K Number
K030663
Device Name
TOKUYAMA SOFRELINER TOUGH
Date Cleared
2003-05-29

(87 days)

Product Code
Regulation Number
872.3760
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
For use as a denture reliner
Device Description
The product is a denture relining resin material for use in relining the tissue contact sur ace cf dentures (21 CFR 872.3760)
More Information

Not Found

No
The summary describes a denture relining resin material and does not mention any software, algorithms, or AI/ML capabilities.

No
The device is a denture relining resin material, not a therapeutic device. It is used to reline dentures, which is a supportive and restorative function rather than a therapeutic one.

No
The device is a denture relining resin material, which is used for treatment (relining dentures) rather than diagnosis. Its intended use describes a restorative or corrective function, not a diagnostic one.

No

The device description explicitly states it is a "denture relining resin material," which is a physical substance, not software.

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

Here's why:

  • Intended Use/Indications for Use: The intended use is "For use as a denture reliner." This describes a material used to modify a dental prosthesis, not a test performed on a sample taken from the human body to diagnose a condition.
  • Device Description: The description confirms it's a "denture relining resin material for use in relining the tissue contact surface of dentures." This further reinforces its function as a material for modifying a device, not for in vitro testing.
  • Lack of IVD Characteristics: The document does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing samples (blood, urine, tissue, etc.)
    • Detecting or measuring substances in samples
    • Providing diagnostic information

The device falls under the category of a dental material used for modifying dentures, which is a medical device but not an IVD.

N/A

Intended Use / Indications for Use

The product is a denture relining resin material for use in relining the tissue contact sur ace cf dentures (21 CFR 872.3760). For use as a denture reliner.

Product codes

EBI

Device Description

The product is a denture relining resin material for use in relining the tissue contact sur ace cf dentures (21 CFR 872.3760). The product is for luse only by dental practitioners; it is not intended for over-the-counter (OTC) use. It contains materials that are common in dental use and pose no nealth hazard when used according to directions.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

dental practitioners

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)

K982537, K953589, K990736, K940566

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 872.3760 Denture relining, repairing, or rebasing resin.

(a)
Identification. A denture relining, repairing, or rebasing resin is a device composed of materials such as methylmethacrylate, intended to reline a denture surface that contacts tissue, to repair a fractured denture, or to form a new denture base. This device is not available for over-the-counter (OTC) use.(b)
Classification. Class II.

0

K030663

EXHIBIT D

510(k) Summary

Daniel J. Manelli Suk mitted by: Manelli, Denison & Selter, P.L.L.C. 2000 Street, NW (Suite 700) Washington, DC 20036 Telephone: 202-261-1000 202-887-0336 Facsimile:

On behalf of Tokuvama America, Inc. 510(k) Submission: Tokuyama SOFRELINING TOUGH February 28, 2003

The product is a denture relining resin material for use in relining the tissue contact sur ace cf dentures (21 CFR 872.3760)

The product is for luse only by dental practitioners; it is not intended for over-thecounter (OTC) use. It contains materials that are common in dental use and pose no nealth hazard when used according to directions. It is substantially equivalent to var ous marketed denture relining products, including the following:

Tokuyama Softrelininer (K982537) Tokuyama Soft Relining (K953589) GC Reline (K990736) Coe Soft (K940566)

The Use of the product is contra-indicated for patients who are sensitive to silicone based products.

1

Image /page/1/Picture/11 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is a stylized image of an eagle with three human profiles incorporated into its design. The image is in black and white.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

MAY 2 9 2003

Tokuyama Dental Corporation C/O Mr. Daniel J. Manelli Manelli, Denison & Selter, P.L.L.C. 2000 M Street, NW, 7th Floor Washington, D.C. 20036-3307

Re: K030663

Trade/Device Name: Tokuyama SOFRELINER TOUGH Regulation Number: 872.3760 Regulation Name: Denture Relining, Repairing or Rebasing Resin Regulatory Class: II Product Code: EBI Dated: February 28, 2003 Received: March 3, 2003

Dear Mr. Manelli:

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.

2

Page 2 - Mr. Manelli

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 Runser

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

3

Exhibit C

Page __ 1__ of __ 1__

510(k) Number (if known): K030663

Device Name: _________________________________________________________________________________________________________________________________________________________________ Tokuyama SOFRELINER TOUGH

Indications For Use:

For use as a denture reliner

(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) OR

Over-The-Counter Use

Robert Sbetz DDS for Dr. K. Mulvey.

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

510(k) Number: K030663