In this video, I review how to repair a pit in a composite restoration. The key to being efficient with your pit repair is to identify the pit early in the contouring process. This video (and blog) is meant to guide the clinician thru the steps to create a seamless repair.
OK, you are contouring and/or polishing your composite restoration, and there it is—the dreaded pit. So, really, you have two choices—deal with it now, or deal with it later. Let’s deal with it now.
If you’ve starting polishing the restoration, you need to go back and roughen the composite with either a fine diamond bur or a coarse disc. I tend to use my coarse Flexidisc from Cosmedent. Very gently now—I don’t want to change the shape or form of the restoration—I just need the surface not to be smooth or polished.
Now here is the question—is the pit only in composite or is the pit also in tooth structure? A second question—if the pit is in tooth structure, is it in enamel, or dentin, or both? Most commonly, the composite pits are superficial, so it is likely that the pit is only in composite. If the pit or repair is on tooth structure also, you’ll see the difference in technique in Step 5, so hang in there.
Essentially, you need to eliminate the pit by creating a deepened chamfer. Do not just create a deeper pit because that will make it much more difficult to disguise the repair in the final restoration. And don’t try to just fill in the small pit, because it is really difficult to get the composite to fill into the small pit. So, create a chamfer by using a large round diamond bur (I usually use Brassler’s #6 or #8 coarse round diamond (black stripe). I create the chamfer just to the depth of the bottom of the pit. There is no need to go any deeper.
If you are in composite only, there is no need to etch with phosphoric acid. It won’t hurt the composite, but it is not going to increase the bond strength. I tend to etch anyway thinking maybe it will help clean the composite and maybe that will help me sleep better tonight when I lay my head on my pillow and think of all the good I have done for my patients’ teeth.
Anyhow, if you etch, rinse, and dry thoroughly, you need to do that isolation thing again.
***If you are also in enamel, etch, rinse, and dry like above, however if you are in dentin (or the root surface), you will need to leave the dentin moist but make sure the composite is dry. I do this by drying everything with air. Then with a moistened microbrush I’ll remoisten the dentin surface. Also, for self-etch users, you can use a self-etch protocol. Use your SE primer on the dentin (or root surface), then use the bonding agent over everything, and then air thin.
Place an unfilled adhesive (bonding agent) over the composite, beyond the chamfer area, onto the roughened composite surface. Air thin thoroughly.
Do NOT light cure! That’s right – do not light cure the bonding agent. Why? This is because the purpose of the bonding agent/adhesive is to act as a wetting agent to allow the new layer of composite to blend into the existing composite. The bonding agents that we have in dentistry are slightly yellow, so in my experience (ahhh, the dreaded experience), I found that if I cured the bonding agent first, then placed my composite—when I went back and polished back the new composite, there was a yellow ‘ring’ around my repair. A little ‘Bulls-eye’ if you will. So instead, air thin, do not light cure.
Place the same composite as you used for the facial surface. I often use Cosmedent’s Renamel microfill for my final surface layer, so I have a couple of options. I can pull out the microfill flowable composite (same shade as the layer I placed) or just use the same microfill that I already have on my resin keeper.
Here’s a tip though—especially for these pit repairs, I like my composite to be easily ‘spreadable’, so I will typically have my dental assistant place the resin keeper pad on my composite warmer (I use AdDent’s Calset Composite Warmer). I slice off a piece of composite and with my gloved fingers (cleaned with alcohol gauze) and I roll the composite into a ball.
I place the warmed ball of composite over the chamfer, then use my thin bladed titanium coated IPC instrument to blend and feather the composite onto the composite surface. I try to blend onto the existing composite as smoothly as possible.
* If you are using the microfill in the compules, warm the compule in AdDent’s warmer and inject the composite into the pit and overfill.
I still use my halogen curing lights, so I like to cure my microfill (and nano) composites for a full 60 seconds.
Gently use coarse discs, working from new composite to existing composite, without water spray, to blend the composites together. As you work the disc over the margin from the new to old composite, you will initially see a white line. This white line is where the composite is not ‘honed’ down to the previous layer and a layer of composite dust is showing you were there is still a ‘step’ between the materials. Keep working the disc gently over the margin and you will see the white line disappear like magic!
Do a final polish with discs (again I use the Flexidisc system). Then finish with your polishing paste (Enamelize, Cosmedent) with a felt Flexi-buff. Rinse and remove cotton rolls/isolation.
Pat yourself on the back because both you and your patient get to smile now—pit-free restorations!
