Free Pulpotomy Note Template (D3220)
A pulpotomy note has to show the pulp was worth keeping. This D3220 template documents the pulpal diagnosis and pre-op radiograph, isolation, coronal pulp removal, the hemostasis that confirmed healthy radicular tissue, the medicament, and the restoration that seals it.
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.
Pulpotomy #[K] (D3220). Diagnosis: [carious pulp exposure, reversible pulpitis; normal apical tissues]. No history of spontaneous pain, swelling, or sinus tract. Pre-operative radiograph [BW]: no furcation or periapical radiolucency, no pathologic root resorption. Behavior: [Frankl 3; tell-show-do]. Consent obtained from [parent]. Topical anesthetic applied. Local anesthesia: [1] carpule of [2% Lidocaine 1:100k epi] via [IANB]. Rubber dam isolation. Caries removed; pulp exposure noted. Coronal pulp removed to the canal orifices with [a slow-speed round bur and spoon excavator]. Hemostasis achieved with a moist cotton pellet in [under 5] minutes. [MTA] placed over the radicular pulp stumps, followed by [glass ionomer base]. Final restoration: stainless steel crown #[K] [size 4], cemented with [glass ionomer cement] (D2930). Occlusion checked. Post-operative instructions given to [parent], including care with chewing until numbness wears off. Monitor clinically and radiographically at recall.
Stop worrying about notes. Get your hours back.
Templates for practically every clinical scenario, with instant custom note generation.
Click-build any note in seconds
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 pulpotomy note template for a therapeutic pulpotomy, most often on a primary molar where caries removal exposed the pulp. CDT D3220 is removal of pulp coronal to the dentinocemental junction and application of medicament, excluding the final restoration. It can be performed on primary or permanent teeth, but it is not to be construed as the first stage of root canal therapy and is not to be used for apexogenesis (partial pulpotomy for apexogenesis on an immature permanent tooth is D3222). An emergency opening before root canal therapy on a permanent tooth is pulpal debridement (D3221), not D3220.
The diagnosis does the clinical work in this note. AAPD guidance lists pulpotomy among the vital pulp therapies for primary teeth with a normal pulp or reversible pulpitis, and notes that a complete pulpotomy may be considered in selected teeth with signs of irreversible pulpitis but no clinical or radiographic signs of infection. So record the pulpal diagnosis, the history (no spontaneous pain, no swelling or sinus tract), and a pre-operative radiograph free of furcation or periapical pathology and pathologic resorption. Then record hemostasis: bleeding from the radicular stumps that stops promptly is the clinical evidence the remaining pulp is healthy. If hemostasis cannot be achieved, the note should say so and change course to pulpectomy or extraction.
Name the isolation and the medicament. AAPD recommends rubber dam or equally effective isolation for pulp therapy, and the medicament (MTA or another calcium silicate, formocresol, ferric sulfate, or others) should be named as used. Because D3220 excludes the final restoration, document the restoration as its own procedure. On primary molars this is usually a stainless steel crown (D2930). Close with follow-up: clinical and radiographic monitoring at recall.
Step by step: how to document this pulpotomy
- 1
Diagnose
Record the pulpal diagnosis, a history without spontaneous pain, swelling or sinus tract, and a pre-op radiograph free of furcation and periapical pathology.
- 2
Anesthetize and isolate
Local anesthesia delivered and confirmed; rubber dam or equally effective isolation placed.
- 3
Remove caries and coronal pulp
Remove caries, unroof the pulp chamber, and amputate the coronal pulp to the canal orifices.
- 4
Achieve hemostasis
Apply a moist cotton pellet; prompt hemostasis confirms healthy radicular pulp. If it fails, change to pulpectomy or extraction.
- 5
Place medicament and base
Place the medicament (MTA, another calcium silicate, formocresol, or ferric sulfate) and a base.
- 6
Restore and follow up
Place the final restoration, usually a stainless steel crown on a primary molar, and plan clinical and radiographic monitoring.
Tips for using this template
- check_circleRecord the pulpal diagnosis and the history that supports it: no spontaneous pain, no swelling, no sinus tract. That is what makes a vital pulp therapy defensible.
- check_circleDocument a pre-operative radiograph showing no furcation or periapical radiolucency and no pathologic resorption. A pulpotomy on a tooth with radiographic infection is a likely failure and hard to defend.
- check_circleWrite the hemostasis line. Bleeding that stops promptly is your evidence the radicular pulp is healthy; if it does not stop, say so and record the change of plan (pulpectomy or extraction).
- check_circleName the isolation. AAPD recommends rubber dam or equally effective isolation for pulp therapy.
- check_circleName the medicament you actually used (MTA, another calcium silicate, formocresol, ferric sulfate). "Medicament placed" is not enough for anyone reviewing the case later.
- check_circleD3220 excludes the final restoration. Document the stainless steel crown (D2930 on a primary tooth) or other restoration as its own procedure.
- check_circleDo not use D3220 for a permanent-tooth emergency opening before RCT (that is pulpal debridement, D3221) or for apexogenesis on an immature permanent tooth (D3222).
- check_circleFor children, record behavior (Frankl score and techniques used) and who gave consent. Pediatric pulp therapy notes are read with that context.
Standards & references
- AAPD: Pulp Therapy for Primary and Immature Permanent Teeth: AAPD best practices: pulpotomy indications by pulpal diagnosis, isolation, and monitoring.
- ADA Code on Dental Procedures (CDT): D3220 (therapeutic pulpotomy, excluding final restoration), D3221, D3222, and D2930 definitions.
Frequently asked questions
Get your hours back.
Click-build any pulpotomy 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.
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.