K Number
K103157
Device Name
DISPOSABLE PROPHY ANGLE; DISPOSABLE PROPHY ANGLE
Date Cleared
2011-01-24

(90 days)

Product Code
Regulation Number
872.4200
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
This Device is to be used by a Dentist or A Dental Hygienist for cleaning procedures on teeth.
Device Description
Disposable Prophy Angle
More Information

Not Found

Not Found

No
The summary describes a simple mechanical device (Disposable Prophy Angle) for cleaning teeth and contains no mention of AI, ML, image processing, or data sets typically associated with AI/ML applications.

No
A prophy angle is used for cleaning procedures, which is a maintenance or preventative measure, not typically considered a therapeutic treatment for a disease or condition.

No
The device is described as being used for "cleaning procedures on teeth," which is a treatment or maintenance function, not a diagnostic one. Diagnostic devices are used to identify or detect medical conditions.

No

The device description explicitly states "Disposable Prophy Angle," which is a physical hardware component used in dental procedures. There is no mention of software as the primary or sole component of the device.

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

Here's why:

  • Intended Use: The intended use is for "cleaning procedures on teeth," which is a physical procedure performed directly on the patient's body.
  • Device Description: A "Disposable Prophy Angle" is a tool used for mechanical cleaning.
  • Lack of IVD Characteristics: The description does not mention any of the key characteristics of an IVD, such as:
    • Analyzing samples (blood, urine, tissue, etc.)
    • Providing information about a patient's health status, disease, or condition based on the analysis of samples.
    • Using reagents or other substances to perform tests on samples.

IVDs are devices used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. This device does not fit that description.

N/A

Intended Use / Indications for Use

This Device is to be used by a Dentist or A Dental Hygienist for cleaning procedures on teeth.

Product codes

EGS

Device Description

Not Found

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

teeth

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Dentist or A Dental Hygienist / dental Professional

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)

Not Found

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 872.4200 Dental handpiece and accessories.

(a)
Identification. A dental handpiece and accessories is an AC-powered, water-powered, air-powered, or belt-driven, hand-held device that may include a foot controller for regulation of speed and direction of rotation or a contra-angle attachment for difficult to reach areas intended to prepare dental cavities for restorations, such as fillings, and for cleaning teeth.(b)
Classification. Class I.

0

Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized depiction of a human figure embracing a globe. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" is arranged in a circular pattern around the emblem.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring, MD 20993-0002

Mr. Chris J. Carron President Angstrom Manufacturing, Incorporated 6539 U.S. Highway 61 Bloomsdale, Missouri 63627

JAN 2 4 2011

Re: K103157

Trade/Device Name: Disposable Prophy Angle Project's 020,021 Regulation Number: 21 CFR 872.4200 Regulation Name: Dental Handpiece and Accessories Regulatory Class: I Product Code: EGS Dated: September 30, 2010 Received: October 26, 2010

Dear Mr. Carron:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to 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. Carron

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); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm 115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR: Part 803), please go to http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Nh foc

Anthony D. Watson, B.S., M.S., M.B.A. Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

Image /page/2/Picture/0 description: The image shows the logo for Angstrom Manufacturing, Inc. The logo features a stylized "A" with a circle above it, enclosed in a square. To the right of the square is the word "NGSTROM" in large, bold letters. Below "NGSTROM" is the text "MANUFACTURING, INC." in a smaller font.

4 Indications for Use Statement

020-10-1004_ Indications for Use - Disposable Prophy Angle.docx Page 1 of 1

September 30, 2010

Indication for Use - Disposable Prophy Angle Project's 020,021

4103157 510(k) Number:

Device Name: Disposable Prophy Angle

Indication:

This Device is to be used by a Dentist or A Dental Hygienist for cleaning procedures on teeth.

Prescription Use: Used by dental Professional Only Over the Counter Use: No

Soren Russer

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

510(k) Number: K103157

Angstrom Manufacturing, Inc. ■ 6539 US Hwy 61 ▪ Bloomsdale MO 63627 Ph: 573-483-3773 ■ Fax: 573-483-2462 ■ E-Mail: chriscarron@angstrom-mfg.com