K Number
K071484
Device Name
PERIACRYL 90,80,70,60, MODEL9010, 8020, 7030, 6040
Manufacturer
Date Cleared
2007-10-10

(133 days)

Product Code
Regulation Number
872.3275
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
PeriAcryl® 90, PeriAcry18 80, PeriAcry1 70, and PeriAcry16 60 are indicated to be used as an adjunct to temporarily assist in securing periodontal dressings.
Device Description
The Family of PeriAcryl® is a formulated compound of the cyanoacrylate series. It is available in 90/10 butyl/octyl, 80/20, butyl/octyl, 70/30 butyl/octyl and 60/40 butyl/octyl formulations depending on the dentist's preference. The compound, which exists in monomeric form in the plastic containers, polymerizes extremely rapidly in the presence of anions, especially of hydroxyl ions [in the presence of water]. It has the ability to adhere to moist living tissues. It demonstrates a favorable tissue response and reveals no toxic or foreign body reaction in humans.
More Information

Not Found

No
The device description focuses on the chemical composition and polymerization properties of the cyanoacrylate compound, with no mention of AI or ML technologies. The "Mentions AI, DNN, or ML" section explicitly states "Not Found".

No
The device is indicated to temporarily assist in securing periodontal dressings, which is a supportive rather than a direct therapeutic function.

No
The device, PeriAcryl®, is indicated to be used as an adjunct to temporarily assist in securing periodontal dressings. It is a formulated compound that polymerizes and adheres to tissues. Its function is to secure dressings, not to diagnose conditions.

No

The device description clearly states it is a "formulated compound of the cyanoacrylate series" 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 to "temporarily assist in securing periodontal dressings." This is a direct application to the body for a physical purpose (securing a dressing), not for examining specimens from the body to provide diagnostic information.
  • Device Description: The description focuses on the chemical composition and how it polymerizes and adheres to tissue. This aligns with a medical device used for a physical function, not an IVD.
  • Lack of IVD Characteristics: There is no mention of analyzing samples (blood, urine, tissue, etc.), detecting analytes, or providing diagnostic information about a patient's health status.

Therefore, PeriAcryl® is a medical device, but not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

PeriAcryl® is indicated to be used as an adjunct to temporarily assist in securing periodontal dressings.

Product codes

EMA

Device Description

The Family of PeriAcryl® is a formulated compound of the cyanoacrylate series. It is available in 90/10 butyl/octyl, 80/20, butyl/octyl, 70/30 butyl/octyl and 60/40 butyl/octyl formulations depending on the dentist's preference. The compound, which exists in monomeric form in the plastic containers, polymerizes extremely rapidly in the presence of anions, especially of hydroxyl ions [in the presence of water]. It has the ability to adhere to moist living tissues. It demonstrates a favorable tissue response and reveals no toxic or foreign body reaction in humans.

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

Dentist's preference, by or on the order of a dentist.

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)

K050658, K974097, K030574

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

KO71484

510(k) SUMMARY

The Summary of Safety and Effectiveness on the GluStitch, Inc. Family of PeriAcry® reflects data available and represented at the time the submission was prepared, but caution should be exercised in interpreting the data. The results of future studies and or tests may require alterations of the conclusions or recommendations set forth.

ApplicantDon Blacklock
GluStitch, Inc.
7188 Progress Way, #307
Delta, British Columbia
Canada V4G 1M6
Telephone800-667-2130
Facsimile877-450-4000
DateAugust 1, 2007
NameFamily of PeriAcryl®
ClassificationDental Cement, 21 CFR 872.3275
Predicate:K050658 Hager WorldWide, Inc., Hager Reso Pac Periodontal
Dressing, market clearance date May 27, 2005; K974097 Blacklock Medical Products, Inc., Periacryl, market
clearance date April 9, 1998; and K030574 GluStitch, Inc., GluSeal, market clearance date August 21,
  1.                                                                                                                                                                                                                                                                                                                   |
    

| Description | The Family of PeriAcryl® is a formulated compound of the cyanoacrylate
series. It is available in 90/10 butyl/octyl, 80/20, butyl/octyl, 70/30
butyl/octyl and 60/40 butyl/octyl formulations depending on the dentist's
preference. The compound, which exists in monomeric form in the
plastic containers, polymerizes extremely rapidly in the presence of
anions, especially of hydroxyl ions [in the presence of water]. It has the
ability to adhere to moist living tissues. It demonstrates a favorable tissue
response and reveals no toxic or foreign body reaction in humans. |
| Intended Use | PeriAcryl® is indicated to be used as an adjunct to temporarily assist in
securing periodontal dressings. |
| Cautions: | CAUTION: Federal law (U.S.A.) restricts this device to sale by or on
the order of a dentist. |
| Substantial
Equivalency
Information | The Family of PeriAcryl® has the same intended use and the same
technological characteristics as the predicate devices listed. The chemical
formulation for the Family of PeriAcryl® does not contain any new
ingredients which raises additional safety and effectiveness concerns. The
identified differences were determined to be minor and did not raise any
concerns regarding the overall safety and effectiveness of the device. |

1

Image /page/1/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle or bird-like figure with three curved lines representing its body and wings. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES · USA" is arranged in a circular fashion around the bird symbol. The text is in all caps and appears to be in a sans-serif font.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Mr. Don Blacklock President GluStitch, Incorporated 7188 Progress Way, 307# Delta, British Columbia CANADA V4G 1M6

Re: K071484

Trade/Device Name: PeriAcry1®90, PeriAcry1® 80, PeriAcry1® 70, and PeriAcry1® 60 Regulation Number: 21 CFR 872.3275 Regulation Name: Dental Cement Regulatory Class: II Product Code: EMA Dated: September 17, 2007 Received: September 26, 2007

OCT 1 0 2007

Dear Mr. Blacklock:

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.

2

Page 2- Mr. Blacklock

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 vours.

Syrite y. Michaeloud.

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

510(k) Number (if known): K071484

Device Name: PeriAcryl® 90, PeriAcry1® 80, PeriAcry1® 70, and PeriAcry1® 60

Indications for Use:

PeriAcryl® 90, PeriAcry18 80, PeriAcry1 70, and PeriAcry16 60 are indicated to be used as an adjunct to temporarily assist in securing periodontal dressings.

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

Over-The-Counter Use (21 CFR Part 807 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Suva Bunno

(Orision Sign-Off) Civision of Anesthesiology, General Hospital, Intection Control, Dental Devices

510(k) Number: K071484

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