One of the most common challenges dentists face during clinical work is dealing with high spots after placing a composite restoration. At first, your composite may look perfect — great contour, beautiful anatomy — but as soon as you check the occlusion, you find a high spot.

If not addressed properly, this can lead to discomfort for the patient and even postoperative complications. However, removing high spots without compromising your restoration’s anatomy requires a precise approach.

Why High Spots Are a Problem

A high spot in a restoration means that when the patient bites, there’s excessive contact pressure at a certain point. This makes the tooth feel as if they’re “biting on a stone” or “a small pebble.”

If left untreated, it can cause transient apical periodontitis, leading to pain during chewing. Many patients will return complaining that the filling hurts “especially when biting down.”

Ignoring the issue is not an option — the patient may stop chewing on that side altogether or demand that the filling be replaced.

The Risks of Over-Correction

Some dentists try to solve the problem by lowering the composite until the high spot disappears. But if you remove too much material, you risk creating under-occlusion. This can cause the opposing tooth to over-erupt over time, changing the contact points and possibly leading to:

• Open proximal contacts

• Class II cavities

• Food impaction

• Periodontal pockets

That’s why a balanced occlusion is essential — not too high, not too low.

How to Prevent High Spots Before They Happen

A smart way to avoid losing your carefully crafted anatomy is to perform pre-articulation or a pre-occlusion check before starting the restoration:

1- Take occlusal records before preparation to identify natural contact points.

By working around these zones, you reduce the need for extensive adjustments later.

The Best Way to Check Occlusion

After completing your restoration:

1- Dry the tooth surface — moisture can cause ink from the articulating paper to spread and give false readings.

2- Use two-color articulating paper — typically blue for static contacts (centric) and red for dynamic contacts (eccentric). The standard blue paper is usually 200 μm thick.

3- For centric occlusion, ask the patient to bite gently but firmly 2–3 times on the blue paper.

4- Look for “eye spots” or “bull’s eyes” — a blue mark with a white shiny center indicates a high spot. Remove only that central shiny point.

5- For eccentric occlusion (dynamic), switch to red paper and have the patient move right, left, forward, and backward while maintaining occlusion.

Key Principle to Remember

“The lighter the bite, the lighter the mark. The harder the bite, the darker the mark.”

Not every colored mark is a problem. Only high-intensity marks with a central shiny spot indicate excessive contact that should be adjusted.

Final Tips

1- Never let a patient leave without ensuring comfortable occlusion.

2- Remove only true high spots — over-adjustment can be just as harmful as leaving them.

By following a systematic approach to occlusion checking, you can prevent postoperative discomfort, protect your restoration’s anatomy, and ensure long-term patient satisfaction.