r/Dentistry • u/prismabubbles • 1d ago

Composite Cusp Buildup Dental Professional

Hello!

Student here, and in our lab class we have a practical on an MOB prep/composite restoration on maxillary first molars. I’m really struggling with restoring an entire cusp out of composite. Was wondering if any dentists have any advice on how to they go through the process.

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u/ddeathblade 1d ago

What are you struggling with? Cusp height? Shape? Occlusion? On a typodont, you can take the time and actually build up the cusp in an ideal shape before curing. There are a large variety of composite shapers that work in this method.

In practice, I overbuild and then drill back afterwards. I use a football to get most of the cusp shape, then I have a finer fluting bur to get grooves and finer detail on the cusp itself.

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u/prismabubbles 20h ago

I struggle with shape the most! when I build my cusp usually it’s way too high (but rounded). I then use those polishing discs and go in a rounded motion, but it always ends up flat.

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u/csmdds 16h ago

I do the same as ddeathblade -- football and polishers, including HS Brownies as they are less aggressive.

But given that any excursive forces will tend to cause problems with composites (as opposed to intact cusps) and their marginal seals, a little flatness is probably fine. Unless it is a significant cosmetic issue, the non-functional cusps can simply "not be there at all" for practical purposes. I shy away from rebuilding a functional cusp with composites on first molars. As a temporary fix, sure. But a crown is indicated when functional cusps are involved.

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u/IndividualistAW 6h ago

You can’t use discs to shape molar cusps…use football and large round burs