Free Bridge Delivery (Cementation) Note Template (D6740/D6245)
A bridge delivery note has to prove the bridge fit before it was cemented, because afterwards nobody can take it off to check. This template documents the try-in, margins and contacts, how the pontic meets the ridge, the cement you used, the occlusion, and the cleaning instructions the patient needs for the pontic.
By Yasmin Byott, DDS, MS · Founder, ButterNote · Updated
Customize your note
Fill in the fields below and we'll generate a complete clinical note for you in seconds.
Copy-paste template
Replace each [bracketed field] with your specific clinical detail. Brackets are placeholders. They don't get saved into the chart.
Bridge delivery, [3]-unit [zirconia] fixed partial denture: abutments #[3] and #[5], pontic #[4], shade [A2]. Medical history reviewed; [no changes]. [Local anesthesia: 1 carpule of 2% Lidocaine 1:100k epi via buccal infiltration.] / [No local anesthesia needed.] Provisional bridge removed; temporary cement cleaned from the abutments; abutments [caries-free and asymptomatic]. Bridge tried in: seats completely on both abutments without rocking; margins verified with an explorer [and a radiograph]; proximal contacts verified with floss; pontic contacts the ridge [lightly, without blanching], and a floss threader passes under it. Shade and appearance [approved by the patient]. Occlusion checked in centric and excursions with articulating paper and adjusted [on #4]; adjusted surfaces polished. Abutments cleaned and dried; bridge cemented with [RelyX Unicem]. Excess cement removed from the margins, embrasures, and under the pontic; contacts flossed. Final occlusion verified. Patient shown how to clean under the pontic with [a floss threader]. Patient tolerated procedure well. Next visit: [recall as scheduled; call if the bite feels high or the bridge feels loose].
Customize this note in seconds, no typing. Get your hours back.
Templates for practically every clinical scenario, with instant custom note generation.
Tap through any clinical scenario
Tap chips for any clinical scenario, get a complete custom note instantly, paste into your EHR.
Or skip clicks entirely
Ambient listening records the appointment in the background. AI writes the note from the conversation itself.
“I'm Dr. Yasmin, a dentist who got tired of staying late writing notes. I used to search the internet for note templates that actually worked, and I could never find good ones. So I built ButterNote to make note writing feel as smooth as butter.
If the click-build flow above just saved you time, you'll love what's behind a free account: templates for practically every clinical scenario you'll see this week, with instant custom note generation. And if you want zero clicks at all, the iOS app handles that too. Ambient listening on your iPhone or Apple Watch turns each appointment into a finished note.
Take whatever's useful here for free.”
Yasmin Byott, DDS, MS
Founder, ButterNote
When to use this template
Use this bridge delivery note template at the seating visit for a fixed partial denture. The codes are the same unit-by-unit codes as the preparation (for example D6740 for each porcelain/ceramic retainer and D6245 for each porcelain/ceramic pontic), and because many payers use the seat date as the date of service, this note often carries the claim. If the bridge later comes loose and is recemented, that is D6930. Anesthesia is optional at delivery: many bridges seat comfortably without it, while sensitive vital abutments may need it. Record it if you used it.
The try-in is the part that protects you. After removing the provisional and cleaning the temporary cement from the abutments, check the abutments themselves, then confirm the bridge seats completely on every abutment without rocking, the margins are closed (explorer, and a radiograph if you cannot see them), the proximal contacts pass floss, and the pontic touches the ridge lightly without blanching while still allowing a floss threader through. Have the patient approve the shade and appearance before cementation, and say so in the note.
Name the cement. The choice depends on the material and the retention of the preparations (self-adhesive resin, resin-modified glass ionomer, glass ionomer, or zinc phosphate), and it decides how the bridge can be removed or recemented later. Record that excess cement was removed from the margins, the embrasures, and under the pontic, and that occlusion was checked in centric and excursions after cementation. Close with home care: patients need to be shown how to clean under the pontic with a floss threader, tufted floss, or interdental brushes, or the abutment margins next to it are at risk.
Step by step: how to document this bridge delivery
- 1
Remove the provisional
Remove the provisional bridge, clean off the temporary cement, and check the abutments.
- 2
Try in
Confirm complete seating, margins, proximal contacts, and passive pontic contact with the ridge.
- 3
Approve and adjust
Get the patient's approval of shade and appearance; adjust the occlusion and polish adjusted areas.
- 4
Cement
Clean and dry the abutments and cement the bridge, recording the cement by name.
- 5
Clean up and verify
Remove excess cement from margins, embrasures, and under the pontic; floss contacts; recheck occlusion.
- 6
Teach home care
Show the patient how to clean under the pontic and set the follow-up.
Tips for using this template
- check_circleRecord the try-in before the cement: complete seating on every abutment, closed margins, contacts through floss, and passive pontic contact with the ridge.
- check_circleGet the patient's approval of shade and appearance before cementing, and write it down. It cannot be changed afterwards without a remake.
- check_circleName the cement, not just "cemented". The next clinician needs it if the bridge debonds or has to be removed.
- check_circleDocument cement clean-up under the pontic and in the embrasures. Retained cement there is easy to miss and hard on the gingiva.
- check_circleCheck the occlusion in centric and excursions after cementation, not only at try-in, and note any adjustment.
- check_circleRecord anesthesia if you used it. Many deliveries need none, but if you numbed a sensitive abutment, the note should say so.
- check_circleTeach cleaning under the pontic (floss threader, tufted floss, or interdental brush) and record it.
- check_circleA loose bridge later is a recementation, D6930, with its own note on why it came off.
Standards & references
- ADA Code on Dental Procedures (CDT): Fixed partial denture retainer and pontic codes (for example D6740 and D6245) and D6930 (re-cement or re-bond fixed partial denture).
- ADA MouthHealthy: Bridges: ADA patient information on fixed bridges and why the supporting teeth must stay healthy.
Frequently asked questions
Get your hours back.
Click-build any bridge delivery note in seconds, or let ambient listening turn your appointments into finished notes.
Built by a dentist who's been in your chair.
Free to start. HIPAA-aware.
Want all 6 templates as a printable PDF?
Other dental note templates
Composite Restoration Note Template (Copy & Paste)
This composite restoration note template covers anesthesia, isolation, caries removal, matrix, etch & bond, layering, and occlusal verification.
Crown Prep Note Template (Copy & Paste)
This crown prep clinical note template documents a full prep visit in 30 seconds: material, shade, retraction cord size, impression type, and temporary cementation, all in one flow.
Crown Delivery Note Template (Copy & Paste)
This crown delivery note template captures temp removal, try-in fit, contact verification, cement choice, and excess-cement check.
Tooth Extraction Note Template (Copy & Paste)
This tooth extraction note template covers every required step (anesthesia, technique, socket care, hemostasis) so you never miss a detail in a rushed appointment.
Comprehensive Dental Exam Note Template (D0150)
This comprehensive dental exam note template (D0150) assembles all 12+ required sections from a 4-field form (chief complaint, radiographs, perio findings, caries risk) and produces a complete, compliant note in seconds.
Periodic Dental Exam Note Template (D0120)
This periodic dental exam note template (D0120) covers all 7+ required sections: interval medical history, intraoral exam, oral cancer screening, perio update, and radiographic findings.
Nitrous Oxide (N₂O/O₂) Note Template (D9230)
This nitrous oxide note template documents the indication, concentration, flow rate, duration, patient monitoring, and the 100% oxygen recovery that prevents diffusion hypoxia.
Root Canal Note Template (D3310–D3330)
This root canal note template covers the full endodontic record: pulpal and periapical diagnosis, rubber dam isolation, canal negotiation, working lengths, irrigation, obturation, and the post-op radiograph.
Scaling & Root Planing (SRP) Note Template (D4341/D4342)
SRP is the most insurance-scrutinized note in general dentistry.
Dental Sealant Note Template (D1351)
This sealant note template documents the four things D1351 claims get checked for (caries-free status, full eruption, caries-risk justification, and the material used), plus the etch/isolation/occlusion steps that make the clinical record complete.
Limited Oral Evaluation Note Template (D0140)
This limited exam note template (D0140) structures the emergency visit the way reviewers read it: chief complaint in the patient’s words, the focused exam, per-tooth diagnostic test results, a diagnosis, and the disposition.
Adult Prophylaxis (Prophy) Note Template (D1110)
The prophy is the note you write most often and think about least.
Periodontal Maintenance Note Template (D4910)
A periodontal maintenance note has to prove two things: that this patient completed active periodontal therapy, and how their periodontium is doing today compared with last time.
Full Mouth Debridement Note Template (D4355)
Full mouth debridement exists for one reason: deposits so heavy you cannot complete a periodontal evaluation.
Silver Diamine Fluoride (SDF) Note Template (D1354)
An SDF note has three jobs: list every tooth treated, show the lesions were active and symptom-free, and record that the patient or parent understood the treated lesions will turn black.
Pulpotomy Note Template (D3220)
A pulpotomy note has to show the pulp was worth keeping.
Emergency Palliative Treatment Note Template (D9110)
This palliative treatment note template documents the emergency visit where you relieved pain without definitive treatment: the complaint, focused findings and tests, exactly what you did and where, how the patient responded, and the plan for definitive care.
Implant Crown Delivery Note Template (D6058/D6065)
This implant crown note template covers the restorative visit after the implant has integrated: the site, implant system and platform, abutment, screw torque, retention method, contacts and occlusion, and the baseline radiograph and probing that every future peri-implant comparison depends on.
Complete Denture Delivery Note Template (D5110/D5120)
This complete denture delivery note documents the insertion visit the way it should be charted: tissue check, pressure-indicator adjustments, border extension, retention and stability, occlusion, phonetics, the patient's approval of esthetics, and the care instructions that keep the next visit from being a sore-spot emergency.
Occlusal Guard (Night Guard) Delivery Note Template (D9944–D9946)
This occlusal guard note template documents the delivery visit: the bruxism indication and the findings behind it, which arch, hard or soft appliance, how fit and retention were verified, where you left the occlusion, and the instructions you gave.
Crown Recement Note Template (D2920)
A crown that comes off is a diagnosis visit before it is a cementation visit.
Surgical Extraction Note Template (D7210)
A surgical extraction note has to show why the tooth could not simply be elevated and delivered with forceps.
Core Buildup Note Template (D2950)
A core buildup is a code payers routinely ask you to justify, and the note is where that justification lives.
Bridge Preparation Note Template (D6740/D6245)
A bridge prep note covers more than two crown preps.
Stainless Steel Crown (SSC) Note Template (D2930)
A stainless steel crown note should tell the next dentist why the tooth got full coverage and how the crown went on.
Child Prophy and Fluoride Varnish Note Template (D1120/D1206)
A child prophy note is short, but the parts that make it defensible are easy to drop.
Curodont (Self-Assembling Peptide) Note Template (D2991)
Curodont is applied to early caries lesions you are choosing not to drill, so the note has to show the lesion was right for it and how you will know whether it worked.
Alveoloplasty Note Template (D7310, D7311, D7320, D7321)
An alveoloplasty note has to show bone recontouring that went beyond the minor smoothing every extraction already includes.
Incision and Drainage (I&D) Note Template (D7510)
An I&D note is an emergency note with a surgical procedure in the middle of it.
Crown Lengthening Note Template (D4249)
Crown lengthening is a surgical procedure, so the note has to read like one.