K Number
K042215
Device Name
RADIOPAQUE, GLASS IONOMER ENDODONTIC CEMENT
Date Cleared
2004-09-21

(36 days)

Product Code
Regulation Number
872.3275
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Cementation of Gutta-Percha in root canal using the single cone technique.
Device Description
Not Found
More Information

Not Found

Not Found

No
The summary provides no information suggesting the use of AI or ML. The intended use and lack of mentions of AI/ML, image processing, or performance studies related to algorithmic analysis indicate a traditional medical device.

No
The device is used for cementation of gutta-percha in root canal, which is a procedural step rather than a direct therapeutic intervention for a disease or condition.

No
The device is described as being used for "Cementation of Gutta-Percha in root canal," which is a treatment or procedural step, not a diagnostic one. There is no information suggesting it's used to identify or determine a disease or condition.

No

The 510(k) summary describes a device for "Cementation of Gutta-Percha in root canal using the single cone technique." This process inherently involves physical materials (gutta-percha, cement) and likely physical tools for application, which are hardware components. The summary lacks information about the device description, but the intended use strongly suggests a hardware component is involved.

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

Here's why:

  • Intended Use: The intended use is "Cementation of Gutta-Percha in root canal using the single cone technique." This describes a procedure performed on a patient's tooth (specifically, within the root canal), not a test performed on a sample taken from a patient to diagnose a condition.
  • Lack of IVD Characteristics: The description does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing a biological sample (blood, urine, tissue, etc.)
    • Providing diagnostic information about a disease or condition
    • Using reagents or assays

This device appears to be a dental material or instrument used in a clinical procedure, not a diagnostic test.

N/A

Intended Use / Indications for Use

Cementation of Gutta-Percha in root canal using the single cone technique.

Product codes

EMA

Device Description

Not Found

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

Not Found

Key Metrics

Not Found

Predicate Device(s)

Not Found

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

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/0/Picture/1 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" around the perimeter. Inside the circle is an abstract symbol resembling an eagle or bird in flight, composed of three curved lines.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

SEP 2 1 2004

Mr. Vince D'Alessandro Regulatory Manager Premier Dental Products Company 1710 Romano Drive Plymouth Meeting, Pennsylvania 19462

Re: K042215

Trade/Device Name: Premier EndoCem Glass Ionomer Cement Regulation Number: 21 CFR 872.3275(b) Regulation Name: Dental Cement Regulatory Class: II Product Code: EMA Dated: August 11, 2004 Received: August 16, 2004

Dear Mr. D'Alessandro:

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 arior 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.

1

Page 2 - Mr. Vince D'Alessandro

Please be advised that FDA's issuance of a substantial equivalence determination does not mean Please be advised that FDA 's Issuance of a substance or and other requirements of the Act or
that FDA has made a determination that your device attemption of our must comply that FDA has made a determination into your dee a compless. You must comply with
any Federal statutes and regulations administered by other Federal and listing (21 CFR Part 8 any Federal statutes and regulations administered by other resustation and listing (21 CFR Part 807);
all the Act's requirements, including, but not limited to: registration all the Act's requirements, Including proctice requirements as set forth in the quality
labeling (21 CFR Part 801); good manufacturing practice requirements as est orth in th labeling (21 CFR Part 801); good manufacturing interests absorbed the electronic product radiation
systems (QS) regulation (21 CFR Part 820); and if applicable, the electroni systems (QS) regulation (21 OFR 120086), Act); 21 CFR 1000-1050.
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 allow you to begin marketing your active of your device of your device to a legally
premarket notification. The FDA finding of substantial equivalence of th premarket notification. The FDA finding of substantial equilter of 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 If you desire specific advice for your device on our and the results on the promotions on the promotion
contact the Office of Compliance at (301) 594-4613. Additionally, for contact the Office of Compliance at (301) 594-4615 for and contact (301) 594-4639. Also,
and advertising of your device, please contact the Office of Compliance at (311 FFR and advertising of your device, prease comact as onemarket notification" (21CFR)
please note the regulation entitled, "Misbranding by references researchilities under the Act please note the regulation entitled, "Misuralion on your responsibilities under the Act may
Part 807.97) you may obtain. Other general information on Consumer Assistance any Part 807.97) you may obtain. Other getter informational Consumer Assistance at its
be obtained from the Division of Small Manufacturers, International Consumer Assistance at be obtained from the Dryiston or chiaon of chian its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

Susan Runner

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

Enclosure

2

Statement of Indications for Use

510(k) Number (If known): __

K042215

Device Name: Premier Endo Cem

Indications for use: Cementation of Gutta-Percha in root canal using the single cone technique.

Please do not write below this line Concurrence of CDRH, Office of Device Evaluation (ODE)

OR Over-the-Counter Use Prescription Use Per 21 CFR 801.109

Optional Format 1-2-96

Sirsen Quorr

(Division Sign-Off) (Division Sign-On)
Division of Anesthesiclogy, General Hospital, Division Control, Dental Devices

Page 3-1

510(k) Number: Kauai15