K Number
K041343
Device Name
XENO NM LIGHT CURED DENTAL ADHESIVE
Date Cleared
2004-06-16

(27 days)

Product Code
Regulation Number
872.3200
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
XENO® NM Light Cured Dental Adhesive is indicated for: - Direct composite and compomer restorations for all cavity classes in anterior and posterior teeth - Veneers - Composite, ceramic and metal repairs - Cavity varnish for use with fresh amalgam
Device Description
The XENO® NM Light Cured Dental Adhesive is a one-component light cure self-etching and self-priming dental adhesive designed to bond composite materials and compomers to enamel and dentin as well as to metals and ceramic. XENO® NM Light Cured Dental Adhesive combines acid etching, priming and adhesive in a single bottle.
More Information

Not Found

No
The summary describes a chemical dental adhesive and does not mention any computational or data-driven components indicative of AI/ML.

No
The device is a dental adhesive used to bond restorative materials to teeth, not to treat a disease or condition.

No
The device is a light-cured dental adhesive used for bonding composite materials and compomers to teeth, metals, and ceramics. Its function is to create a bond, not to diagnose a condition or disease.

No

The device description clearly states it is a "one-component light cure self-etching and self-priming dental adhesive," which is a physical substance, not software.

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

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections.
  • Device Function: The XENO® NM Light Cured Dental Adhesive is a material used directly in the mouth to bond dental restorations to teeth. It is applied to the tooth structure itself, not used to analyze a sample taken from the body.
  • Intended Use: The intended use clearly describes its application in dental procedures for bonding restorations, not for diagnostic testing of biological samples.

Therefore, the device falls under the category of a dental restorative material, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

XENO® NM Light Cured Dental Adhesive is indicated for:

  • Direct composite and compomer restorations for all cavity classes in anterior and posterior . teeth
  • Veneers .
  • Composite, ceramic and metal repairs ●
  • Cavity varnish for use with fresh amalgam .

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

KLE

Device Description

The XENO® NM Light Cured Dental Adhesive is a one-component light cure self-etching and self-priming dental adhesive designed to bond composite materials and compomers to enamel and dentin as well as to metals and ceramic.
XENO® NM Light Cured Dental Adhesive combines acid etching, priming and adhesive in a single bottle.

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

Not Found

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.

K982394

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

§ 872.3200 Resin tooth bonding agent.

(a)
Identification. A resin tooth bonding agent is a device material, such as methylmethacrylate, intended to be painted on the interior of a prepared cavity of a tooth to improve retention of a restoration, such as a filling.(b)
Classification. Class II.

0

1041343

510(k) SUMMARY

JUN 1 6 2004

DENTSPLY International World Headquarters Susquehanna Commerce Center 221 West Philadelphia Street, Suite 60 York, PA 17405-0872 P. J. Lehn Telefax (717) 849-4343

XENO® NM Light Cured Dental Adhesive

P. Jeffery Lehn CONTACT:

May 17, 2004 DATE PREPARED:

TRADE OR PROPRIETARY NAME:

Resin tooth bonding agent (872.3200) CLASSIFICATION NAME:

Prime & Bond® NT™ Nano-Technology Light Cured PREDICATE DEVICES: K982394 Dental Adhesive

DEVICE DESCRIPTION:

The XENO® NM Light Cured Dental Adhesive is a one-component light cure self-etching and self-priming dental adhesive designed to bond composite materials and compomers to enamel and dentin as well as to metals and ceramic.

XENO® NM Light Cured Dental Adhesive combines acid etching, priming and adhesive in a single bottle.

INTENDED USE:

  • Direct composite and compomer restorations. .
  • . Veneer
  • Composite, ceramic and metal repairs. ●
  • Cavity varnish for use with fresh amalgam .

TECHNOLOGICAL CHARACTERISTICS:

All of the components found in XENO® NM Light Cured Dental Adhesive have been used in legally marketed devices.

XENO® NM Light Cured Dental Adhesive final formulation was evaluated for biocompatibility for genotoxicity, cytotoxicity, and sensitivity and found acceptable.

We believe that the prior use of the components of XENO® NM Light Cured Dental Adhesive in legally marketed devices, the biocompatibility data provided, and the performance data provided support the safety and effectiveness of XENO® NM Light Cured Dental Adhesive for the indicated uses.

1

Image /page/1/Picture/1 description: The image shows the seal of the U.S. Department of Health & Human Services. The seal is circular and contains the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. In the center of the seal is a stylized image of an eagle with three lines representing its wings.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUN 1 6 2004

Dentsply International Mr. P. Jeffery Lehn Director of Corporate Compliance and Regulatory Affairs Susquehanna Commerce Center West 221 West Philadelphia Street, Suite 60 York, Pennsylvania 17404-0872

Re: K041343

Trade/Device Name: XENO® NM Light Cured Dental Adhesive Regulation Number: 872.3200 Regulation Name: Resin tooth Bonding Agent Regulatory Class: II Product Code: KLE Dated: May 17, 2004 Received: May 20, 2004

Dear Mr. Lehn:

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 referenced above and have acterinatiosure) 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 Amendinens, of to actived acosmetic 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 confors providens of an 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 II your device is classified (bood additional controls. Existing major regulations affecting (1 Nr.), it may of bund in the Code of Federal Regulations, Title 21, Parts 800 to 898. In your device can be found in ther announcements concerning your device in the Federal Register.

2

Page 2 - Mr. Lehn

Please be advised that FDA's issuance of a substantial equivalence determination does not Please be advised that I DA 3 issualled on that your device complies with other requirements mean that FDA nas made a decornmances wating administered by other Federal agencies. of the Act of ally I cucral statutes and regulations, but not limited to: registration You must colliply with an the Act b requirement 801); good manufacturing practices
and listing (21 CFR Part 807); labeling (21 CFR Part 801); gED (21 CFR Part 800); and and listing (21 CFR Purt 007), laceling (QS) regulation (21 CFR Part 820); and if requirements as set form in the quality bjections (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 you to begin mailering your substantial equivalence of your device to a premarket notification. The PDF Intelligence and the 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 advice for your de at (301) 594-4613. Also, please note the regulation prease contact une Other or Somplians premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the may outain of Small Manufacturers, International and Consumer Assistance at its toll-free Diviser (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

Ke Muluy

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 STATEMENT

(As Required by 21 CFR 807.87(e)

510(K) Number (if known):------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

XENO® NM Light Cured Dental Adhesive Device Name:

Indications for Use:

XENO® NM Light Cured Dental Adhesive is indicated for:

  • Direct composite and compomer restorations for all cavity classes in anterior and posterior . teeth
  • Veneers .
  • Composite, ceramic and metal repairs ●
  • Cavity varnish for use with fresh amalgam .

Prescription Use _ X (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 Rupp

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

510(k) Number: Kal 1343