Headings
Tooth · Diagnosis · Anesthetic · Preparation · Impression or scan · Shade · Temporary crown · Lab instructions · Next visit
When to use it
Use this for the first appointment of a crown, onlay or bridge abutment, when the tooth is prepared and a temporary goes on. It records what the lab needs, like shade and clearance, and what to check at the seat visit. A simple filling belongs in the restorative visit note.
Example
Fictional example
Tooth
#3.
Diagnosis
Large failing amalgam with fractured mesiobuccal cusp. Vital, asymptomatic.
Anesthetic
Buccal and palatal infiltration, 2 carpules 2% lidocaine with 1:100,000 epinephrine, 72 mg.
Preparation
Amalgam removed. Composite core buildup. Full coverage prep with chamfer margins and 1.5 mm occlusal reduction. Retraction cord placed.
Impression or scan
Digital intraoral scan with bite registration.
Shade
A3 body. Photo sent with case.
Temporary crown
Bis-acryl, temporary cement. Contacts and bite checked.
Lab instructions
Full contour zirconia. Light proximal contacts.
Next visit
Seat crown in 2 weeks.