers involved (Pages 2-3/ Lines 83-99). 

The search period has been updated accordingly (1998- February 2025). 

Comment 6: Suggestion: Organize the discussion thematically or based on clinical relevance, ranking findings by evidence strength.

1. In vitro findings, case reports, and clinical trials are discussed in the same terms, without clear distinction in evidentiary weight. This can be misleading, especially in areas like periodontal response or long-term failure rates. Suggestion: Clearly distinguish insights based on clinical studies vs. in vitro or theoretical models.
2. Some arguments are repeated across subsections (e.g., the importance of respecting the supracrestal tissue attachment or the impact of isolation), which could have been consolidated for conciseness and clarity. Suggestion: Avoid repeating clinical advice unless supported by new evidence or context.
3. Although alternatives like crown lengthening and orthodontic extrusion are mentioned, their limitations are briefly reviewed without a critical or evidence-based comparison to DME in terms of patient-centered outcomes, healing time, or cost-effectiveness.

Suggestion: Include a comparative analysis of DME vs. alternative techniques using literature data.

1. While limitations are acknowledged, the discussion does not sufficiently elaborate on future research needs. For instance, more emphasis could be placed on the need for randomized clinical trials, standardized outcome measures, or evaluation of DME in anterior esthetic zones. Suggestion: Dedicate a specific subsection to future directions and research priorities.
2. The discussion would benefit from a final summarizing paragraph that clearly states the practical implications and the main evidence-based conclusions drawn from the review. Suggestion: Conclude the discussion with a concise synthesis of key clinical takeaways.

Response 6: The Discussion section has been reconstructed thematically, following key clinical aspects (Adhesive Strategies and Material Selection for Deep Margins, Mechanical Behavior and Stress Distribution, Long-Term Clinical Performance and Failures, . Periodontal Implications and Biological Integration, . DME Compared to Alternative Margin Management Techniques, . DME Compared to Alternative Margin Management Techniques, Future Research Directions,, Summary and Clinical Recommendations)

We have added  the evidentiary weight of every reference in the Discussion by mentioning the type of study , and in case of in vitro studies, the indexes utilized. 

We minimized redundancy and added an observation on lack of comparative studies for DME and alternative techniques regarding outcome, healing time, cost-effectiveness.

We have also added two paragraphs: one for future research directions and one for summary of findings and conclusions. Pages 24-25/ Lines 413-429.

Comment 7: Conclusion

Appropriate but somewhat generic. It lacks clinically actionable recommendations based on levels of evidence or strength of recommendation.

Response 7: Conclusion was updated accordingly. 

Comment 8:References

Response 8: References have been updated to Adhesives  format.

Comment 9: Figure captions

Figure 1 –  PRISMA instead of Prisma

Figure 2 - ??

Response 9: Numerization and structure of figures has been corrected.

Once again thank you for your constructive comments. We are open to new assessments and comments. 

Kind regards,

The authors of the manuscript.

 

 

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

 I thank the authors for implementing the suggested points in the revised manuscript. All points raised during round oune were addressed. The manuscript is significantly improved and presents a well organized and more valuable contribution to the field.

Author Response

For Narrative Review-Minor Revisions

We sincerely thank the reviewer for their positive and encouraging feedback. We truly appreciate the insightful comments and suggestions provided during the first round.

Kind regards,

The Authors' team

Reviewer 4 Report

Comments and Suggestions for Authors

General Assessment:
The revised manuscript demonstrates significant improvement in clarity, language precision, and structural coherence. The authors have clearly taken into account the initial feedback and have made notable efforts to enhance the scientific presentation and readability of the text.
The abstract is now more concise and better aligned with the study’s objectives and findings.
The introduction has been refined for greater focus and relevance.
Methodological reporting, particularly regarding inclusion criteria and search strategy, has improved in precision.
The overall language quality is more fluid and professional, contributing to improved comprehension.
The discussion, in particular, could still benefit from minor stylistic tightening to avoid redundancy.

Consider cross-checking consistency in terminology across sections (e.g., "proximal box elevation" vs. "deep margin elevation") to avoid ambiguity.
Ensure all references conform strictly to the journal's required citation style (some inconsistency persists).

Reference 1
Improper punctuation, missing semicolon between authors, year/date formatting inconsistent.
Correction needed to match: Sadeghnezhad P.; Sarraf Shirazi A.; Borouziniat A. etc.

Reference 2
Same issues as above — authors not separated by semicolons, journal name not abbreviated as per standard.

Reference 4
Title capitalization inconsistent, author separation not using semicolons.

Reference 5
Medicina 2023, 59, 1948. — but should ensure semicolons and author formatting match journal style.

Reference 6
Uses inconsistent formatting with full names and missing proper semicolons.

Reference 7
Not in journal-abbreviation format (should be BMC Oral Health 2024, 24, 1498); uses non-standard sentence structure.

Reference 8
Misplaced commas in author names and inconsistent formatting.

Reference 9
Marked "in press" — this should be handled in a standardized placeholder format if publication details are missing.

Reference 10
Journal abbreviation is long and not abbreviated (e.g., Dental Press J Orthod.), and punctuation is inconsistent.

Reference 12
This is a book, not a journal article. The format is not appropriate for journal citations.

Reference 18
This is a website. It does not follow the format for journal articles and should be clearly separated from the numbered list.

Reference 31
Formatted as an abstract or conference paper (e.g., “127 - Effect…”), with incorrect volume/page formatting and missing semicolon-separated author list.

Reference 56
Has inconsistent punctuation and formatting, and includes commas after author names.

Reference 55
Includes a DOI but is a journal article in magazine format (Dental Update), with inconsistent citation style.

Author Response

For Narrative Review- Minor Revisions

Thank you very much for your constructive comments and valuable suggestions. We have carefully revised the manuscript accordingly:

• The references have been updated to fully comply with the MDPI referencing format.

• With regard to reference no. 18, we have clarified in the Methodology section that this online source informed the development of our literature search strategy. To maintain consistency and transparency in citation, we have retained it within the numbered reference list. Page 3/Lines 100-103

• In the Discussion section, several paragraphs were merged to improve flow and enhance readability, avoiding excessive segmentation.

We sincerely hope that these revisions meet your expectations and contribute to the overall quality of the manuscript.

Kind regards,
The authors' team

Author Response File: Author Response.pdf