DR. DENNIS HARTLIEB
Composite Pit Repair
Composite Pit Repair
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.
Composite Pit Repair Steps
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.
1. Roughen the composite
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.
2. Rinse well, dry and isolate
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.
3. Create Chamfer
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.
4. Rinse, dry and isolate (again!)
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.
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.
5. Place Adhesive
Place an unfilled adhesive (bonding agent) over the composite, beyond the chamfer area, onto the roughened composite surface. Air thin thoroughly.
6. THE MOST IMPORTANT PART OF THE TECHNIQUE SO DO NOT SKIP AHEAD UNTIL YOU READ THIS NEXT STEP!
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.
7. Place composite
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.
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.
8. Sculpt with proper instrumentation
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.
* 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.
9. Light Cure
I still use my halogen curing lights, so I like to cure my microfill (and nano) composites for a full 60 seconds.
10. Polish
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!
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!
Dennis Hartlieb, DDS, AAACD
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Materials Included
Light Brown tints, Enamelize, Unfilled Resin Flexidiscs, Flexibuffs 1/2", #1 artist’s brush, Silicone Polishing Points, IPC Off Angle Short Titanium Coated Composite Instrument
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Meet Dr. Dennis Hartlieb
Dr. Dennis Hartlieb owns his own practice in Chicago,IL and has been teaching dentistry for over 30 years. Dr. Hartlieb is the CEO and the main instructor at Dental Online Training. He is an active member in the American Academy of Cosmetic Dentistry where he’s both an Accredited Member and Examiner for Accreditation.
Dr. Hartlieb is also the President of the Chicago Academy of Interdisciplinary Dentofacial Therapy, and a member of the prestigious American Academy of Restorative Dentistry.
Dr. Hartlieb is also the President of the Chicago Academy of Interdisciplinary Dentofacial Therapy, and a member of the prestigious American Academy of Restorative Dentistry.
Meet Dr. Angela Luek
Dr. Angela M. Lueck is a Wisconsin native and was the youngest female in her class from Marquette University in 1998. Since completing her residency she has consistently taken more than 100 hours a year of continuing education to keep current on the latest trends, techniques, and materials available in dentistry.
She volunteers her time to teach at Marquette University providing the students additional training with anterior and posterior bonding techniques as well as dental photography. She is also the co-chair of the mentorship program at the University. Dr. Lueck has been voted as one of Milwaukee’s top dentists multiple times by Milwaukee Magazine.
She volunteers her time to teach at Marquette University providing the students additional training with anterior and posterior bonding techniques as well as dental photography. She is also the co-chair of the mentorship program at the University. Dr. Lueck has been voted as one of Milwaukee’s top dentists multiple times by Milwaukee Magazine.
Meet Clare O'Neill
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Clare graduated from Georgia State University with a Bachelor’s degree is Sociology. Clare wanted you to know that she is a dog person, loves the colors emerald green and periwinkle, and would eat french fries at every meal if she could!
Clare graduated from Georgia State University with a Bachelor’s degree is Sociology. Clare wanted you to know that she is a dog person, loves the colors emerald green and periwinkle, and would eat french fries at every meal if she could!
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He has lectured both nationally and internationally for over 25 years and directs several study clubs. Dr. McKee graduated from the University of Notre Dame in 1980 and earned his dental degree from the University of Illinois College of Dentistry in 1984.
He has lectured both nationally and internationally for over 25 years and directs several study clubs. Dr. McKee graduated from the University of Notre Dame in 1980 and earned his dental degree from the University of Illinois College of Dentistry in 1984.
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With over 25 years of experience in the field, Kirk has dedicated his professional life to optimizing the best systems and practices in dentistry.
Kirk Behrendt is the founder of ACT Dental, and his vision is driven by the commitment to provide highly personalized care to the dental profession. By creating a talented team of experts, Kirk and his team continue to positively impact the practice of dentistry on practice at a time. Kirk lectures all over the world to help individuals take control of their own lives.
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Her current research projects involve investigating ceramic overlays, zirconia and salivary contamination of universal adhesives. Dr. Seibert is the creator and host of the top dental podcast, Dental Digest. She lectures to national and international audiences.
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Meet Dr. Sofya Kats
Dr. Sofya Kats is local to Milwaukee, WI. She grew up in Bayside and attended Nicolet HS, UW-Milwaukee and Marquette University School of Dentistry. Dr. Kats is a member of the Greater Milwaukee Dental Association, Wisconsin Dental Association, American Dental Association, and The Forum Study Club (oldest Dental Study Club in the United States).
Dr. Kats loves the art of dentistry, and healing it can bring to her patients. She volunteers her time by going on international dental mission trips and local events, such as the Mission of Mercy (free dental care sponsored by the Wisconsin Dental Association).
Dr. Kats loves the art of dentistry, and healing it can bring to her patients. She volunteers her time by going on international dental mission trips and local events, such as the Mission of Mercy (free dental care sponsored by the Wisconsin Dental Association).