Free Composite Restoration Clinical Note Template
Stop retyping the same composite note for every patient. This AAPD-aligned template covers anesthesia, isolation, caries removal, matrix, etch & bond, layering, and occlusal verification — fill in five brackets and you're done.
Customize your note
Fill in the fields below — we'll generate a complete clinical note for you in seconds.
Tap the teeth that received composite restorations.
M / O / D / B / L / F / I — choose all that apply for each tooth.
Pick a tooth above to set surfaces.
Pick a tooth above to set shade.
Copy-paste template
Replace each [bracketed field] with your specific clinical detail. Brackets are placeholders — they don't get saved into the chart.
Tooth #[14] [MOD] composite restoration. Local anesthesia: [1.5] carpule(s) of [4% Septocaine 1:100k epi] via [buccal infiltration]. Adequate anesthesia confirmed. Isolation achieved with [rubber dam]. [Complete caries removal to sound dentin]. Matrix band, wedge placed. Etched and bonded per manufacturer instructions. Composite placed and light cured, shade [A2]. CO/CR verified, contacts flossed. Patient tolerated procedure well. Post-operative instructions given.
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Tap chips for any clinical scenario, get a complete custom note instantly, paste into your EHR.
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“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 template after any direct composite restoration on permanent or primary dentition. It covers Class I through Class V preps and works for single-surface fillings as well as multi-surface restorations. The template assumes standard rubber-dam or cotton-roll isolation, complete caries removal to sound dentin, and shade-matched composite placement. Adjust the bracketed fields for your specific case: tooth number, surfaces involved, shade chosen, anesthesia type and volume, and the isolation method you used. The post-op sentence at the end satisfies most insurance reviewers and creates a defensible record of patient education.
Tips for using this template
- check_circleSpecify the isolation method explicitly — insurance reviewers flag notes that omit it.
- check_circleDocument caries-removal completeness ("complete to sound dentin" vs. "selective" vs. "stepwise") — this drives billing distinctions.
- check_circleAlways record the shade chosen, even for posterior composites. Future restorations on adjacent teeth depend on this match.
- check_circleIf you used a liner (Vitrebond, Dycal, TheraCal, etc.), add a sentence: "Liner placed at deepest portion of preparation."
- check_circleFor Class II restorations, mention the matrix and wedge — "Tofflemire, matrix band, wedge placed" — to satisfy contour-verification requirements.
Frequently asked questions
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