K Number
K012761
Device Name
PRIME-DENT VISIBLE LIGHT CURE PIT & FISSURE SEALANT
Date Cleared
2001-11-01

(76 days)

Product Code
Regulation Number
872.3765
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Prime-Dent® Visible Light Cure Pit & Fissure Sealant (opaque and clear) is a BisGMA based visible light cured resin for the sealing of deciduos teeth and the filling of fissures in primary tooth structure.
Device Description
Not Found
More Information

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Not Found

No
The summary describes a dental sealant and contains no mention of AI, ML, image processing, or any other technology typically associated with AI/ML in medical devices.

Yes
The device is used for "sealing of deciduos teeth and the filling of fissures in primary tooth structure," which is a therapeutic intervention aimed at preventing dental decay.

No
Explanation: The device is described as a sealant for teeth and fissures, which is a treatment rather than a diagnostic tool. It does not mention identifying or characterizing a disease or condition.

No

The 510(k) summary describes a dental sealant, which is a physical material applied to teeth. It does not describe a software product.

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

Here's why:

  • Intended Use: The intended use describes a material applied directly to teeth for sealing and filling. This is a dental restorative material, not a diagnostic test performed on samples taken from the body (like blood, urine, or tissue).
  • Lack of IVD Characteristics: The description does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples.
    • Detecting or measuring substances in the body.
    • Providing information for diagnosis, monitoring, or screening of diseases or conditions.

Therefore, Prime-Dent® Visible Light Cure Pit & Fissure Sealant falls under the category of a dental device, specifically a restorative material, and not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

Prime-Dent® Visible Light Cure Pit & Fissure Sealant (opaque and clear) is a BisGMA based visible light cured resin for the sealing of deciduos teeth and the filling of fissures in primary tooth structure.

Product codes

EBC

Device Description

Not Found

Mentions image processing

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Mentions AI, DNN, or ML

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Input Imaging Modality

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Anatomical Site

deciduos teeth, primary tooth structure

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

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

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

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

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

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Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

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Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

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Predetermined Change Control Plan (PCCP) - All Relevant Information

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§ 872.3765 Pit and fissure sealant and conditioner.

(a)
Identification. A pit and fissure sealant and conditioner is a device composed of resin, such as polymethylmethacrylate, intended for use primarily in young children to seal pit and fissure depressions (faults in the enamel) in the biting surfaces of teeth to prevent cavities.(b)
Classification. Class II.

0

Image /page/0/Picture/1 description: The image is a black and white seal for the Department of Health & Human Services - USA. The seal is circular, with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. In the center of the seal is a stylized design featuring a symbol that resembles an abstract eagle or bird-like figure with three wing-like shapes.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

NOV 0 1 2001

Mr. Roland Marasigan Vice President of Manufacturing Prime Dental Manufacturing, Incorporated 3735 West Belmont Avenue Chicago, Illinois 60618

Re: K012761

Trade/Device Name: Prime-Dent Visible Light Cure Pit & Fissure Sealant Regulation Number: 872.3765 Regulation Name: Sealant Regulatory Class: II Product Code: EBC Dated: August 14, 2001 Received: August 17, 2001

Dear Mr. Marasigan:

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 approvisions 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 (1 vir 1) vice 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.

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.

1

Page 2 - Mr. Marasigan

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 and additionally 21 CFR Part 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 regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). Other general 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,

Timothy A. Ulatowski Director Division of Dental, Infection Control and General Hospital Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

K012761

Indications for Use

Prime-Dent® Visible Light Cure Pit & Fissure Sealant (opaque and clear) is a BisGMA based visible light cured resin for the sealing of deciduos teeth and the filling of fissures in primary tooth structure.

Susan Rummer

Pivision Sign-Off) f mislen of Dental, Infection Control, Feberal Hospital Devices Pumber __