K Number
K042278
Date Cleared
2005-01-28

(158 days)

Product Code
Regulation Number
872.4760
Panel
Dental
Reference & Predicate Devices
Predicate For
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The Rod-5 Distraction device is intended for use in patients with bone loss due to periodontal disease, trauma or post tumor resection, Ankylosed teeth, or Atrophic boney areas inadequate for implant placements or restorative procedures which need to increase in bone mass and height by means of distraction osteogenesis.

Device Description

The device consists of two bondable attachments and a horizontal rod that spans the distraction site. the rod is supported by these attachments which are bonded to the teeth and has holes for engagement of distraction wire. The spring washers and detents allow for activation of the device during distraction and provide a self-locking mechanism to prevent deactivation of the device. The device is activated by a screwdriver, which is inserted in to the screwdriver slot, pushed against the washer to disengage the detent, and then rotated. The device is predominately - tooth bone, with only a fixation wire attached to the bone; no screws are required. Removal of the device requires only cutting the fixation wire. The wire can then be pulled through the bone and soft tissue without the need for an incision.

AI/ML Overview

The provided document is a 510(k) summary for a medical device (Oral Osteodistraction Distraction Rod Appliance (ROD 5)) and does not contain any information about acceptance criteria or a study proving the device meets acceptance criteria related to a performance study with a test set, expert ground truth, or an AI algorithm.

The document discusses substantial equivalence to a predicate device (KLS-Martin Track Distractor K002152) and uses a comparison chart to highlight similarities in material, distraction rate, distraction mechanism, activation, site of distraction, target use, latency period, distraction period, retention period, intended use, and surgical technique. This type of comparison is standard for 510(k) submissions to demonstrate that a new device is as safe and effective as a legally marketed predicate, rather than proving performance against specific acceptance criteria through a clinical study.

Therefore, I cannot provide the requested information. The document focuses on regulatory approval based on substantial equivalence, not on a detailed performance study with the elements you've listed.

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K042278

510(K) SUMMARY (as required by 807.92(c))

JAN 2 8 2005

Submitter of 510(k):Oral Osteodistraction, L.P.600 W. Lake Cook Rd., Suite 150Buffalo Grove, IL 60089
Phone: 847-215-7554Fax: 847-215-7563
Contact Person:Yan Razdolsky
Date of Summary:July 1, 2004
Trade/Proprietary Name:Oral Osteodistraction Distraction Rod Appliance(ROD 5)
Classification Name:External Mandibular Fixator and/or Distractor
Product Code:MQN
Predicate Device:KLS-Martin Track Distractor K002152
Intended Use:

The Rod-5 Distraction device is intended for use in patients with bone loss due to periodontal disease, trauma or post tumor resection, Ankylosed teeth, or Atrophic boney areas inadequate for implant placements or restorative procedures which need to increase in bone mass and height by means of distraction osteogenesis.

Device Description:

The device consists of two bondable attachments and a horizontal rod that spans the distraction site. the rod is supported by these attachments which are bonded to the teeth and has holes for engagement of distraction wire. The spring washers and detents allow for activation of the device during distraction and provide a self-locking mechanism to prevent deactivation of the device. The device is activated by a screwdriver, which is inserted in to the screwdriver slot, pushed against the washer to disengage the detent, and then rotated. The device is predominately - tooth bone, with only a fixation wire attached to the bone; no screws are required. Removal of the device requires only cutting the fixation wire. The wire can then be pulled through the bone and soft tissue without the need for an incision.

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Comparison Chart

Oral OsteodistractionROD - 5KLS Martin TrackDistractor - K002152
MaterialPolyurethane and StainlessSteelT1-6AL-4V Titanium Alloy
Distraction Rate1.0 mm/daySame
Distraction MechanismRod with holes for distractionwire (.025") attached throughpt. boneThreaded rod with attachedtitanium plates fixed to onewith titanium screws
Distraction ActivationScrewdriverSame
Site of DistractionTooth-borne, bone borne(wire only)Bone borne
Target UseCranio/Facial surgeonsSame
Latency Period3-7 Days5-7 Days
Distraction Period7-14 DaysSame
Retention Period3-6 WeeksSame
Intended UseMaxillo MandibulardeficienciesSame
Surgical TechniqueOsteotomySame

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Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo is a circular emblem with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is a stylized image of an eagle or bird with three curved lines representing its wings or feathers.

Public Health Service

JAN 2 8 2005

ood and Drug Administratio 00 Corporate Boulevard Rockville MD 20850

Oral Osteodistraction, L.P. C/O Mr. Arthur J. Ward AJW Technology Consultants, Incorporated 962 Allegro Lane, Apollo Beach, Florida 33572

Re: K042278

Trade/Device Name: Oral Osteodistraction Distraction Rod Appliance (ROD 5) Regulation Number: 21 CFR 872.4760 Regulation Name: Bone Plate Regulatory Class: II Product Code: MQN Dated: December 22, 2004 Received: January 21, 2005

Dear Mr. Ward:

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.

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Page 2 - Mr. Ward

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 (240) 276-0115. 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/industry/support/index.html.

Sincerely yours,

Chiu, 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

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Indications for Use

510(k) Number (if known): _ |< < < < > > 2 2 7 8

Device Name: Oral Osteodistraction Distraction Rod Appliance (ROD 5)

Indications for Use:

The Rod-5 Distraction device is intended for use in patients with bone loss due to periodontal disease, trauma or post tumor resection, Ankylosed teeth, or Atrophic boney areas inadequate for implant placements or restorative procedures which need to increase in bone mass and height by means of distraction osteogenesis.

Prescription Use (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 OF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Sun. Rur

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

510(k) Number. K042278

Page 1 of 1

§ 872.4760 Bone plate.

(a)
Identification. A bone plate is a metal device intended to stabilize fractured bone structures in the oral cavity. The bone segments are attached to the plate with screws to prevent movement of the segments.(b)
Classification. Class II.