Free 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 — every time, the same way. Cementation visits are the highest-risk for documentation gaps; this template closes them.
By Yasmin Byott, DDS, MS · Founder, ButterNote · Updated
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Replace each [bracketed field] with your specific clinical detail. Brackets are placeholders — they don't get saved into the chart.
Crown cementation #[19], [Zirconia]. Temp removed. Crown seated, bite verified. Contacts checked. Cemented with [Resin]. Excess cement removed. Patient tolerated procedure well. Post-operative instructions given.
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When to use this template
Use this crown delivery note template at the cementation visit for any indirect restoration — full crown, onlay, 3/4 crown, or short-span bridge. The template assumes the case has returned from the lab and the temporary is being removed today. Document the cement type chosen (resin, RMGI, glass ionomer, zinc phosphate), as cement type affects future debonding decisions and patient expectations.
The standard sequence is: temp removal → try-in → bite check → contact check → isolate → bond/cement → seat → excess removal. For aesthetic anterior crowns, add a patient-approval step before final cementation. Excess cement removal is a critical step that's frequently under-documented; retained sub-gingival cement is the leading cause of post-cementation peri-implantitis-like inflammation around natural teeth as well as implant-supported crowns.
The cement-type field affects more than just the day-of visit. Resin cements are essentially permanent and require a high-speed bur for retrieval; RMGI and zinc phosphate cements are easier to remove. Future clinicians need this information in the chart to plan re-treatment safely. If you adjusted the occlusion (which is normal for any newly seated crown), add a sentence about high-spot adjustment and polishing — this prevents post-op pain calls and supports the standard of care under ADA CDT documentation guidance.
Step by step: how to document this crown delivery
- 1
Remove temporary
Temporary crown removed atraumatically; tooth and prep cleaned of residual cement.
- 2
Try-in the crown
Crown seated for try-in; marginal fit, contour, and shade verified.
- 3
Verify bite
Articulating paper used to confirm occlusion in CO and excursive movements.
- 4
Verify contacts
Floss passed through proximal contacts to confirm closed, snap-resistant contact.
- 5
Isolate and cement
Tooth isolated; cement applied per manufacturer instructions; crown seated.
- 6
Remove excess cement
Excess cement removed with explorer, floss, and scaler — including sub-gingival cleanup.
- 7
Document post-op
Post-operative instructions delivered (cold sensitivity expectations, biting precautions); patient dismissed.
Tips for using this template
- check_circleAlways document the cement type — debonding protocol depends on it years later.
- check_circleNote "excess cement removed" explicitly. Retained sub-gingival cement is the leading cause of post-cementation peri-implantitis-like inflammation.
- check_circleIf you adjusted the occlusion (which is normal), add: "Occlusal adjustment performed; high spots relieved with diamond bur and polished."
- check_circleFor aesthetic anterior crowns, add a sentence: "Patient approved final shade and shape prior to cementation."
- check_circleIf you used a try-in paste before bonding, document the brand (Variolink, Multilink, etc.) — relevant for repeat-cementation visits.
- check_circleAvoid the common pitfall of skipping the contact check — open contacts cause food impaction within days and result in painful follow-up visits.
- check_circleIf excess cement was difficult to remove sub-gingivally, note the technique used (explorer, floss, scaler) — important if peri-implantitis or gingival inflammation develops later.
- check_circleDocument any pre-cementation try-in with paste (Variolink Esthetic, Multilink, etc.) for aesthetic cases — relevant for any repeat-cementation visit.
Standards & references
- ADA Code on Dental Procedures (CDT) — Crown insertion / cementation codes (D2740–D2799) and procedural documentation.
- AAP — Cement-Induced Peri-Implant Disease — Why excess-cement documentation matters for long-term tissue health.
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