K Number
K043177
Device Name
CLEAFIL DC CORE AUTOMIX
Date Cleared
2004-12-17

(31 days)

Product Code
Regulation Number
872.3690
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
CLEARFIL DC CORE AUTOMIX is indicated for the following application 1) Core build up of vital or non-vital tooth
Device Description
Not Found
More Information

Not Found

Not Found

No
The summary describes a dental core build-up material and does not mention any AI or ML components or functionalities.

No
The device is a restorative material for core build-up of teeth, which is a dental procedure. It is not designed to treat or alleviate a disease or condition, but rather to restore tooth structure.

No
The device is described for "Core build up of vital or non-vital tooth," which is a restorative or reconstructive procedure, not a diagnostic one.

No

The device description and intended use clearly indicate a material used for dental core build-up, 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: The intended use is "Core build up of vital or non-vital tooth". This describes a procedure performed directly on a patient's tooth, not a test performed on a sample taken from the body.
  • Lack of IVD Characteristics: The description does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Providing diagnostic information about a disease or condition
    • Using reagents or assays

The device appears to be a dental material used for restorative procedures.

N/A

Intended Use / Indications for Use

CLEARFIL DC CORE AUTOMIX is indicated for the following application 1) Core build up of vital or non-vital tooth

Product codes

EBF

Device Description

Not Found

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

tooth

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

§ 872.3690 Tooth shade resin material.

(a)
Identification. Tooth shade resin material is a device composed of materials such as bisphenol-A glycidyl methacrylate (Bis-GMA) intended to restore carious lesions or structural defects in teeth.(b)
Classification. Class II.

0

Image /page/0/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. Inside the circle is a stylized image of an eagle with three stripes extending from its wing.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

DEC 17 2004

Kuraray Medical, Incorporated C/O Mr. Satoshi Yamaguchi Kuraray America, Incorporated 101 East 52nd Street, 26th Floor New York, New York 10022

Re: K043177

Trade/Device Names: CLEARFIL™ DC Core Automix Regulation Number: 21 CFR 872.3690 Regulation Name: Tooth Shade Resin Material Regulatory Class: II Product Code: EBF Dated: November 12, 2004 Received: November 22, 2004

Dear Mr. Yamaguchi:

We have reviewed your Section 510(k) premarket notification of intent to market the device we nave leviewed your bootion 910(x) produce is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce use stated in the encreative to regary inter of the Medical Device Amendments, or to devices that prof to May 26, 1770, the endentions aske the provisions of the Federal Food, Drug, and Cosmetic Ilave bech recidissimou in accerances nof a premarket approval application (PMA). You may, Act (Act) that ao not require approval othe general controls provisions of the Act. The general therefore, market the device, sabject to annual registration, listing of devices, good Controls provisions of the rise necessary misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it If your device to such additional controls. Existing major regulations affecting your device can be Illay be subject to such additions. Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

1

Page 2 -- Mr. Satoshi Yamaguchi

Please be advised that FDA's issuance of a substantial equivalence determination does not mean Flease be advised that I DAY 3 issualite or our device complies with other requirements of the Act or mall Ford nas made a decemination administered by other Federal agencies. You must comply with ally rederal statutes and regulations abut not limited to: registration and listing (21 CFR Part 807); an the Act 3 requirements, moracturing practice requirements as set forth in the quality labemig (21 CFR Part 801), good fart 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) I mis letter wilf anow you've ough mating of substantial equivalence of your device to a legally premaired noutied.com - The Plassification 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 if you desire of Compliance at (240) 276-0115. Also, please note the regulation entitled, Colifical in Other of Compilance matification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small general information on your and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrth/dsma/dsmamain.html

Sincerely yours,

Chiu S. Liu, Ph.D.

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

510(k) Number (if known): K04 3177

Device Name: CLEARFIL DC CORE AUTOMIX

Indications for Use

CLEARFIL DC CORE AUTOMIX is indicated for the following application 1) Core build up of vital or non-vital tooth

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

Susan Rinner

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

Prescription Use

OR

Over-The-Counter Use

(Optional Format 1-2-96)