K Number
K113401
Manufacturer
Date Cleared
2012-02-07

(82 days)

Product Code
Regulation Number
872.3750
Panel
Dental
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The indication for use of Ortho-1 is a bracket bonding system in the oral cavity of dental patients.

Device Description

Ortho-1 is an orthodontic no-mix direct bonding system consisting of Paste, a Primer, and Liquid Etchant. The micromechanical bond to enamel utilizes the acid.etch technique and Bisco's unique composite chemistry. Ortho-1 will bond to brackets (such as metal, plastic, or porcelain) without additional conditioners. Ortho-1 will also bond any type of bracket to properly conditioned dental material restorative materials (such as porcelain, composites, and metal).

AI/ML Overview

The acceptance criteria and study proving the device meets those criteria are described below:

1. Table of Acceptance Criteria and Reported Device Performance

Feature/PropertyAcceptance Criteria (Predicate)Reported Device Performance (Ortho-1)
Chemical CompositionChemical Cure PresentChemical Cure Present (X)
Solvent-free, unfilled, methacrylate-based primer presentSolvent-free, unfilled, methacrylate-based primer present (X)
Silica filled methacrylate-based paste presentSilica filled methacrylate-based paste present (X)
Phosphoric Acid present (Liquid Etchant)Phosphoric Acid present (X)
Physical/Mechanical PropertiesLow viscosity Primer (Ortho-One K962946)Low viscosity Primer (X)
Tacky Paste (Ortho-One K962946)Tacky Paste (X)
Medium viscosity paste (Not specified for predicate)Medium viscosity paste (X)
Low viscosity paste (Not specified for predicate)Low viscosity paste (X)
High viscosity paste (Ortho-One K962946)High viscosity paste (X)
Low viscosity, semi-gel (Bisco Etchants K101485)Low viscosity, semi-gel (X)
Green color (Bisco Etchants K101485)Green color (X)
BiocompatibilitySafe for intended uses (implied from legally marketed predicate)Cytotoxicity-agarose diffusion testing conducted; safe for intended uses

2. Sample Size Used for the Test Set and Data Provenance

The provided document does not specify a numerical sample size for the test set. The performance data section states that "The physical/mechanical properties of Ortho-1 and Liquid Etchant were tested in the lab using R&D testing protocols."

The data provenance is retrospective, as the testing was conducted in a lab setting by the manufacturer (BISCO, Inc.) for the purpose of demonstrating substantial equivalence to predicate devices. The country of origin can be inferred as USA, where BISCO, Inc. is located.

3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications of Those Experts

This information is not provided in the document. The performance data appears to be based on internal R&D testing protocols rather than expert-established ground truth.

4. Adjudication Method for the Test Set

This information is not provided in the document, as the testing described is primarily laboratory-based physical/mechanical property comparison, not clinical evaluation requiring adjudication.

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

A Multi-Reader Multi-Case (MRMC) comparative effectiveness study was not done. This device is an orthodontic adhesive, and the evaluation focuses on its chemical and physical properties for bonding, not on interpretation by human readers. Therefore, the concept of improvement with AI assistance is not applicable in this context.

6. If a Standalone (i.e. algorithm only without human-in-the-loop performance) Was Done

This question is not applicable as the device is a physical orthodontic adhesive, not a software algorithm or AI.

7. The Type of Ground Truth Used

The ground truth used for performance evaluation is primarily comparison to established chemical and physical characteristics of legally marketed predicate devices. For biocompatibility, "cytotoxicity-agarose diffusion testing" was conducted, indicating a laboratory-based biological assessment.

8. The Sample Size for the Training Set

This information is not applicable as this is not an artificial intelligence or machine learning device that requires a training set.

9. How the Ground Truth for the Training Set Was Established

This information is not applicable as this is not an artificial intelligence or machine learning device that requires a training set.

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K113401

Image /page/0/Picture/1 description: The image shows the logo for BISCO. The logo is made up of hexagons with the letters B, I, S, C, and O inside. Below the logo is the text "Bringing Science to the Art of Dentistry™".

FEB - 7 2012

510 (k) SUMMARY

Applicant:

Contact Person:

Date Prepared: Trade Name: Common Name: Product Code: Classification/Name: Bisco, Inc. 1100 W. Irving Park Road Schaumburg IL, 60193 Michelle Schiltz-Taing Tel: 847-534-6146 Fax: 847-534-6146

Ortho-1 Orthodontic Adhesive DYH Bracket Adhesive Resin Class II per 21 CFR 872.3750

Predicate Devices:

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Light Bond (Quick Cure) by Reliance Orthodontic Products Inc., Itasca IL K001048: And Bisco Etchants by Bisco, Inc. Schaumburg IL K101485.

Indications for Use:

The indication for use of Ortho-1 is a bracket bonding system in the oral cavity of dental patients.

Description of Applicant Device:

Ortho-1 is an orthodontic no-mix direct bonding system consisting of Paste, a Primer, and Liquid Etchant. The micromechanical bond to enamel utilizes the acid.etch technique and Bisco's unique composite chemistry. Ortho-1 will bond to brackets (such as metal, plastic, or porcelain) without additional conditioners. Ortho-1 will also bond any type of bracket to properly conditioned dental material restorative materials (such as porcelain, composites, and metal).

Technological Characteristics:

All components of Ortho-1 are based upon industry standard monomer chemistry and are found in the legally marketed predicate device Ortho-One (K962946) and Bisco Etchants K101485. Comparisons of the chemical composition of Ortho-1 to the predicates are provided on the following page:

BISCO, Inc. 1100 W. Irving Park Road Schaumburg, IL 60193 U.S.A.

800-247-3368 or 847-534-6000 Fax: 847-891-5049 ww.bisco.com

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Image /page/1/Picture/0 description: The image shows the logo for BISCO, a dental supply company. The logo consists of the letters "BISCO" arranged in a hexagonal pattern. Below the logo is the tagline "Bringing Science to the Art of Dentistry."

Chemical CompositionOrtho-OneK962946Ortho-1
Chemical CureXX
Solvent free, unfilled, methacrylate based primerXX
Silica filled methacrylate based pasteXX
Chemical CompositionBisco EtchantsK101485Liquid Etchant
Phosphoric AcidXX

Performance Data:

The physical/mechanical properties of Ortho-1 and Liquid Etchant were tested in the lab using R&D testing protocols. The information provided in this 510(k) of Ortho-1 and Liquid Etchant compared to the predicates demonstrates that they are effective for its indications of use. A comparison of the physical/mechanical properties are included below: --

Physical / Mechanical PropertyComparisonOrtho-OneK962946Ortho-1
Low viscosity PrimerXX
Tacky PasteXX
Medium viscosity pasteX
Low viscosity pasteX
High viscosity pasteXX
Physical / Mechanical PropertyComparisonBisco EtchantsK101485Liquid Etchant
Low viscosity, semi-gelXX
Green colorXX

Biocompatibility:

An evaluation of biocompatibility was conducted to determine the safety of Ortho-1 and Liquid Etchant. Ortho-1 had cytotoxicity-agarose diffusion testing conducted. The conclusions of the safety evaluations are that Ortho-1 and Liquid Etchant are safe for their intended uses.

Conclusion:

Side by side comparisons clearly demonstrate that the applicantially equivalient to other legally marketed devices. It is concluded that the information supplied in this submission has BISCO, Inc. proven the safety and efficacy of these products.

An ISO 13485 Certified Company

1100 W. Irving Park Road Schaumburg, IL 60193 U.S.A. 800-247-3368 or 847-534-6000 Fax: 847-891-5049 www.bisco.com

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Image /page/2/Picture/1 description: The image shows the logo for the Department of Health & Human Services (HHS). The logo consists of a stylized eagle or bird-like figure with outstretched wings, rendered in black. The bird is positioned to the right of a circular arrangement of text that reads "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA". The text is also in black and is arranged around the upper and left portions of the circle.

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

FEB - 7 2012

Ms. Michelle Schiltz-Taing Regulatory Affairs Coordinator BISCO, Incorporated 1100 West Irving Park Road Schaumburg, Illinois 60193

Re: K113401

Trade/Device Names: Ortho-1 Regulation Number: 21 CFR 872.3750 Regulation Name: Bracket Adhesive Resin and Tooth Conditioner Regulatory Class: II Product Code: DYH Dated: November 15, 2011 Received: November 17, 2011

Dear Ms. Schiltz-Taing:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

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.

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Page 2 - Ms. Schiltz-Taing

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 go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices /ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. 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 go to http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Nh for

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

Enclosure

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510 (k) Number (if known):

Device Name: _ Ortho-1

Indications for Use:

The indication for use of Ortho-1 is a bracket bonding system in the oral cavity of dental patients.

2113 40

Prescription Use V (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use (21 CFR 807 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Susan Rummie

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

510(k) Number: K113401

§ 872.3750 Bracket adhesive resin and tooth conditioner.

(a)
Identification. A bracket adhesive resin and tooth conditioner is a device composed of an adhesive compound, such as polymethylmethacrylate, intended to cement an orthodontic bracket to a tooth surface.(b)
Classification. Class II.