K Number
K092616
Manufacturer
Date Cleared
2009-10-21

(56 days)

Product Code
Regulation Number
872.3200
Panel
Dental
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

Ascent Bond Universal Adhesive System is indicated for direct bonding to and desensitizing of dentin and enamel, and direct bonding to composite, porcelain, and base metals.

Device Description

The Ascent Bond Universal Adhesive is an ethanol-based composition containing a special formulation of resins to achieve an excellent bond to materials such as restorative composites, dentin, enamel, metals and porcelain. The composition is polymerized by means of a dental polymerization light source.

AI/ML Overview

The provided text is a 510(k) summary for the Ascent Bond Universal Adhesive System. This document outlines the device's substantial equivalence to predicate devices, its intended uses, and technological characteristics. However, it explicitly states "Performance Standards: None" and refers to "Part 7: Performance Data" which is not included in the provided snippets.

Therefore,Based on the information provided, it is not possible to describe the acceptance criteria, reported device performance, or the details of any study that proves the device meets acceptance criteria. The document states "Performance Standards: None" and does not include the "Part 7: Performance Data" which would contain such information.

Here's what can be stated based on the available text:

General Information from the 510(k) Summary

  • Device Name: Ascent Bond Universal Adhesive System
  • Manufacturer: CAO Group, Inc.
  • 510(k) Number: K092616
  • Product Classification: Agent, Tooth Bonding, Resin (21 CFR 872.3200, Product Code: KLE)
  • Intended Uses: Direct bonding to and desensitizing of dentin and enamel, and direct bonding to composite, porcelain, and base metals.
  • Predicate Devices:
    • Ascent Universal Adhesive (K070413)
    • Gluma Comfort Bond + Desensitizer (K992292)
  • Rationale for Substantial Equivalence: Similar indications for use, ingredients, application methods, and composition to predicate devices.
  • Performance Standards: None explicitly stated as required for the device. The document mentions "Performance Data" but this section is not provided.

Regarding your specific questions:

  1. A table of acceptance criteria and the reported device performance: Cannot be provided. The document explicitly states "Performance Standards: None" and the section containing "Performance Data" is not included.
  2. Sample size used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective): Cannot be provided. This information would be within the "Performance Data" section, which is missing.
  3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience): Cannot be provided. This information would be within the "Performance Data" section, which is missing.
  4. Adjudication method (e.g. 2+1, 3+1, none) for the test set: Cannot be provided. This information would be within the "Performance Data" section, which is missing.
  5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance: Not applicable. This device is a dental adhesive, not an AI software or diagnostic tool that involves human readers.
  6. If a standalone (i.e. algorithm only without human-in-the loop performance) was done: Not applicable. This device is a dental adhesive, not an algorithm.
  7. The type of ground truth used (expert concensus, pathology, outcomes data, etc): Cannot be provided. This information would be within the "Performance Data" section, which is missing. The concept of "ground truth" as typically applied to diagnostic algorithms or AI models doesn't directly apply to a dental adhesive in the same way. Performance data for an adhesive would typically involve mechanical testing (e.g., bond strength, shear strength) or clinical trials observing its efficacy over time.
  8. The sample size for the training set: Not applicable. This device is a dental adhesive, not an AI model requiring a training set.
  9. How the ground truth for the training set was established: Not applicable. This device is a dental adhesive, not an AI model.

In summary, the provided 510(k) summary primarily focuses on establishing substantial equivalence based on composition and intended use, rather than presenting detailed performance study results with specific acceptance criteria.

{0}------------------------------------------------

K692616

510(k) Summary of Safety and Effectiveness

CAO GROUP 4628 West Skyhawk Drive Sandy, UT 84070 Tel: 801.256.9282 Fax: 801.256.9287 www.caogroup.com Robert K. Larsen, Regulatory Affairs Manager Preparation Date: August 14, 2009

OCT 21 2009

Device Name:

Trade Name:Ascent Bond Universal Adhesive System
Common Name:Dental adhesive
Product Classification:Agent, Tooth Bonding, Resin (21 CFR 872.3200, Product Code: KLE)

Legally Marketed Predicate Devices for Substantial Equivalence:

  • Ascent Universal Adhesive, Manufactured by CAO Group, Inc. . 510(k) Number: K070413
  • Gluma Comfort Bond + Desensitizer, Manufactured by Heraeus Kulzer, Inc. 0 510(k) Number: K992292

Rationale for Substantial Equivalence:

The aforementioned device shares similarities for use in the oral environment for the purpose of adhering restorative materials to tooth structure. This device features similar indications for use, ingredients, and application methods to the predicate devices.

Description of Submitted Device:

The Ascent Bond Universal Adhesive is an ethanol-based composition containing a special formulation of resins to achieve an excellent bond to materials such as restorative composites, dentin, enamel, metals and porcelain. The composition is polymerized by means of a dental polymerization light source. Exact information regarding the material's constituents is found in Part 6: Specifications

{1}------------------------------------------------

Intended Uses of the Ascent Bond Universal Adhesive System:

Ascent Bond Universal Adhesive System is indicated for direct bonding to and desensitizing of dentin and enamel, and direct bonding to composite, porcelain, and base metals.

Technological Characteristics of Substantial Equivalence:

Both the submitted and predicate devices are composed of similar substances, with similar active constituents in similar concentrations. Both have similar indications for use. Both have similar methods of application. Both are used in conjunction with dental restorative and preventative procedures.

Performance Standards:

None

Performance Data

See Part 7: Performance Data

Conclusion -------------------------------------------------------------------------------------------------------------------------------------------------------------------

The Ascent Bond Universal Adhesive System is substantially equivalent to the aforementioned predicate device with regards to purpose of the device, general composition, methods of application, and indications for use without raising any new issues regarding safety and/or effectiveness.

{2}------------------------------------------------

Image /page/2/Picture/1 description: The image shows the seal of the Department of Health & Human Services USA. The seal is circular, with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" arranged around the perimeter. In the center of the seal is an abstract image of an eagle.

Food and Drug Administration 10903 New Hampshire Avenue Document Mail Center - WO66-G609 Silver Spring, MD 20993-0002

Mr. Robert K. Larsen Regulatory Affairs Manager CAO Group, Incorporated 4628 West Skyhawk Drive West Jordan, Utah 84084

OCT 2 1 2009

Re: K092616

Trade/Device Name: Ascent Bond Universal Adhesive System Regulation Number: 21 CFR 872.3200 Regulation Name: Resin Tooth Bonding Agent Regulatory Class: II Product Codes: KLE and LBH Dated: August 14, 2009 Received: August 26, 2009

Dear Mr. Larsen:

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 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. Larsen

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); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Center for Devices and Radiological Health's (CDRH's) Office of Compliance at (240) 276-0115. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please contact the CDRH/Office of Surveillance and Biometrics/Division of Postmarket Surveillance at 240-276-3464. For more information regarding the reporting of adverse events, please go to http://www.fda.gov/cdrh/mdr/.

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 (240) 276-3150 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

ht far

Susan Runner, D.D.S., M.A. Acting Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

{4}------------------------------------------------

Indications for Use

510(k) Number (if known):

K092616

Device Name: Ascent Bond Universal Adhesive System

Indications For Use:

Ascent Bond Universal Adhesive System is indicated for direct bonding to and desensitizing of dentin and enamel, and direct bonding to composite, porcelain, and base metals.

(PLEASE DO NOT WRITE BELOW THIS LINE – CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use

(Per 21 CFR 801.109)

X OR

Keen Muley for MSR

(Division Sign-Off) Division of Anesthesiology, General Hospital Infection Control, Dental Devices

Over-The-Counter Use

510(k) Number:

2-1

§ 872.3200 Resin tooth bonding agent.

(a)
Identification. A resin tooth bonding agent is a device material, such as methylmethacrylate, intended to be painted on the interior of a prepared cavity of a tooth to improve retention of a restoration, such as a filling.(b)
Classification. Class II.