Crown Preparation Procedure Note

Date: [Date of service]

Provider: [Treating dentist name and credentials]

Tooth/Teeth: [Tooth numbers being prepared]

Encounter Type: Crown Preparation Procedure Note

Indication and Diagnosis

(For multi-tooth preparations, create a separate bullet for each tooth.)

• [Tooth #]

  • [Indication for crown]
  • [Clinical diagnosis]
  • [Key pre-operative findings] (Existing restoration type/condition; fracture characteristics; caries extent; other pertinent findings.)
  • [Imaging reviewed: modality and date] — [Interpretation summary]

Verification and Consent

• [Pre-procedure verification completed] (Confirmed correct patient, tooth number(s), and planned procedure.)
• [Informed consent obtained] (Discussed preparation, impression/scan, provisional, subsequent cementation; material options and rationale; risks including sensitivity, possible pulpitis/need for RCT, fracture, provisional loss; and alternatives such as direct restoration, onlay, extraction, or no treatment as applicable.)
• [Intra-procedure plan modification discussion] (Only include if plan changed due to findings such as deeper caries, crack extension, or need for build-up; document patient agreement.)

Anesthesia

• [Topical anesthetic: agent, site(s)] (Only include if used.)
• [Local anesthetic: drug and concentration, vasoconstrictor if applicable, total volume in mL, injection type/site, patient tolerance] (Only include if administered.)
• [Nitrous oxide/sedation: agents and parameters, or reference to separate anesthesia record] (Only include if used.)
• [No anesthetic administered] (Include this statement if none was used.)

Procedure

• Isolation: [Rubber dam / Isolite / Cotton roll isolation / Other]
• Removal of existing restoration: [Material removed and findings] (Include recurrent caries, marginal integrity, cracks, secondary dentin. Omit if no prior restoration.)
• Caries excavation: [Extent and findings] (Depth, remaining dentin thickness estimate, proximity to pulp, affected vs. infected dentin removal. Omit if no caries present.)
• Crack assessment: [Location, extent, and effect on treatment plan] (Only include if crack identified.)
• Tooth preparation:
  • [Restoration type: full coverage crown / partial coverage]
  • [Finish line: chamfer / shoulder / shoulder with bevel], [Margin location: supragingival / equigingival / subgingival by region]
  • [Reduction verified adequate; path of draw confirmed without undercuts]
  • [Liner or immediate dentin sealing: material and rationale] (Only include if performed.)
• Core build-up: (Only include this element if true build-up performed for retention/resistance, not minor undercut elimination.)
  • [Indication], [Material], [Retentive features if used], [Preparation refined after placement]
• Gingival management: [Method: cord type/size, paste, laser/electrosurgery], [Hemostatic agents], [Tissue condition achieved] (Omit if margins supragingival with no retraction needed.)

(For multi-tooth cases, note tooth-specific variations or indicate shared steps.)

Final Record

• Impression/Scan:
  • [Conventional impression: tray type, material system, technique] — [Quality verified: margins captured without voids or tears] (Note remakes if performed.)
  • [Digital scan: prep(s), opposing, buccal bite captured] — [Quality verified: 360-degree margin capture confirmed in software] (Note rescans if performed.)
  • [Records transmitted to lab: method and date]
• Bite registration: [Method: buccal bite scan / PVS / wax], [Occlusal considerations for lab if relevant: limited clearance, bruxism, opposing restoration material]

Shade and Material

• Shade: [Shade system] — [Selected shade] (Note stump shade if taken; note characterization/translucency directives if applicable; note dehydration or lighting limitations if relevant.)
• Material: [Monolithic zirconia / Lithium disilicate / PFM / Other] (Include rationale if non-standard or patient-driven.)

(For multi-tooth cases, specify per tooth if different.)

Provisional Restoration

• [Type: chairside fabricated / preformed shell / CAD/CAM], [Material: bis-acryl / PMMA / other]
• [Fit verification: marginal adaptation, proximal contacts, and occlusion verified and adjusted]
• [Temporary cement: eugenol-based / non-eugenol / resin temporary]
• [Patient tolerance and provisional care instructions provided]

Lab Prescription

• [Lab name], [Restoration type and material per tooth], [Shade and esthetic directives]
• [Special instructions: margin notes, occlusal scheme, contact preferences] (Only include if applicable.)
• [Requested return date], [Seat appointment: date or pending]
• [Reference to attached lab authorization form]

Post-Operative Plan

• [Post-operative instructions provided / Reference standard instruction set]
• [Prescriptions: drug, dose, directions / None issued]
• [Expected sensitivity and red-flag symptoms reviewed; contingency plan discussed]
• [Follow-up: crown seat date/timeframe]

Complications

Complications: [No complications encountered / Complication(s): description and management / Variance from plan: description and rationale] (This statement is required for every note.)

Attachments

• [Radiographs: type, tooth numbers]
• [Intraoral photographs, including shade photos if taken]
• [Digital scan file or case identifier]
• [Lab prescription document reference]
• [Consent form reference] (Only include if separate document.)
• [Sedation/anesthesia record reference] (Only include if applicable.)