K Number
K061860
Device Name
CLEARFIL MAJESTY ESTHETIC
Date Cleared
2006-09-18

(80 days)

Product Code
Regulation Number
872.3690
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
1) Direct restorations for anterior and posterior teeth (Class I - V cavities) 2) Direct veneers 3) Correction of tooth position and tooth shape (e.g. diastema closure, dwarfed tooth, etc.) 4) Intraoral repairs of fractured crowns/bridges
Device Description
CLEARFIL MAJESTY Esthetic is a light-cure, radiopaque restorative composite resin which provides accurate color matching, high polish ability and excellent physical properties, making it suitable for a wide range of restorations. It is formulated with optimal viscosity assuring easy handling and placement. It is classified into tooth shade resin material (21 CFR section 872.3690, Product code: EBF) according to 21 CFR § 872 since it is composed of materials such as 2, 2'-Bis-[p-( 7 -methacryloxy- 3 -hydroxypropoxy) phenyl] propane (Bis-GMA). According to the applicable FDA recognized consensus standard, ISO 4049, 2000 "Dentistry - Polymer-based filling, restorative and luting materials", this device is classified into the following: Type 1: polymer-based filling and restorative materials; Class 2: materials whose setting is effected by light; Class 2. materials whose setting is the energy to be applied intra-orally.
More Information

Not Found

No
The description details a composite resin material for dental restorations, focusing on its physical and chemical properties, not software or algorithms.

No
The device is a restorative composite resin used for dental fillings, veneers, and repairs; it does not explicitly describe a therapeutic action like treating a disease or condition.

No

This device is a restorative composite resin used for direct restorations, veneers, and repairs of teeth, not for diagnosing medical conditions.

No

The device description clearly states it is a "light-cure, radiopaque restorative composite resin," which is a physical material, not software.

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

Here's why:

  • Intended Use: The intended uses are for direct restorations, veneers, correction of tooth position/shape, and intraoral repairs of fractured crowns/bridges. These are all procedures performed directly on the patient's teeth.
  • Device Description: The device is described as a light-cure, radiopaque restorative composite resin. It's classified as a tooth shade resin material and a polymer-based filling and restorative material. These are materials used for physical restoration of teeth.
  • Lack of Diagnostic Purpose: There is no mention of the device being used to diagnose a condition, analyze a sample from the body (like blood, urine, or tissue), or provide information about a patient's health status based on in vitro testing.

IVD devices are used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. This device is a restorative material used for treatment, not diagnosis.

N/A

Intended Use / Indications for Use

    1. Direct restorations for anterior and posterior teeth (Class I V cavities)
    1. Direct veneers
    1. Direction of tooth position and tooth shape (e.g. diastema closure, dwarfed tooth, etc.)
    1. Intraoral repairs of fractured crowns/bridges

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

EBF

Device Description

CLEARFIL MAJESTY Esthetic is a light-cure, radiopaque restorative composite resin which provides accurate color matching, high polish ability and excellent physical properties. CLEARFIL MAJESTY Esthetic is formulated with optimal viscosity assuring easy handling and placement. It is classified into tooth shade resin material (21 CFR section 872.3690, Product code: EBF) according to 21 CFR § 872 since it is composed of materials such as 2, 2'-Bis-[p-( 7 -methacryloxy- 3 -hydroxypropoxy) phenyl] propane (Bis-GMA).

According to the applicable FDA recognized consensus standard, ISO 4049, 2000 "Dentistry - Polymer-based filling, restorative and luting materials", this device is classified into the following:

  • Type 1: polymer-based filling and restorative materials;
  • Class 2: materials whose setting is effected by light;
  • Class 2. materials whose secting is the energy to be applied intra-orally.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

anterior and posterior teeth, crowns/bridges

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)

CLEARFIL MAJESTY Esthetic, the applicant device, is verified to comply with the applicable FDA recognized consensus standard, ISO 4049. 2000. "Dentistry - Polymer-based filling, restorative and luting materials". Comparative studies of physical properties and chemical ingredients with the predicate devices indicate that the applicant device is as effective as and performs as well as the predicate devices and that the safety of the applicant device is substantially equivalent to the predicate devices.

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.

K012740, K033267, K023814, K042819

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

§ 872.3690 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

[CLEARFIL MA.JESTY Esthetic, KURARAY MEDICAL INC.] Section 3: Summary

SEP 1 8 2006

Quality Assurance Department

1-1-3 Otemachi, Chiyoda-ku, Tokyo, 100-00044 : +81-(0)3-6701-1706 Phone Facsimile: +81-(0)3-6701-1805

Date: June 28, 2006

510(k) Summary

3-1. 510(k) owner (submitter)

    1. Name
  1. Address

  2. Contact person

  3. Contact person in U.S.

1621 Sakazu, Kurashiki, Okayama 710-0801, Japan

Michio Takigawa Quality A surance Department

KURARAY MEDICAL INC.

Koji Nishida KURARAY AMERICA INC. 101 East #2nd Street, 26th Floor New York, NY 10022 Tel: (212)-986-2230 (Ext. 115) or (800)-879-1676 Fax: (212)-867-3543

3-2. Name of Device

1) Trade / Proprietary nameCLEARFIL MAJESTY Esthetic
2) Classification nameTooth shade resin material

Tooth shade resin material (21 CFR section 872.3690. Product code: EBF)

Restorative composite resin

3-3. Predicate device

  1. Common name

K012740 510(k) Number: 1) CLEARFIL AP-X EBF Product Code: 872.3690 21 CFR Section: KURARAY MEDICAL INC. Applicant: K033267 510(k) Number: 2) EPRICORD Product Code: EBF 872.3690 21 CFR Section: KURARAY MEDICAL INC. Applicant: 510(k) Number: K023814 3) GRADIA DIRECT EBF Product Code: 21 CFR Section: 872.3690 GC AMERICA, INC. Applicant: 510(k) Number: K042819 4) TETRIC EVOCERAM Product Code: EBF 872.3690 21 CFR Section: IVOCLAR VIVADENT, INC. Applicant:

1

3-4. Description of device

CLEARFIL MAJESTY Esthetic is a light-cure, radiopaque restorative composite resin which CLEARFIL MAJESTY ESInetic is a lign=cuts; futtopaqle veellent physical properties, making
provides accurate color matching, high polish ability and excellent provides and ing provides accurate color matering, mga ponon assimily is formulated with optimal viscosity assuring easy handling and placement.

It is classified into tooth shade resin material (21 CFR section 872.3690, Product code: EBF ) according to 21 CFR § 872 since it is composed of materials such as

2, 2'-Bis-[p-( 7 -methacryloxy- 3 -hydroxypropoxy) phenyl] propane (Bis-GMA).

According to the applicable FDA recognized consensus standard, ISO 4049, 2000 According to the applicable i Brilling, restorative and luting materials", this device is classified into the following:

  • Type 1: polymer-based filling and restorative materials; ..
  • Class 2: materials whose setting is effected by light; -
  • Class 2. materials whose secting is the energy to be applied intra-orally. 『

3-5. Intended uses

It is intended to be used for the indications listed in the left hand column of the below table that are equivalent to the predicate devices.

Table 3: Indications for Use and predicate devices

Indications for UsePredicate devices
1) Direct restorations for anterior and posterior
teeth (Class 1 - V cavities)CLEARFIL AP-X, TETRIC EVOCERAM,
GRADIA DIRECT
2) Direct veneersTETRIC EVOCERAM, GRADIA DIRECT
3) Correction of tooth position and tooth shape
(e.g. diastema closure, dwarfed tooth, etc.)GRADIA DIRECT
4) Intraoral repairs of fractured crowns/bridgesTETRIC EVOCERAM

3-6. Technological characteristics of device

1) Effectiveness / Performance

CLEARFIL MAJESTY Esthetic, the applicant device, is verified to comply with the CLEARFIL MAJESTY Estibelte, the upplicatio consensus standard, ISO 4049. 2000. "Dentistry - Polymer-based filling, restorative and Juting materials". As to compare with "Dentistry - Polymer-Dased Ining, restorative and the pplice of and the predicate the predicate devices according to 1000 indicating that the applicant device is as effective as and performs as well as the predicate devices.

2) Chemical ingredients

All the chemical ingredients of CLEARFIL MAJESTY Esthetic, the applicant device, All the chemical ingredicate devices indicating that the safety of the applicant device is substantially equivalent to the predicate devices.

2

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/2 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo features a stylized caduceus symbol, which is a staff with two snakes entwined around it. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular pattern around the caduceus symbol.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

SEP 1 8 2006

Kuraray Medical, Incorporated C/O Mr. Koji Nishida General Manager Kuraray America, Incorporated 101 East 52"d Street, 26th Floor New York, New York 10022

Rc: K()61860

Trade/Device Name: CLEARFIL MAJESTY Esthetic Regulation Number: 872.3690 Regulation Name: Tooth Shade Resin Material Regulatory Class: II Product Code: EBF Dated: June 28, 2006 Received: July 11, 2006

Dear Mr. Nishida:

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.

3

Page 2 – Mr. Nishida

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

4

Indications for Use

510(k) Number (if known): _

Device Name: _CLEARFIL MAJESTY Esthetic

Indications for Use:

    1. Direct restorations for anterior and posterior teeth (Class I V cavities)
    1. Direct veneers
    1. Direction of tooth position and tooth shape (e.g. diastema closure, dwarfed tooth, etc.)
    1. Intraoral repairs of fractured crowns/bridges

Prescription Use _____________________________________________________________________________________________________________________________________________________________ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------AND/OR (Part 21 CFR 801 Subpart D)

Over-The-Counter Use __N/A (21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Susan Quares

-Off)
Anesthesiology, General Hospital,
Control, Dental Devices
Kala/Ka

Number: K0614