The Composite Bonding (Cosmetic) Notes Template

Consent gaps (no discussion of maintenance, colour change, longevity) AND missing pre-op photographs are a recurring pattern in composite bonding complaints. Below is a template for UK clinicians to paste into their PMS to address both directly.

Why this composite bonding (cosmetic) template wins

• Pre-treatment photographs — without them you have no baseline if a cosmetic complaint is made.
• Aetiology assessment explicit — addresses recurrence risk and avoids "you didn't fix the cause" claims.
• Maintenance commitment in consent — "I wasn't told it needed maintenance" is a recurring complaint pattern in composite bonding cases.
• Smile analysis structured — defends aesthetic decisions.
• WRITTEN consent for cosmetic procedure — best practice and indemnity-recommended.

The template (paste into your PMS notes field)

Paste the composite bonding (cosmetic) template below into your PMS notes field. Patient demographics are left out because your PMS already holds them.

TEETH: [FDI — typically UR3-UL3 for 6 unit smile makeover, or specific teeth]
INDICATION: [Aesthetic — discolouration / chipping / spacing / wear / asymmetry / patient preference]

PRE-TREATMENT PHOTOGRAPHS (STORED IN PATIENT RECORD):
- Full face smiling
- Retracted close-up of teeth at rest
- Retracted close-up at smile
- Incisal view
- Shade reference photo
- Date / clinician name on photos

SMILE ANALYSIS:
- Midline: [Coincident with facial midline / shifted __ mm]
- Smile line: [Convex (ideal) / flat / reverse]
- Lip line: [Low / medium / high]
- Buccal corridor: [Adequate / wide / narrow]
- Tooth proportions:
  - UR1 / UL1: Width:length ratio (ideal 0.75-0.85)
  - UR2 / UL2: Should be slightly narrower than centrals
  - UR3 / UL3: Vary per face shape
- Gingival margins: [Symmetrical / asymmetric — recession noted]
- Existing tooth surface loss / wear: [None / mild / moderate]

AETIOLOGY ASSESSMENT (must address before treatment):
- Acid erosion: [None / dietary acid / GORD]
- Attrition: [Parafunction signs / bruxism]
- Abrasion: [Toothbrush trauma]
- Discolouration cause: [Intrinsic (tetracycline, fluorosis) / extrinsic (stain) / age]
- Recurrence risk if untreated: [Document]

SHADE SELECTION:
- Shade guide: [VITA Classical / 3D Master]
- Shade map per tooth: [Body / cervical / incisal]
- Patient agreement: [Documented]

VITALITY OF ALL TREATED TEETH: [Cold + EPT — response for each]

OCCLUSAL ASSESSMENT:
- Canine guidance: [Confirmed L + R]
- Anterior protrusive contact location: [Palatal — acceptable / incisal — will need management]
- Working/non-working interferences planned: [None]

CONSENT (Montgomery — written for elective cosmetic procedure):
- Risks: longevity (3-7yr typical, then replacement needed), staining (composite stains more than enamel), chipping (avoidable with care), sensitivity (uncommon for additive), aetiology continues if untreated (acid erosion will recur), inability to achieve EXACT match against natural teeth, possibility of repolishing every 6-12 months for stain management
- Benefits: aesthetic improvement, additive (reversible if no prep done), more conservative than porcelain veneers
- Alternatives: whitening alone, porcelain veneers (more expensive, requires preparation), no treatment
- Maintenance commitment: explicit — composite bonding requires 6-month polishes, periodic touch-ups, full replacement at 5-7yr
- Realistic expectations: discussed
- WRITTEN consent signed

LA: [Required Y/N — usually NO for pure additive]

ISOLATION: [Rubber dam / OptraGate / cotton rolls + suction]

PROCEDURE — COMPOSITE LAYERING:
- Acid etch: 35% phosphoric — 30s enamel (additive: enamel-only etch)
- Bond system: [Brand — total-etch / self-etch] — applied, air-thinned, cured
- Composite brand + shade: [Specific products]
- Layering: [Number of layers + technique — body / dentine / enamel translucent]
- Each layer cured: [Seconds]
- Shaping: [Sculpted to width-length proportions per smile analysis]
- Articulation paper occlusion check during placement: [Confirmed no interferences]

FINISHING:
- Disc + strip polishing: [Sequence]
- Final polish: [System used]
- Post-op smoothness: [Confirmed]

POST-OP OCCLUSION: [Articulating paper — no working / non-working / protrusive interferences]

POST-OP PHOTOGRAPH: [Taken — full smile, retracted, incisal]

POST-OP ADVICE (verbal + written):
- Diet: Avoid hard biting (no nail biting, no opening packets with teeth, no chewing pens/ice)
- Staining: Reduce coffee, tea, red wine, smoking
- Hygiene: Soft toothbrush + non-abrasive toothpaste
- Maintenance: Polish appointment at 1-2 weeks (post-op polish for stain resistance), then 6-monthly
- Long-term: Composite stains over years; replacement at 5-7 years anticipated

REVIEW:
- 1-2 week polish appointment booked
- 6-month maintenance review
- Annual photographic comparison

WRITTEN INFORMATION GIVEN: [Patient information leaflet on composite bonding maintenance — Y/N]

Try the composite bonding (cosmetic) note in the live demo → No account needed.

What good looks like — a worked example

The same composite bonding (cosmetic) template, completed for a realistic case.

TEETH: UR3, UR2, UR1, UL1, UL2, UL3 (6 anterior upper teeth)
INDICATION: Patient seeking aesthetic improvement — mild crowding causing slight rotations + UR1 chipped corner + minor staining + asymmetry between UR2 and UL2 widths. Wants improvement without orthodontics (declined ortho previously).

PRE-TREATMENT PHOTOGRAPHS: All 5 standard views taken and stored — full face smiling, retracted at rest, retracted at smile, incisal view, with shade tab reference. Dated and clinician name on file.

SMILE ANALYSIS:
- Midline: Coincident with facial midline
- Smile line: Slightly flat (slightly reverse on right side — to be improved with composite addition to UR2 incisal edge)
- Lip line: Medium
- Buccal corridor: Adequate
- Tooth proportions:
  - UR1: 0.85 width:length (acceptable, no adjustment)
  - UL1: 0.85 width:length (acceptable, no adjustment)
  - UR2: 0.75 — slightly narrow, will widen with composite
  - UL2: 0.85 — acceptable
  - UR3, UL3: Standard
- Gingival margins: Symmetrical
- Existing tooth surface loss: Mild incisal wear UR1 (~1mm)

AETIOLOGY:
- Acid erosion: None
- Attrition: None — no parafunction signs, no bruxism
- Discolouration: Mild extrinsic stain (tea, coffee) + age-related slight yellowing
- Recurrence risk: Low if dietary modification adopted

SHADE SELECTION:
- VITA Classical
- Shade map: UR1 / UL1 / UR2 / UL2 — body B1, cervical A1, incisal translucent. UR3 / UL3 — body A1, cervical A2.
- Patient agreement: Yes, agreed at consultation.

VITALITY OF ALL TREATED TEETH: All cold-responsive (brief, resolves). All vital.

OCCLUSAL ASSESSMENT:
- Canine guidance confirmed L + R
- Anterior protrusive contact: Palatal surface contact UR1 / UL1 (acceptable — composite addition to labial will not interfere)
- No working/non-working interferences planned

CONSENT (Montgomery — written):
- Risks discussed: longevity (3-7yr typical), composite stains more than natural enamel (will need maintenance polishing), chipping possible if hard biting (no nail biting, no opening packets), inability to achieve perfect colour match against UR4 / UL4 (will continue to look slightly different), aetiology (extrinsic stain) will continue without dietary change
- Benefits: aesthetic improvement, additive procedure (reversible — no enamel removed), more conservative than porcelain veneers
- Alternatives: whitening alone (offered previously, mild effect), porcelain veneers (£__ per tooth, requires enamel preparation, longer-lasting), no treatment
- Maintenance commitment: explicitly agreed — 1-2 week polish + 6-monthly polish appointments + full replacement at 5-7yr
- Realistic expectations: discussed
- WRITTEN consent signed today

LA: Not given (pure additive procedure, no preparation needed).

ISOLATION: OptraGate + cotton rolls + saliva ejector. Cotton roll behind upper lip.

PROCEDURE — COMPOSITE LAYERING:
- Acid etch: 35% phosphoric (Total Etch Kerr) — 30s enamel only (additive — no dentine exposure)
- Bond: Optibond FL — applied, air-thinned, cured 20s per tooth
- Composite: Filtek Supreme Ultra (3M)
- Layering per tooth: Body B1 (~1mm thickness) → cervical blend A1 (cervical 1/3) → incisal translucent enamel (incisal 1/3)
- Each layer cured: 20s
- Shaping: Sculpted using composite instruments + brush. UR2 widened ~0.5mm to match UL2 width. UR1 incisal edge restored (chip repair) + slightly lengthened.
- Articulation paper occlusion check during placement: confirmed no interferences emerging

FINISHING:
- Disc + strip polishing: Sof-Lex discs (coarse → medium → fine → super-fine)
- Final polish: Enhance + PoGo cup system
- Post-op smoothness: Confirmed mirror finish

POST-OP OCCLUSION: Articulating paper — no working-side, non-working-side, or protrusive interferences on bonded teeth. Canine guidance preserved.

POST-OP PHOTOGRAPH: Taken (full smile, retracted, incisal).

POST-OP ADVICE (verbal + written leaflet given):
- Diet: Avoid hard biting (no nail biting, no opening packets with teeth)
- Staining: Reduce coffee / tea / red wine consumption. Smoking strongly affects composite colour.
- Hygiene: Soft toothbrush + non-abrasive toothpaste (Sensodyne ProNamel or Aquafresh recommended)
- Maintenance: Polish appointment booked in 2 weeks (final surface polish)
- Long-term: Composite changes colour over time; replacement at 5-7yr anticipated

REVIEW:
- 2-week polish: booked
- 6-month maintenance review: booked
- Annual photographic comparison: scheduled at routine recall

Compliance: the medico-legal angle

• CGDent Clinical Examination & Record-Keeping (3rd ed) — cosmetic restorative records.
• GDC Standards Principle 3 — informed consent for elective cosmetic procedures.
• Montgomery — irreversibility (if any prep), longevity, maintenance, limitations all material risks.

Common documentation mistakes

• No pre-treatment photographs — a common weakness when a complaint is made.
• No discussion of maintenance and colour change over time — patient expects "permanent" and complains.
• Aetiology not addressed (especially acid erosion) — wear recurs after bonding, complaint follows.
• No occlusal assessment — anterior interference fractures composite quickly.
• No written consent for elective procedure — indemnity weakness.

Sources

• GDC Standards for the Dental Team, Principle 3: Obtain valid consent (accessed 18 October 2026)
• CGDent: Clinical Examination and Record-Keeping, Good Practice Guidelines (3rd edition) (accessed 18 October 2026)
• Montgomery v Lanarkshire Health Board (UK Supreme Court, 2015, UKSC 11) (accessed 18 October 2026)

Frequently asked questions

Patient leaflets for this treatment

• After Your Composite Bonding or Veneers
• Your Guide to Composite Bonding
• Composite Bonding vs Porcelain Veneers — What Is the Difference?

Related dental note templates

Browse the full set of free dental notes templates.