AIGIS-SUPER

{0}------------------------------------------------ Ko24142 MAR 1 0 2003 #### 510(K) SUMMARY SB LUCIUS, INC. Submitter of 510(k): 9778 Katella Ave. Ste. 205, Anaheim, CA 92804 Phone: (714) 530-2814, Fax : (714) 530-3448, | Contact person: | Dae Kyu Chang | |-----------------|---------------------| | Phone: | (714) 530-2814 | | Fax: | (714) 530-3448 | | E-mail: | Gatorkr@yahoo.co.kr | Dec 15, 2002 Date of Summary: | Trade name: | AIGIS-SUPER | |----------------------|-----------------------------------------------------------------| | Common: | Dental casting alloy | | Classification name: | Gold based alloys and precious metal alloys for<br>clinical use | | Product code: | EJT | | Classification: | Class II | Legally marketed device: JENSEN'S JYE 510(k) number: ### SUMMARY OF THE TECHNOLOGICAL CHARACTERISTICS Test methods applied: as in ANSI/ADA 5 and ISO 9693 #### Comparison of composition: | | | | | <br>And Am S & S & S & S & S . C . C . C . C . C . C . C . C . C . C . C . C . C . 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This device is dependable 53% gold alloy with a high gold appearance. AIGIS-SUPER is excellent for inlays, three-quarter crowns, long and short-span bridges. AIGIS-SUPER is substantially equivalent to JENSEN'S JYE and the minor differences between them do not affect safety or effectiveness. {2}------------------------------------------------ Image /page/2/Picture/1 description: The image is a black and white logo for the Department of Health & Human Services - USA. The logo is circular in shape, with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter of the circle. Inside the circle is an abstract symbol that resembles a stylized human figure or a bird in flight, composed of three curved lines. Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850 ## MAR 1 0 2003 Mr. Dae-Kyu Chang SB LUCIUS, Incorporated 9778 Katella Avenue, Suite 205 Anaheim, California 92804 Re: K024142 Trade/Device Name: AIGIS-SUPER Regulation Number: 872.3060 Regulation Name: Gold-based Alloys and Precious Metal Alloys for Clinical Use Regulatory Class: II Product Code: EJT Dated: December 15, 2002 Received: December 16, 200 Dear Mr. Chang We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register. {3}------------------------------------------------ Page 2 - Mr. Chang Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050. This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market. If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at (301) 594-4613. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html Sincerely yours, Susan Tanner Susan Runner, DDS, MA Interim Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health Enclosure {4}------------------------------------------------ SE LUCIUS, INC 9778 Katella Ave. Ste. 205, Anaheim, CA 92804 Phone: (714) 530-2814, Fax : (714) 530-3448, # INDICATIONS FOR USE 510(K) Number : K₀24/4₂ Device Name(s) : AIGIS-SUPER AIGIS-SUPER is intended for manufacturing - Inlay / Onlays - - Crowns - - Short span bridges - - Long span bridges - - Removable partials - (PLEASE DO NOT WRITE BELOW THIS LINE CONTINUE ON ANOTHER PAGE IF NEEDED) concurrence of chrd,office of DEVICE EVALUATION(OED) MEadh ke MSR siology, General Hospital. 510(k) Number 10