K Number
K112046
Device Name
MTA ANGELUS
Date Cleared
2012-01-06

(172 days)

Product Code
Regulation Number
872.3820
Panel
Dental
Reference & Predicate Devices
Predicate For
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use
  • Treatment of perforations of root canal and furcation caused iatrogenically or by caries lesions
  • Via canal treatment of root perforation due to internal resorption
  • Surgical treatment of root perforation due to internal resorption
  • Periapical surgery with reverse filling
  • Pulp capping
  • Pulpotomy (removal of affected coronal pulp to preserve vitality of remaining pulp tissue)
  • Apexogenesis (induction of root development in vital teeth with an inflamed coronal pulp).
  • Apexification (induction of formation of a mineralized barrier at the root tip of young permanent teeth with incomplete root development and a necrotic pulp)
Device Description

MTA Angelus is a mineral trioxide aggregate cement used for root repair during endodontic treatment, combining the powder and liquid produces a colloidal gel that solidifies to form a barrier.

AI/ML Overview

The provided text describes the 510(k) summary for MTA Angelus, a root canal filling resin, and its establishment of substantial equivalence to predicate devices. However, it does not contain the detailed information required to answer all parts of your request about acceptance criteria and a study proving device performance in the context of an AI/algorithm-based device.

The document is for a traditional medical device (a dental material), not an AI/algorithm-driven one. Therefore, the concept of "acceptance criteria" and "study proving the device meets the criteria" as you've framed it, usually referring to performance metrics like sensitivity, specificity, AUC for an algorithm, is not applicable here.

Instead, the "acceptance criteria" for MTA Angelus are based on demonstrating substantial equivalence to existing legally marketed devices (predicates) by showing similar intended use, technological characteristics, materials, and performing in vitro or bench testing according to existing standards.

Here's a breakdown of what can and cannot be extracted from the provided text based on your request:


1. A table of acceptance criteria and the reported device performance

Acceptance Criteria (based on ISO 6876 for substantial equivalence)Reported Device Performance (MTA Angelus)
Setting timePerformance testing conducted to demonstrate substantial equivalence to predicates.
SolubilityPerformance testing conducted to demonstrate substantial equivalence to predicates.
RadiopacityPerformance testing conducted to demonstrate substantial equivalence to predicates.
Dimensional changesPerformance testing conducted to demonstrate substantial equivalence to predicates.
Implicit Criteria: Similar intended use, operating principle, basic design, materials, and packaging compared to predicate devices.MTA Angelus has the same or similar intended use, uses the same operating principle, incorporates the same basic design, incorporates the same or very similar materials, and has similar packaging as the predicate devices.

Study that proves the device meets the acceptance criteria:

The study proving the device meets the acceptance criteria is performance testing conducted for setting time, solubility, radiopacity, and dimensional changes, which included methods described in ISO 6876 Dental Root Canal Sealing Materials. This testing was performed to "demonstrate substantial equivalence."


The following information CANNOT be extracted from the provided text, as it pertains to AI/algorithm-driven devices, which MTA Angelus is not:

  • 2. Sample size used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective)
    • The document describes bench testing (in vitro) not clinical or algorithm testing on data sets.
  • 3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience)
    • Not applicable for a materials science bench test.
  • 4. Adjudication method (e.g. 2+1, 3+1, none) for the test set
    • Not applicable.
  • 5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance
    • Not applicable as it's not an AI device.
  • 6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done
    • Not applicable as it's not an AI device.
  • 7. The type of ground truth used (expert consensus, pathology, outcomes data, etc)
    • Ground truth for materials testing is typically measured physical or chemical properties, referenced against a standard (like ISO 6876).
  • 8. The sample size for the training set
    • Not applicable as it's not an AI device.
  • 9. How the ground truth for the training set was established
    • Not applicable as it's not an AI device.

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510(k) Summary

Angelus Indústria de Produtos Odontológicos S/A

MTA Angelus K112046

December 27, 2011

ADMINISTRATIVE INFORMATION

Manufacturer Name:Angelus Indústria de Produtos Odontológicos S/ARua Waldir Landgraf, 101Londrina - PR - 86031-218Brazil
Telephone:+55 (43) 2101-3200
Fax:+55 (43) 2101-3201
Official Contact:Marco CanonicoInternational Business Director
Representative/Consultant:Linda K. SchulzKevin A. ThomasPaxMed International, LLC11234 El Camino Real, Suite 200San Diego, CA 92130
Telephone:+1 (858) 792-1235
Fax:+1 (858) 792-1236
Email:lschulz@paxmed.comkthomas@paxmed.com

DEVICE NAME AND CLASSIFICATION

Trade/Proprietary Name:MTA Angelus
Classification Name:Root Canal Filling Resin
Classification Regulations:21 CFR 872.3820, Class II
Product Code:KIF
Classification Panel:Dental Products Panel
Reviewing Branch:Dental Devices Branch

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K112046

510(k) Summary

INTENDED USE

  • . Treatment of perforations of root canal and furcation caused iatrogenically or by caries lesions
  • . Via canal treatment of root perforation due to internal resorption
  • . Surgical treatment of root perforation due to internal resorption
  • . Periapical surgery with reverse filling
  • . Pulp capping
  • . Pulpotomy (removal of affected coronal pulp to preserve vitality of remaining pulp tissue)
  • . Apexogenesis (induction of root development in vital teeth with an inflamed coronal pulp).
  • . Apexification (induction of formation of a mineralized barrier at the root tip of young permanent teeth with incomplete root development and a necrotic pulp)

DEVICE DESCRIPTION

MTA Angelus is a mineral trioxide aggregate cement used for root repair during endodontic treatment, combining the powder and liquid produces a colloidal gel that solidifies to form a barrier.

EQUIVALENCE TO MARKETED DEVICE

Angelus Indústria de Produtos Odontológicos S/A demonstrated that, for the purposes of FDA's regulation of medical devices, MTA Angelus is substantially equivalent in indications and design principles to the following predicate devices:

DENTSPLY International, MTA Advanced Material cleared under K073218 and DENTSPLY International, White MTA Material cleared under K011009. DENTSPLY International, MTA Root Canal Sealer K080203

The subject device and the predicate devices have the same or similar intended use and have the same technological characteristics and are made of the same or similar materials. They encompass the same range of physical and chemical properties. The subject and predicate devices are packaged in similar materials and use similar methods of application. Any differences in the technological characteristics do not raise new issues of safety or efficacy.

Performance testing was conducted for setting time, solubility, radiopacity and dimensional changes to demonstrate substantial equivalence and included methods described in ISO 6876 Dental Root Canal Sealing Materials.

Overall, MTA Angelus has the following similarities to the predicate devices:

  • has the same or similar intended use, .
  • uses the same operating principle, .
  • incorporates the same basic design, .
  • incorporates the same or very similar materials, and .
  • . has similar packaging.

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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 consists of a stylized eagle with its wings spread, and the words "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" are arranged in a circular pattern around the eagle. The logo is black and white.

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

Angelus Industria de Produtos Odontologicos S/A C/O Ms. Linda K. Schulz Regulatory Affairs PaxMed International, LLC 11234 El Camino Real, Suite 200 San Diego, California 92130

JAN - 6 2012

Re: K112046

Trade/Device Name: MTA Angelus Regulation Number: 21 CFR 872.3820 Regulation Name: Root Canal Filling Resin Regulatory Class: II Product Code: KIF Dated: December 27, 2011 Received: December 28, 2011

Dear Ms. Schulz:

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.

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Page 2 -- Ms. Schulz

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 (veparine 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 /ucm115809.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/Resourcesfor You/Industry/default.htm.

Sincerely yours,

Nh for

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

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K112046

Indications for Use

510(k) Number:

Device Name: MTA Angelus

Indications for Use:

  • Treatment of perforations of root canal and furcation caused iatrogenically or by caries . lesions
  • Via canal treatment of root perforation due to internal resorption .
  • Surgical treatment of root perforation due to internal resorption .
  • . Periapical surgery with reverse filling
  • . Pulp capping
  • Pulpotomy (removal of affected coronal pulp to preserve vitality of remaining pulp tissue) .
  • Apexogenesis (induction of root development in vital teeth with an inflamed coronal pulp) .
  • Apexification (induction of formation of a mineralized barrier at the root tip of young . permanent teeth with incomplete root development and a necrotic pulp)

Prescription Use X (Part 21 CFR 801 Subpart D)

Over-The-Counter Use AND/OR (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)

Page 1 of

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

510(k) Number: _______________________________________________________________________________________________________________________________________________________________

§ 872.3820 Root canal filling resin.

(a)
Identification. A root canal filling resin is a device composed of material, such as methylmethacrylate, intended for use during endodontic therapy to fill the root canal of a tooth.(b)
Classification. (1) Class II if chloroform is not used as an ingredient in the device.(2) Class III if chloroform is used as an ingredient in the device.
(c)
Date PMA or notice of completion of a PDP is required. A PMA or a notice of completion of a PDP is required to be filed with the Food and Drug Administration on or before December 26, 1996 for any root canal filling resin described in paragraph (b)(2) of this section that was in commercial distribution before May 28, 1976, or that has, on or before December 26, 1996 been found to be substantially equivalent to a root canal filling resin described in paragraph (b)(2) of this section that was in commercial distribution before May 28, 1976. Any other root canal filling resin shall have an approved PMA or a declared completed PDP in effect before being placed in commercial distribution.