Restoration Repair

By completing this survey, you give Pulpdent Corporation permission to use the information you provide below for quality assurance and compliance purposes.

Question Title

* 1) How often do you personally repair fractured porcelain?

0-1 times per month

2 times per month

More than 2 times per month

Question Title

* 2) Which repair material do you use regularly? (Please select only one for this survey)

Porcelain Prep Kit: Porcelain Etch Gel, Silane, Dry-Rite and Kool-Dam

Kool Dam

Silane

Porcelain Etch Gel

Dry-Rite

Embrace Restoration & PFM Repair Kit: Embrace First Coat, Embrace Seal-N-Shine, Embrace Esthetic Opaquer, Kool Dam, Porcelain Etch Gel

Embrace First Coat

Embrace Seal-N-Shine

Embrace Esthetic Opaquer

Other (please specify)

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

0-1 year

1-3 years

More than 3 years

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

Question Title

* 5) Please rate the characteristics of the material you chose

	Excellent	Good	Fair	Poor	N/A
Marginal integration	Marginal integration Excellent	Marginal integration Good	Marginal integration Fair	Marginal integration Poor	Marginal integration 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
Color Match	Color Match Excellent	Color Match Good	Color Match Fair	Color Match Poor	Color Match N/A
Finishing/ Polishing	Finishing/ Polishing Excellent	Finishing/ Polishing Good	Finishing/ Polishing Fair	Finishing/ Polishing Poor	Finishing/ Polishing 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

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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?

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

Question Title

* 8) How often have you had to redo the repair done with this material?

0-2 times per year

3-5 times per year

More than 5 times per year

Question Title

* 9) If you have had to redo the repair done with this material, how many were replaced within;

Under a year of original placement (#)

2-3 years of original placement (#)

Over 3 years of original placement (#)

Question Title

* 10) What are the main reasons you have had to redo a repair done with this material?

Sensitivity

Broken material

Missing material

Other (please specify)

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* Comments:

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* Are you a dental healthcare provider?

Yes

Question Title

* I give Pulpdent consent to follow up in 6 months

Agree

Disagree

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.

Name

Company

Email Address

Phone Number

Restoration Repair

Question Title

* 1) How often do you personally repair fractured porcelain?

Question Title

* 2) Which repair material do you use regularly? (Please select only one for this survey)

Question Title

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

Question Title

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

Question Title

* 5) Please rate the characteristics of the material you chose

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?

Question Title

* If yes, please rate the severity of the issue

Question Title

* 8) How often have you had to redo the repair done with this material?

Question Title

* 9) If you have had to redo the repair done with this material, how many were replaced within;

Question Title

* 10) What are the main reasons you have had to redo a repair done with this material?

Question Title

* Comments:

Question Title

* Are you a dental healthcare provider?

Question Title

* I give Pulpdent consent to follow up in 6 months

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