Free Crown Recement Note Template (D2920)
A crown that comes off is a diagnosis visit before it is a cementation visit. This recement note template documents how and when it came off, what you found on the tooth and inside the crown, why recementing was appropriate, the cement used, and the prognosis conversation, so a second debond does not turn into a dispute.
By Yasmin Byott, DDS, MS · Founder, ButterNote · Updated
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Crown recementation #[19] (D2920). Chief complaint: crown came off [2 days ago while eating]; patient [brought the crown]. Medical history reviewed; [no changes]. Crown evaluated: [intact, no fractures, margins intact]. Tooth evaluated: [no recurrent caries, core intact, no fracture, retention form adequate]; tooth is [vital, asymptomatic]. Radiograph: PA #[19]: [no recurrent caries, no periapical pathology]. Old cement removed from the crown intaglio and the preparation; [intaglio air-abraded]. Crown tried in: complete seating, margins verified with explorer, contacts verified with floss. Crown recemented with [RelyX Unicem]. Excess cement removed; contacts flossed. Occlusion checked [and adjusted]. Prognosis discussed: [fair; repeat debond possible given short clinical crown; replacement crown with improved retention offered]. Patient [elected recementation]. Patient tolerated procedure well. Next visit: [recall as scheduled; return if the crown loosens again].
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When to use this template
Use this crown recementation note when you re-cement or re-bond a crown that has come loose on a natural tooth (D2920). Neighboring codes cover the other cases: D2910 for an inlay, onlay, veneer, or partial-coverage restoration; D2915 for a post and core; D6092 for an implant or abutment-supported crown; and D6930 for a fixed partial denture. Recementing a provisional crown during your own crown treatment is normally part of that treatment, not D2920, and many payers will not pay D2920 within a set period after the original seat by the same office.
The evaluation is the part that protects you. Before recementing, document why the crown came off and whether it should go back on: the condition of the crown (intact, fractured, worn through), the margins and fit, the preparation (recurrent caries, fractured core or tooth, short or overtapered walls), the pulpal or endodontic status, and the periodontal condition. A periapical or bitewing radiograph supports the call. If you find recurrent caries or a fracture, recementing as-is is usually not appropriate. Document the options instead (new crown with buildup, crown lengthening, endodontic treatment, extraction) and what the patient chose.
When you do recement, record how the crown and preparation were cleaned, that the crown seated completely with margins and contacts verified, the cement you used, excess removal, and the occlusion check. Then document the prognosis conversation. If the tooth has limited retention form or the crown is near the end of its life, saying so in the note before it comes off again is the difference between an expected outcome and a complaint.
Step by step: how to document this crown recementation
- 1
Take the history
Record when and how the crown came off, symptoms since, and whether the patient brought the crown.
- 2
Evaluate the crown
Check the crown for fracture, wear-through, and margin integrity.
- 3
Evaluate the tooth
Check for recurrent caries, core or tooth fracture, retention form, and pulpal and periodontal status; take a radiograph.
- 4
Decide and consent
Discuss recementation versus replacement or other treatment, with the prognosis, and record the patient's choice.
- 5
Clean and recement
Remove old cement from crown and preparation, try in, verify seating, margins, and contacts, and cement; remove all excess.
- 6
Verify
Check and adjust occlusion, floss the contacts, and set the follow-up.
Tips for using this template
- check_circleRecord why it came off: cement washout, recurrent caries, short or overtapered preparation, fractured core, or parafunction. The cause drives whether recementing is reasonable.
- check_circleRule out recurrent caries and fracture before recementing, and take a radiograph to support it. Recementing over decay is the classic failed recement.
- check_circleName the cement and any surface treatment (air abrasion, primer). If it debonds again, the next decision depends on what was used.
- check_circleDocument complete seating: margins checked with an explorer and contacts with floss. A crown seated slightly open is a callback waiting to happen.
- check_circleWrite the prognosis and the alternatives into the note, along with what the patient chose. A guarded prognosis recorded today prevents a dispute tomorrow.
- check_circleUse the right code for the restoration: D2920 natural-tooth crown, D6092 implant or abutment-supported crown, D6930 bridge, D2910 inlay, onlay, or veneer.
- check_circleExpect payer limits on D2920 soon after the original seat by the same office, and do not bill provisional recementation during your own crown treatment as D2920.
Standards & references
- ADA Code on Dental Procedures (CDT): D2920 (re-cement or re-bond crown) and related codes D2910, D2915, D6092, and D6930.
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