Implant System Preferences Survey

About you:

Dentist Name _________________________________

Clinic Name _________________________________

Phone Number ________________________________

Email ________________________________________

1- Does your clinic per form implant surgeries?
( ) Yes ( ) No

1.1- Brands of dental implants used at your clinic, (m.c)
( ) BioHorizons

( ) Zimmer Biomet 3iTm ( ) MegagenTm

( ) Astra Tech Tm
( ) XlveTm

( ) Nobel Blocare Tm
( ) Straumann Tm
( ) Other _______

1.2- Approx. Number of dental implants used by your clinic per month?

____________________________________________

1.3- Which type of implantation procedures do you carry out? (m.c)
( ) one stage implantation
( ) Two stage implantation
( ) Immediate loading
( ) Basal/Compressive
( ) Guided surgery
_____________________________________________

2- Does your clinic also carry out the restoration process?

( ) Yes ( ) No

2.1- Implant abutment connection - choose your preference, (m.c)

( ) Conical connection

( ) Internal hex connection

( ) Other ______________ _

2.2- What is your clinic's main restoration method? (m.c)

( ) Cemented restoration

( ) Screwed restoration

( ) CAD/CAM restoration

( ) Removable restoration

2.3- Do you restore, (m.cl

( ) Single units

( ) Multiple units

( ) Full arches

3-What can be added to your currently used brand? (Im.cl)

( ) More restoration options

( ) CAD/CAM restoration

( ) Guided surgery

( ) Primary stability and Immediate loading

Q Other ______________

4-Does your current brand provide, (m.c)

( ) Single restoration platform

( ) 3.0mm diameter implant

( ) Full CAD/CAM prosthetic solution

( ) Guided surgical service

( ) Bioactive surface

6- What do you like about your current Implant system?

_____________________________________________

7- Additional comments,

______________________________________________

Name Date