K Number
K011854
Device Name
TOKUYAMA M-BOND
Date Cleared
2001-09-04

(83 days)

Product Code
Regulation Number
872.3275
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
For use as a dental cement for adhesion and fixation between tooth and prosthesis, tooth and tooth, and between two or more prostheses.
Device Description
The product is a self cured adhesive resin cement.
More Information

None

No
The summary describes a dental cement and explicitly states "Not Found" for mentions of AI, DNN, or ML, and lacks any description of AI/ML-related components or performance studies.

No
The device is described as a dental cement for adhesion and fixation, which is a structural or material function, not a therapeutic or treatment function for a disease or medical condition.

No
The device is described as a dental cement used for adhesion and fixation, which indicates a therapeutic or restorative purpose, not a diagnostic one.

No

The device is described as a "self cured adhesive resin cement," which is a physical material, not software.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is for "adhesion and fixation between tooth and prosthesis, tooth and tooth, and between two or more prostheses." This describes a physical function within the body (or on the surface of the body), not a diagnostic test performed on samples taken from the body.
  • Device Description: The device is described as a "self cured adhesive resin cement." This is a material used for bonding, not for analyzing biological samples.
  • Lack of IVD Characteristics: The description does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Providing information about a patient's health status, disease, or condition
    • Using reagents or assays

The device is clearly a dental material used for restorative and prosthetic procedures.

N/A

Intended Use / Indications for Use

The product is a self cured adhesive resin cement. It is intended for use in adhesion and fixation between tooth and prosthesis, tooth and tooth, and between two or more prostheses. Clinical applications include the cementation of inlays, onlays, crowns, metal posts and cores and similar applications. For use as a dental cement for adhesion and fixation between tooth and prosthesis, tooth and tooth, and between two or more prostheses.

Product codes

Not Found

Device Description

The product is a self cured adhesive resin cement.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Tooth

Indicated Patient Age Range

Not Found

Intended User / Care Setting

For use only by dental practitioners; it is not intended for OTC use.

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

K991711, K960464, K933030

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 872.3275 Dental cement.

(a)
Zinc oxide-eugenol —(1)Identification. Zinc oxide-eugenol is a device composed of zinc oxide-eugenol intended to serve as a temporary tooth filling or as a base cement to affix a temporary tooth filling, to affix dental devices such as crowns or bridges, or to be applied to a tooth to protect the tooth pulp.(2)
Classification. Class I (general controls). The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 872.9.(b)
Dental cement other than zinc oxide-eugenol —(1)Identification. Dental cement other than zinc oxide-eugenol is a device composed of various materials other than zinc oxide-eugenol intended to serve as a temporary tooth filling or as a base cement to affix a temporary tooth filling, to affix dental devices such as crowns or bridges, or to be applied to a tooth to protect the tooth pulp.(2)
Classification. Class II.

0

Exhibit D

510(k) Summary

K011854

Submitted by: - Daniel J. Manelli Manelli Denison & Selter, P.L.L.C. 2000 M Street, NW (Suite 700)

Washington, DC 20036

Telephone: 202-261-1000

On behalf of Tokuyama America, Inc. 510(k) Submission: Tokuyama M Bond August 10, 2001

The product is a self cured adhesive resin cement. It is intended for use in adhesion and fixation between tooth and prosthesis, tooth and tooth, and between two or more prostheses. Clinical applications include the cementation of inlays, onlays, crowns, metal posts and cores and similar applications.

The product is for use only by dental practitioners; it is not intended for OTC use. It contains materials that pose no health hazard when used according to directions and has received the approval of the Japanese Government. It is substantially equivalent to various marketed dental cement products, including the following:

Bistite II SC (Tokuyama)K991711
C&B Metabond (Parkhill)K960464
Panavia 21 (Kurarey)K933030

The use of the product is contra-indicated for patients who are hypersensitive to methacrylate monomers. It should not be allowed to come into contact with skin, mucosal membrane, eyes or clothing. Should contact with the eyes occur, the eyes should be thoroughly flushed with water followed by immediate contact with a physician.

1

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/1/Picture/1 description: The image is a black and white logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle with three swooping lines forming its body and wings. The eagle faces to the right. Encircling the eagle is the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" in a circular arrangement.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

SEP - 4 2001

Tokuyama America, Incorporated C/O Mr. Daniel J. Manelli Attorney Manelli, Dension & Selter, P.L.L.C 2000 M Street Northwest, Suite 700 Washington, DC 20036

Re : K011854 Tokuvama M-Bond Trade/Device Name: Requlation Number: 872.3275 II Regulatory Class: Product Code: EMA Dated: June 13, 2001 Received: June 13, 2001

Dear Mr. Manelli:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we 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). 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 (Premarket Approval), it may be subject to such additional controls. Existing major requlations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 895. ਸੈ substantially equivalent determination assumes compliance with the Current Good Manufacturing Practice requirements, as set forth in the Quality System Regulation (QS) for Medical Devices: General requlation (21 CFR Part 820) and that, through periodic QS inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP regulation may result in regulatory In addition, FDA may publish further announcements action.

2

Page 2 - Mr. Manelli

concerning your device in the Federal Register. Please note: this response to your premarket notification submission does ent affect any obligation you might have under sections 531 through 542 of the Act for devices under the Electronic emroduct Radiation Control provisions, or other Federal laws or regulations.

This letter will allow you to begin marketing your device as described in your 510(k) premarket notification. The FDA asbeing 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 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4613. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the requlation entitled, "Misbranding by reference to premarket notification" (21CFR 807.97). Other qeneral information on your responsibilities under the Act may be obtained 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,

Victor

Timothy A. Ulatowski

Timot Director Division of Dental, Infection Control and General Hospital Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

3

Exhibit C

510(k) Number (if known): K011854

Tokuyama M - Bond Device Name: _________________________________________________________________________________________________________________________________________________________________

Indications For Use:

For use as a dental cement for adhesion and fixation between tooth and r or ass a a actiture of noth, and between two or more prostheses.

(Please Do Not Write Below This Line - Continue On Another Page If Needed)

Concurrence of CDRH, Office of Device evaluation (ODE)

Susan Rumm

OR

(Division Sign-Off) Division of Dental, Infection Control, General Hospital Deyic Humber .......................................................................................................................................................................

Prescription Use
(Per 21 CFR 801.109) $\checkmark$

Over-The-Counter Use