Pit and Fissure Sealants Survey

Question Title

1) How often do you personally place pit and fissure sealants?

0-10 times per week

10-20 times per week

More than 20 times per week

Question Title

2) Which pit and fissure sealant material do you use regularly? (Please select only one for this survey) (Required.)

Embrace WetBond

Embrace WetBond Low Fill

Seal-Rite

Seal-Rite Low Viscosity

Other (please specify)

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3) How long have you been using this material? (Required.)

0-1 year

1-3 years

More than 3 years

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4) What do you like most about this product?

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5) Please rate the characteristics of the sealant material you chose (Required.)

	Excellent	Good	Fair	Poor	N/A
Marginal Integrity	Marginal Integrity Excellent	Marginal Integrity Good	Marginal Integrity Fair	Marginal Integrity Poor	Marginal Integrity N/A
Flowability	Flowability Excellent	Flowability Good	Flowability Fair	Flowability Poor	Flowability N/A
Handling	Handling Excellent	Handling Good	Handling Fair	Handling Poor	Handling N/A
Setting Time	Setting Time Excellent	Setting Time Good	Setting Time Fair	Setting Time Poor	Setting Time N/A
Retention	Retention Excellent	Retention Good	Retention Fair	Retention Poor	Retention N/A
Color Match	Color Match Excellent	Color Match Good	Color Match Fair	Color Match Poor	Color Match N/A
Durability	Durability Excellent	Durability Good	Durability Fair	Durability Poor	Durability N/A
Strength	Strength Excellent	Strength Good	Strength Fair	Strength Poor	Strength N/A
Ion Release	Ion Release Excellent	Ion Release Good	Ion Release Fair	Ion Release Poor	Ion Release N/A

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6) For any answer of fair or poor, please explain:

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7) Have your patients experienced any negative issues such as allergic reaction, post-op sensitivity, or infection after use of this material? (Required.)

Yes, please specify

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If yes, please rate the severity of the issue

Temporary mild

Temporary moderate

Temporary severe

Required medical attention

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8) How often have you had to replace or repair a sealant done with this material?

None within 3 years

1-2 times within 3 years

More than 2 times within 3 years

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9) If you have had to replace sealants done with this material, how many were replaced within;

A: Under first year of original placement (#)

B: 1-2 years of original placement (#)

C: Over 2 years of original placement (#)

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10) What are the main reasons you have had to replace or repair sealants done with this material?

Recurrent caries

Broken sealant

Missing sealant

Sensitivity

Other (please specify)

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Comments:

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Are you a dental healthcare provider? (Required.)

Yes

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I give Pulpdent consent to follow up in 6 months (Required.)

Agree

Disagree

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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

Pit and Fissure Sealants

Question Title

* 1) How often do you personally place pit and fissure sealants?

Question Title

* 2) Which pit and fissure sealant material do you use regularly? (Please select only one for this survey) (Required.)

Question Title

* 3) How long have you been using this material? (Required.)

Question Title

* 4) What do you like most about this product?

Question Title

* 5) Please rate the characteristics of the sealant material you chose (Required.)

Question Title

* 6) For any answer of fair or poor, please explain:

Question Title

* 7) Have your patients experienced any negative issues such as allergic reaction, post-op sensitivity, or infection after use of this material? (Required.)

Question Title

* If yes, please rate the severity of the issue

Question Title

* 8) How often have you had to replace or repair a sealant done with this material?

Question Title

* 9) If you have had to replace sealants done with this material, how many were replaced within;

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* 10) What are the main reasons you have had to replace or repair sealants done with this material?

Question Title

* Comments:

Question Title

* Are you a dental healthcare provider? (Required.)

Question Title

* I give Pulpdent consent to follow up in 6 months (Required.)

Question Title

* 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.

Question Title

* Internal use only

1) How often do you personally place pit and fissure sealants?

2) Which pit and fissure sealant material do you use regularly? (Please select only one for this survey) (Required.)

3) How long have you been using this material? (Required.)

4) What do you like most about this product?

5) Please rate the characteristics of the sealant material you chose (Required.)

6) For any answer of fair or poor, please explain:

7) Have your patients experienced any negative issues such as allergic reaction, post-op sensitivity, or infection after use of this material? (Required.)

If yes, please rate the severity of the issue

8) How often have you had to replace or repair a sealant done with this material?

9) If you have had to replace sealants done with this material, how many were replaced within;

10) What are the main reasons you have had to replace or repair sealants done with this material?

Comments:

Are you a dental healthcare provider? (Required.)

I give Pulpdent consent to follow up in 6 months (Required.)

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.

Internal use only