Free 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.
By Yasmin Byott, DDS, MS · Founder, ButterNote · Updated
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Complete denture delivery, [maxillary (D5110) and mandibular (D5120)]. [Conventional heat-cured acrylic]; tooth shade [A2], gingival shade [pink]. Oral tissues examined before insertion: [no lesions, ridges healthy]. Intaglio surfaces inspected; [acrylic nodules] removed. Pressure-indicating paste used; pressure areas relieved at [right maxillary tuberosity, mandibular lingual flange]. Border extension and frenum relief verified. Retention and stability [adequate]. Vertical dimension and centric relation verified; occlusion [bilaterally balanced], adjusted with articulating paper. Phonetics [satisfactory, "s" and "f/v" sounds clear]. Esthetics and lip support reviewed; patient [approved appearance]. Patient instructed on insertion and removal, the adaptation period, a soft diet at first, daily cleaning with a non-abrasive denture cleanser, removing dentures overnight and storing them in water, and to call for sore spots. Patient tolerated procedure well. Next visit: [24 to 48 hour adjustment check].
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When to use this template
Use this denture delivery note at the insertion of a conventional complete denture: D5110 for the maxillary arch and D5120 for the mandibular arch, one line per arch. Immediate dentures, delivered the same day as the extractions, have their own codes (D5130 maxillary, D5140 mandibular), so say which kind you delivered. Routine adjustments in the months after delivery are usually treated by payers as part of the denture fee; later adjustments are reported as D5410 (maxillary) or D5411 (mandibular). The exact window varies by plan.
The insertion checks are the clinical heart of the note. Inspect the intaglio for sharp edges and acrylic nodules before seating, then use pressure-indicating paste to find and relieve pressure areas and record where you relieved. Verify border extension and frenum relief, retention and stability, vertical dimension and centric relation, and adjust the occlusion. Check phonetics (the "s" and "f/v" sounds are the quick screen) and lip support. Then record that the patient saw and approved the esthetics. That one sentence is what protects you when a family member dislikes the teeth three weeks later.
Home care belongs in the record because it drives tissue health. The American College of Prosthodontists' evidence-based guidelines recommend cleaning dentures daily by soaking and brushing with a nonabrasive denture cleanser, not wearing them continuously, and annual recall for denture wearers. The ADA adds that dentures should be stored in water or cleanser when out of the mouth and never cleaned with hot water or bleach. Schedule the first adjustment check within a few days: sore spots are expected, and documenting that you said so in advance sets the right expectation.
Step by step: how to document this complete denture delivery
- 1
Check the tissues
Examine the ridges and soft tissues before insertion and record any lesions or inflammation.
- 2
Prepare the denture
Inspect the intaglio and borders; remove acrylic nodules and sharp edges.
- 3
Seat and relieve
Seat with pressure-indicating paste, relieve pressure areas, and verify border extension and frenum relief.
- 4
Verify function
Confirm retention, stability, vertical dimension, and centric relation; adjust occlusion with articulating paper; check phonetics.
- 5
Confirm esthetics
Review tooth display and lip support with the patient and record their approval.
- 6
Instruct and schedule
Cover insertion and removal, adaptation, cleaning, overnight removal, and storage; book the 24 to 48 hour adjustment check.
Tips for using this template
- check_circleCode by arch and type: D5110 maxillary and D5120 mandibular for conventional dentures; D5130 and D5140 when they are immediate dentures delivered with the extractions.
- check_circleRecord that you used pressure-indicating paste and where you relieved. It shows the fit was verified, and it gives you a map when the patient returns with a sore spot.
- check_circleDocument vertical dimension and centric relation verification. A wrong VDO is the most expensive denture problem to fix after processing.
- check_circleWrite down that the patient approved the esthetics at delivery. Some offices also have the patient sign an esthetic approval at try-in.
- check_circleGive and record the home-care basics: daily soaking and brushing with a nonabrasive cleanser, not wearing the dentures continuously, storing them in water, and no hot water or bleach.
- check_circleSchedule the first adjustment within a few days. Early adjustments are usually included in the denture fee; later ones are D5410/D5411, depending on the plan.
- check_circleExamine the soft tissues at every denture visit and recall edentulous patients at least annually, per ACP guidance. Edentulous patients still need oral cancer screening.
Standards & references
- ADA Code on Dental Procedures (CDT): Complete dentures D5110 (maxillary) and D5120 (mandibular), immediate dentures D5130/D5140, and adjustments D5410/D5411.
- ADA Oral Health Topics: Dentures: ADA guidance on daily denture cleaning, storage in water or cleanser, adhesives, and when a denture needs evaluation for replacement.
- Felton et al. Evidence-based guidelines for the care and maintenance of complete dentures (ACP, J Prosthodont 2011): American College of Prosthodontists guidelines on cleaning, overnight removal, and annual recall for complete denture wearers.
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