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Dental Restoratives
By completing this survey, you give Pulpdent Corporation permission to use the information you provide below for quality assurance and compliance purposes.
1) How often do you personally perform any kind of restorations?
0-5 times per
day
6-10 times per
day
More than 10 times per
day
*
2) Which restorative material do you use regularly?
(Required.)
ACTIVA Kids
ACTIVA BioACTIVE Restorative
ACTIVA Presto
Embrace Esthetic Opaquer
Embrace WetBond Class V
Flows-Rite
GlassFill Glass Ionomer
Seal-n-Shine
Pulpdent Opaquer
Spee-Dee Build up
HardCore Build up
Other (please specify)
*
3) How long have you been using this material?
(Required.)
0-1
year
1-3
years
More than 3
years
4) What do you like most about this product?
*
5) Please rate the characteristics of the material you chose;
(Required.)
Excellent
Good
Fair
Poor
N/A
Marginal Integrity
Excellent
Good
Fair
Poor
N/A
Flowability
Excellent
Good
Fair
Poor
N/A
Handling
Excellent
Good
Fair
Poor
N/A
Setting Time
Excellent
Good
Fair
Poor
N/A
Color Match
Excellent
Good
Fair
Poor
N/A
Finishing/ Polishing
Excellent
Good
Fair
Poor
N/A
Durability
Excellent
Good
Fair
Poor
N/A
Strength
Excellent
Good
Fair
Poor
N/A
6) For any answer of fair or poor, please explain:
*
Have your patients experienced any negative issues such as allergic reaction, post-op sensitivity, or infection after use of this material?
(Required.)
No
Yes
If yes, please specify
If yes, please rate the severity of the issue
Temporary mild
Temporary moderate
Temporary severe
Required medical attention
*
8) How often have you had to replace or repair a restoration done with this material?
(Required.)
0-2 times per year
3-10 times per year
More than 10 times per year
9) If you have had to replace restorations done with this material, how many were replaced within;
Under 2 years of original placement (#)
2-5 years of original placement (#)
Over 5 years of original placement (#)
10) What is the main reason you have had to replace or repair restorations done with this material?
Recurrent caries
Broken filling
Missing filling
Sensitivity
Other (please specify)
Comments:
*
Are you a dental healthcare provider?
(Required.)
Yes
No
*
I give Pulpdent consent to follow up in 6 months
(Required.)
Agree
Disagree
We ask that you provide your contact information so we may reach you if needed to ensure the safety of our products. Information will not be used for marketing e-mails or phone calls, apart from notifying eligibility parties for gift card giveaways.
Name
Company
Email Address
Phone Number
Internal use only
