Augma form: Bond Apatite - Shaked Digital שקד דיגיטל

Doc no: F036-BA Doc title: PMS activities report Bond Apatite - English Version: 5

Dear customer,
Augma Biomaterials is committed to ensure the highest level of quality for all its products and services. In order to reevaluate our products and our striving for improvement, we kindly ask your feedback. This questionnaire aims to enable us an evaluation of safety, effectiveness, convenience, quality and clinical success of our products. Augma Biomaterials appreciate your time and your cooperation.

User Details

Name

Title:

Dentist Assistant Other

(if other, elaborate):

Company/Clinic name:

Phone number:

Address

Date:

Professional background

Overall dental experience:

more than 20 years 10-20 years less than 10 years

Special Degree

No Yes

(if yes, elaborate):

Experience with dental bone grafts:

more than 20 years 10-20 years less than 10 years

Frequency of augmentation procedure:

<1 per month 2-10 per month 10-20 per month >20 per month

Clinical Questionnaire – Bond Apatite®

Instruction for use

Have you read the instruction for use before using?

Yes No

Guidance

Have you passed training prior to use?

Yes No

Have you used a DEMO prior to use?

Yes No

(if other, elaborate):

Is there more information you would like Augma to provide?

No Yes

(if yes, elaborate):

Strengths and weaknesses

(5 = high score, 1 = low score)

Clinical performance

(5 = high score, 1 = low score)

Bond Apatite® remains pliable after mixing, which allows handling time to complete the bone reconstruction procedure

Setting time

too long appropriate too short

Clinical cases

Have you used Bond Apatite® in the following clinical cases?

Sinus augmentation

Yes No

Periodontal defect

Yes No

Dehiscence, fenestrations

Yes No

Alveolar ridge augmentation

Yes No

Horizontal defect (and crest widening)

Yes No

Filling bony defects pre implant placement

Yes No

Filling of cyst cavities

Yes No

Augmentation around implant with immediate implant placement

Yes No

Other Clinical Case:

Follow up

Was follow up performed post augmentation procedure?

Yes No

If yes, after ______ months post augmentation

Are you satisfied from bone quality at the implantation site during follow up?

Yes No

How long post bone augmentation procedure had you implanted the implant?

less than 3 months 3 months 6 months

The overall augmentation procedure was successful

Yes No

Summary

Will you consider using Bond Apatite® in the future?

Yes No

Will you recommend Bond Apatite® to others?

Yes No

Open Questions

Have you encountered risks or safety issues relating to device usage?

Have you encountered any major usability issues?

Have there been any un-anticipated adverse events during your use of the product (related to patients, handling, safety or other)?

Comments: