K Number
K041124
Device Name
IRRIGATION TUBING SET 2.2M AND 3.8M
Date Cleared
2004-06-07

(39 days)

Product Code
Regulation Number
872.4200
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The irrigation tubing set is an accessory to dental surgical units. The irrigation tubing set is used to supply treatment fluid from the reservoir to the handpiece via a pump.
Device Description
elcoMED SA-200, elcoMED SA-200 C and implantMED SI-95 consist of fa elcoMED SA-200, elcoMED OA 200 control and a controller. They are designed for use in dental surgery. Optimum irrigation of the treatment site is an important factor for successful Oplinium imgation of the treatment one 10 all of all and its reservoir via a pump to the motor / handpiece.
More Information

Not Found

Not Found

No
The summary describes a simple irrigation tubing set and dental surgical units, with no mention of AI, ML, image processing, or performance studies related to algorithmic analysis.

No.
The device is described as an accessory (irrigation tubing set) to dental surgical units, supplying fluid to the handpiece. While it supports the surgical treatment, it does not directly perform a therapeutic action on the patient.

No
The device is described as irrigation tubing that supplies fluid to a handpiece for dental surgery. There is no mention of it being used to diagnose conditions or process diagnostic information.

No

The device description explicitly mentions hardware components like a control unit, controller, pump, and tubing set, indicating it is not software-only.

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

Here's why:

  • Intended Use: The intended use is to supply treatment fluid during dental surgery. This is a procedural function, not a diagnostic one.
  • Device Description: The description focuses on the mechanical function of delivering fluid to a surgical site. There is no mention of analyzing samples from the body or providing diagnostic information.
  • Lack of IVD Characteristics: The document does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Detecting or measuring substances in samples
    • Providing information for diagnosis, monitoring, or screening of diseases or conditions.

The device is clearly described as an accessory to dental surgical units used for irrigation during procedures. This falls under the category of surgical or procedural devices, not in vitro diagnostics.

N/A

Intended Use / Indications for Use

The irrigation tubing set is an accessory to dental surgical units. The irrigation tubing set is used to supply treatment fluid from the reservoir to the handpiece via a pump.

Product codes (comma separated list FDA assigned to the subject device)

EBW

Device Description

elcoMED SA-200, elcoMED SA-200 C and implantMED SI-95 consist of fa elcoMED SA-200, elcoMED OA 200 control and a controller. They are designed for use in dental surgery.
Optimum irrigation of the treatment site is an important factor for successful Oplinium imgation of the treatment one 10 all of all and its reservoir via a pump to the motor / handpiece.
The irrigation tubing set is the update of the previous tubings. It is a single use The inigation tubing sec is the upacts of the procement prior to use. It is delivered sterile.

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 surgery

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): 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.

Not Found

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.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 872.4200 Dental handpiece and accessories.

(a)
Identification. A dental handpiece and accessories is an AC-powered, water-powered, air-powered, or belt-driven, hand-held device that may include a foot controller for regulation of speed and direction of rotation or a contra-angle attachment for difficult to reach areas intended to prepare dental cavities for restorations, such as fillings, and for cleaning teeth.(b)
Classification. Class I.

0

JUN - 7 2004510(k) SUMMARY
Submitted by:W & H Dentalwerk Buermoos GmbH
Ignaz-Glaser-Strasse 53
A - 5111 Buermoos
AustriaK04112
Contact person:Ralf Benda
Tel.: +43-6274-6236-193
Fax: +43-6274-6236-234
Date of Preparation:21/04/2004
Device name:Accessory for:elcoMED SA-200
elcoMED SA-200 C
implantMED SI-95
Common name:Irrigation tubing set and Y-switch
Classification name:Controller, foot, handpiece and cord
Predicate device:Irrigation tubings, which were part (accessory) of
the submissions of the dental surgical units
elcoMED SA-200, elcoMED SA-200 C and
implantMED

Device Description:

elcoMED SA-200, elcoMED SA-200 C and implantMED SI-95 consist of fa elcoMED SA-200, elcoMED OA 200 control and a controller. They are designed for use in dental surgery.

use in dental surgery.
Optimum irrigation of the treatment site is an important factor for successful Oplinium imgation of the treatment one 10 all of all and its reservoir via a pump to the motor / handpiece.

Intended use:

  • Supply of the fluid from the reservoir via a drip chamber to the pump, ।
  • Passage of the fluid through the pump and r
  • Supply of the fluid to the handpiece. ।

Technological Characteristics:

The irrigation tubing set is the update of the previous tubings. It is a single use The inigation tubing sec is the upacts of the procement prior to use. It is delivered sterile.

Substantial equivalence:

The irrigation tubing sets and the predicate device share the same indication for use and similar characteristics.

1

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/1/Picture/1 description: The image shows the logo for the U.S. Department of Health and 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 symbol resembling three overlapping lines or stripes, which is a common element in the department's branding.

Public Health Service

JUN - 7 2004

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Mr. Ralf Benda W&H Dentalwerk Bürmoos GmbH Ignaz-Glaser-Strasse 53 A- 5111 Buermoos AUSTRIA

Re: K041124

Trade/Device Name: Irrigation Tubing Set 2.2M and 3.8M Regulation Number: 872.4200 Regulation Name: Dental Handpiece and Accessories Regulatory Class: I Product Code: EBW Dated: April 21, 2004 Received: April 29, 2004

Dear Mr. Benda:

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. Benda

Please be advised that FDA's issuance of a substantial equivalence determination does not I Ticase be advisod that I Da determination that your device complies with other requirements Incall that 1 DA mas made a actes and regulations administered by other Federal agencies. of the Act of any I oderal barrequirements, including, but not limited to: registration r ou intist comply will and 807); labeling (21 CFR Part 801); good manufacturing practice and listing (21 CF RT rat 007), abouting systems (QS) regulation (21 CFR Part 820); and if requirements as set form in the quality sion 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) This letter will anow your even substantial equivalence of your device to a premarket notification. - The PDF 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), If you desire specific at 700 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 may obtain other general 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,

Chih-Lin, Ph.D.

Chiu Lin, Ph.D. Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

3

Indications for Use

510(k) Number (if known): ____________________________________________________________________________________________________________________________________________________

Device Name: Indications for Use: Irrigation tubing set and y-swich The irrigation tubing set is an accessory to dental surgical units. surgical units.
The irrigation tubing set is used to supply treatment The frigation tabing on the reservoir to the handpiece via a pump

Over-The-Counter Use Prescription Use _____________________________________________________________________________________________________________________________________________________________ (21 CFR 807 Subpart C) (Part 21 CFR 801 Subpart D)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Susan Runne

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

04/126 510(k) Number:_

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