Core Build-up Notes Template for UK Dentists

Ferrule assessment is a frequently missed entry in core build-up notes — and a defensible record when a root-treated tooth later fractures. Below is a template for UK clinicians to paste into their PMS for any pre-crown core.

Why this core build-up template wins

• Ferrule measured per surface — 2mm circumferential minimum is the evidence-based threshold; absent ferrule notation is a frequent gap when a restored tooth later fractures.
• Post decision flowchart — sufficient coronal structure? No → post. With explicit type/length/diameter selection rationale.
• Prognosis assessment recorded (good / guarded / poor) — when the tooth fails, this is the defensive line: you predicted it and warned the patient.
• RCT cross-reference — date, WL, obturation quality — gives any subsequent clinician (or specialist) full picture without rifling through old notes.
• Patient consent specifically about crown viability — Montgomery defensible when prognosis is guarded.

The template (paste into your PMS notes field)

Paste the core build-up template below into your PMS notes field. Patient demographics are left out because your PMS already holds them.

TOOTH: [FDI]
RCT STATUS: [Date completed / clinician / WL / obturation quality from PA / asymptomatic since]

PRE-OP RADIOGRAPH: [Reviewed — quality A/N — obturation density / post space available / periapical status]

REMAINING TOOTH STRUCTURE:
- Coronal tissue: [Circumferential / partial / minimal]
- Ferrule assessment: [Minimum 2mm circumferential ferrule of sound tooth structure above CEJ measured / NO ferrule available — crown lengthening / extraction considered]
- Prognosis for crown: [Good / guarded / poor — reason]

CARIES REMOVAL: [Complete / extent noted]

POST DECISION:
- Indicated: [No (sufficient coronal structure) / Yes (insufficient retention)]
- If yes:
  - Type: [Fibre / metal / cast]
  - Length: [Minimum 2/3 root length OR equal to crown height]
  - Diameter: [<1/3 root width at narrowest]
  - Brand / size: [Document]

CORE MATERIAL:
- Type: [Composite / amalgam / GIC]
- Shade: [If tooth-coloured / aesthetic zone]
- Bonding: [System used if composite]

CORE MARGIN RELATIVE TO GINGIVAL MARGIN: [Supragingival / equigingival / subgingival]

OCCLUSAL CHECK: [Adjusted if temporising before crown / no occlusal load until crown placed]

CONSENT: Crown viability discussed honestly. Prognosis [good/guarded/poor] given remaining structure. Risk of fracture during functional load before crown placed — discussed. Alternative: extraction + implant/bridge — discussed.

PROGNOSIS / CROWN PLAN: [Crown booked for __ weeks (typically 2-3 weeks for healing) / refer to specialist if compromised]

POST-OP ADVICE: Avoid heavy chewing on this tooth until crown placed. Tooth is vulnerable until crowned. Contact if fracture, debonding, or pain.

Try the core build-up note in the live demo → No account needed.

What good looks like — a worked example

The same core build-up template, completed for a realistic case.

TOOTH: UR6
RCT STATUS: RCT completed 2 weeks ago (visit 2 obturation). WL: MB 19mm, ML 18mm, P 22mm. Obturation density good on post-op PA. Asymptomatic since.

PRE-OP RADIOGRAPH: PA UR6 reviewed (quality A, taken today). Obturation density adequate, no voids. Post space available in palatal canal if required. No periapical pathology developing.

REMAINING TOOTH STRUCTURE:
- Coronal tissue: Partial. Mesial wall present, distal wall lost previously to access + caries. Buccal cusp and palatal cusp present but heavily restored.
- Ferrule assessment: Buccal — 2.5mm sound tooth above CEJ. Palatal — 2mm. Mesial — 2mm. Distal — 1mm (compromised but acceptable). Minimum 2mm circumferential present (just).
- Prognosis for crown: Guarded due to distal ferrule limitation. Patient counselled.

CARIES REMOVAL: Complete. Caries detector dye confirmed clearance.

POST DECISION:
- Indicated: Yes — insufficient coronal structure for composite-only core retention.
- Type: Fibre post (radiolucent, easy to retrieve if needed)
- Length: 12mm (2/3 of palatal canal length, equal to anticipated crown height)
- Diameter: 1.2mm (RelyX Fiber Post size 1)
- Brand / size: RelyX Fiber Post, size 1 (RelyX Post and Core system)

POST PLACEMENT: Palatal canal preparation — Peeso reamer to 10mm depth. GP removed to predetermined depth. Post tried in. Cemented with RelyX Unicem self-adhesive resin cement. Light cured 20s + 40s indirect.

CORE MATERIAL:
- Type: Composite (RelyX Core Build-up)
- Shade: A3
- Bonding: Self-etch via the self-adhesive cement system (RelyX Unicem)

CORE MARGIN RELATIVE TO GINGIVAL MARGIN: Equigingival buccal and palatal. Subgingival distal (1mm).

OCCLUSAL CHECK: Temporary crown (preformed shell) placed over core. Occlusion checked — slight relief in ICP. Patient advised no heavy chewing.

CONSENT: Crown viability discussed honestly — guarded prognosis due to distal ferrule limitation. Risk of root fracture during functional load before crown placed (now and after) — discussed. Risk of crown loss requiring re-treatment or extraction — discussed. Alternative: extraction + implant — discussed (patient prefers to attempt crown given cost differential).

PROGNOSIS / CROWN PLAN: Crown booked in 2 weeks. Crown lengthening surgery considered if distal ferrule fails at prep — patient warned.

POST-OP ADVICE: Avoid heavy chewing on UR6 until crown placed. Tooth is vulnerable until crowned. Contact if fracture, debonding, or pain.

Compliance: the medico-legal angle

• CGDent restorative records — operative detail including pre-existing structure, materials, and prognosis.
• RCS England endodontic-restorative interface — ferrule, post-and-core design, and prognosis assessment must be documented before crown.
• ESE Quality Guidelines — post space, post design, and final restoration plan all integral to long-term RCT success.
• Montgomery — guarded prognosis must be discussed; "the tooth might fracture" is a material risk patients want to know.

Common documentation mistakes

• No ferrule assessment recorded — when the tooth later fractures, you cannot demonstrate you evaluated this critical prognostic factor.
• Post placed without documenting type, length, diameter — if a post fails or the canal perforates, you can't demonstrate appropriate technique.
• No prognosis discussion in consent — Montgomery breach for any heavily compromised tooth.
• Building up to crown prep height without composite shrinkage management — internal voids weaken the foundation.
• No "avoid heavy chewing until crowned" advice — if tooth fractures before crown, the patient claims you didn't warn.

Sources

• 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 Dental Filling

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