K Number
K121901
Device Name
TI-MAX Z45
Manufacturer
Date Cleared
2013-02-28

(244 days)

Product Code
Regulation Number
872.4200
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
TI-MAX Z45 is powered by either an air-motor or electronic micromotor for use in general dentistry. The device is intended for cutting and grinding teeth, cavity preparations, tooth and crown preparations, finishing and trimming teeth and filling materials, and removal of crowns and filling materials.
Device Description
The Ti-MAX Z45 is a contra-angle dental handpiece which is powered by either an air-motor or electronic-micromotor for use in general dentistry. The TI-MAX Z45 is intended for cutting and grinding teeth, cavity preparations, tooth and crown preparations, finishing and trimming teeth and filling materials, and removal of crowns and filling materials. The Tr-MAX Z45 transmits rotational force from the motor to the gears through a clutch, and then the rotation force reaches the chuck and the dental bur receives the rotation force. The dental bur is able to cut and grind teeth and dentures using the rotation force.
More Information

Not Found

No
The description focuses on mechanical function and does not mention any AI/ML components or capabilities.

No.
A therapeutic device is one that treats a disease or condition. This device is used for cutting and grinding teeth and other dental materials, which are procedural actions, not therapeutic treatments.

No

The device description indicates that the Ti-MAX Z45 is used for cutting, grinding, and removal of dental materials and tissues, which are therapeutic and restorative actions, not diagnostic ones.

No

The device description clearly states it is a contra-angle dental handpiece that transmits rotational force from a motor to a dental bur, indicating it is a physical hardware device.

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

Here's why:

  • IVD Definition: In Vitro Diagnostic devices are used to examine specimens taken from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening.
  • Device Function: The description clearly states the device is a dental handpiece used for mechanical procedures on teeth (cutting, grinding, preparing, finishing, removing). It operates directly on the patient's teeth, not on a specimen taken from the body.
  • Intended Use: The intended use is for general dentistry procedures performed directly in the mouth.

Therefore, the Ti-MAX Z45 is a dental device used for treatment and preparation, not for in vitro diagnostic testing.

N/A

Intended Use / Indications for Use

TI-MAX Z45 is powered by either an air-motor or electronic micromotor for use in general dentistry.

The device is intended for cutting and grinding teeth, cavity preparations, tooth and crown preparations, finishing and trimming teeth and filling materials, and removal of crowns and filling materials.

Product codes

EGS

Device Description

The Ti-MAX Z45 is a contra-angle dental handpiece which is powered by either an air-motor or electronic-micromotor for use in general dentistry. The TI-MAX Z45 is intended for cutting and grinding teeth, cavity preparations, tooth and crown preparations, finishing and trimming teeth and filling materials, and removal of crowns and filling materials. The Tr-MAX Z45 transmits rotational force from the motor to the gears through a clutch, and then the rotation force reaches the chuck and the dental bur receives the rotation force. The dental bur is able to cut and grind teeth and dentures using the rotation force.

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

general dentistry

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)

Bench testing was performed in order to ensure the safety and effectiveness of the TI-MAX Z45, verify conformity to ISO 7785-2 and demonstrate substantial equivalence to the predicates. All TI-MAX Z45 samples were compliant with ISO 7785-2 and demonstrated substantial equivalence to the predicates.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

K070663, K011061

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/0 description: The image shows the NSK logo in the upper portion of the image. The logo is white text on a black background. The lower portion of the image contains the text "510(k) Summary" in a large font. The text is black on a white background.

Image /page/0/Picture/1 description: The image contains a sequence of alphanumeric characters. The characters appear to be handwritten and include the letters 'KI' followed by the numbers '21901'. The characters are written in black ink on a white background. The writing style is somewhat cursive, with some characters connected.

FEB 2 8 2013

  • Owner/Company name, address a. NAKANISHI, INC. 700 Shimohinata, Kanuma-shi, Tochigi, 322-8666, Japan

b. Contact

Toshihiko Shinozaki Assistant Manager, R&D Department, Pharmaceutical Affairs Group NAKANISHI, INC. 700 Shimohinata, Kanuma-shi, Tochigi, 322-8666, Japan

Phone:011-81-289-64-3380
Fax:011-81-289-62-6665
Email:t-shinozaki@nsk-nakanishi.co.jp

Application Correspondent C.

Fumiaki Kanai, Ph.D. President and CEO MIC International 4-1-17 Hongo, Bunkyo-ku Tokyo, 113-0033, Japan

Phone: 011-81-3-3818-8577 Fax: 011-81-3-3818-8573 Email: kanaif@mici.co.jp

d. Date prepared

June 28, 2012

e. Name of device

Trade Name: Classification Name: Regulation Name: Regulatory Class: Product Code:

TI-MAX Z45 Handpiece, Contra-and Right-angle Attachment, Dental Dental handpiece and accessories Class I EGS

510(k) Summary: Page 1 of 6

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NSK

Predicate devices ﮨﺖ

The Ti-MAX Z45 is substantially equivalent to the following legally marketed devices:

510(k):K070663
Trade name:A-DEC/W&H SYNEA AIR-DRIVEN HIGHSPEED HANDPIECE,
MODELS TA-98, TA-97
A-DEC/W&H SYNEA HANDPIECE ATTACHMENT, MODELS WA-99LT,
WA-86LT, WA-66LT, WA-56LT, HA-43LT
Product code:EFB
Classification Name:Handpiece, Air-powered, Dental
510(k):K011061
Trade name:SURGICAL CONTRA-ANGLE HANDPIECES TYPES WS-56E,
WS-75-E/KM, WS-92E/3
Product code:EGS

Classification Name: Handpiece, Contra-and Right-angle Attachment, Dental

Hereinafter, the predicate devices are called "the SYNEA HANDPIECE (K070663)" and "the SURGICAL CONTRA-ANGLE HANDPIECES (K011061)", respectively, for convenience of discussion in this application. Regarding the SYNEA HANDPIECE (K070663), A-DEC/W&H SYNEA HANDPIECE ATTACHMENT is the exact predicate device for the TI-MAX Z45. Since the HA-43LT type of the A-DEC/W&H SYNEA HANDPIECE ATTACHMENT is a straight handpiece, the type is eliminated as the predicate device for the T1-MAX Z45 hereinafter in this submission. The SYNEA HANDPIECE (K070663) indicates A-DEC/W&H SYNEA HANDPIECE ATTACHMENT MODELS WA-99LT, WA-86LT, WA-66LT, WA-56LT in this application.

g. Description of the device

The Ti-MAX Z45 is a contra-angle dental handpiece which is powered by either an air-motor or electronic-micromotor for use in general dentistry. The TI-MAX Z45 is intended for cutting and grinding teeth, cavity preparations, tooth and crown preparations, finishing and trimming teeth and filling materials, and removal of crowns and filling materials. The Tr-MAX Z45 transmits rotational force from the motor to the gears through a clutch, and then the rotation force reaches the chuck and the dental bur receives the rotation force. The dental bur is able to cut and grind teeth and dentures using the rotation force.

h. Statement of Intended Use

TI-MAX Z45 is powered by either an air-motor or electronic micromotor for use in general dentistry.

The device is intended for cutting and grinding teeth, cavity preparations, tooth and crown

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NET

preparations, finishing and trimming teeth and filling materials, and removal of crowns and filling materials.

i. Summary of Technological Characteristics

Summary or receded in rotation of the TI-MAX Z45 is 168,000 min1. The rotation speed is increased by 4.2-fold at the chuck using the gears. Since the TI-MAX Z45 uses rotational force for the treatment, temperature increase may occur on the drilling point. Therefore, the TI-MAX Z45 has 4-port water spray outlet on the head in order to cool down the treatment area. It is possible to switch the type of coolant water flow, water jet or water spray. The TI-MAX Z45 has opticfiber for lighting.

The friction grip bur (not exceed 25 mm) which conforms ISO 1797-1 is intended to use for the TI-MAX Z45. The TI-MAX Z45 uses the push-button chuck mechanism.

The TI-MAX Z45 can be connected only E-type motors which conforms ISO 3964.

Statement of substantial equivalence i.

The Indications for Use of the TI-MAX Z45 is similar to the SYNEA HANDPIECE (K070663). The principle of operation of the TI-MAX Z45 is identical to the predicates. That is, the TI-MAX Z45 and the predicates transmit rotational force from the motor to the dental bur using the gears. The dental bur is able to cut and grind teeth and dentures using the rotation force. In addition, design features (Contra-Angle, Push-Button Chuck, Motor coupling, Thermal safety system) of the Ti-MAX Z45 are identical to those of the predicates.

Following table is comparison between the TI-MAX Z45 and the predicates.

| | TI-MAX Z45 | SYNEA HANDPIECE
(K070663) | SURGICAL
CONTRA-ANGLE
HANDPIECES
(K011061) |
|-------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Indications for Use | TI-MAX Z45 is powered
by either an air-motor or
electronic micromotor
for use in general
dentistry.
The device is intended
for cutting and grinding
teeth, cavity
preparations, tooth and
crown preparations,
finishing and trimming | The A-dec/W&H Synea
Air-Driven Highspeed
Handpiece is an
air-powered dental
handpiece for use in
general dentistry. This
device is designed for
removing carious
material and excess
filling material, cavity
and crown preparation,
root canal preparations, | Indications are very
widespread in the field
of implantology and
surgery. The
mentioned handpieces
have been developed
especially for the
following applications:
WS-56 E:for e,g.
osteotomla on the
upper and lower jaw.
germectomls, |
| | teeth and filling
materials, and removal
of crowns and filling
materials. | finishing tooth
preparations,
restorations and
polishing teeth. | sequestrotomla
WS-75 E/KM: for e.g.
implantology
(preparation of the
bone cavity, placing
the implants), surgical
treatment of
dysgnathia,
osteosynthesis,
segmentosteotomla
and especially mild
osteotomla.
WS-92 E/3 : for e.g.
hemisection, wisdom
tooth extraction. |
| Product Code | EGS | EFB | EGS |
| Classification
Name | Handpiece, Contra-and
Right-angle Attachment,
Dental | Handpiece, Air-powered,
Dental | Handpiece, Contra-and
Right-angle
Attachment, Dental |
| Design features | Contra-Angle,
Push-Button Chuck,
Motor coupling,
Thermal safety system | Contra-Angle,
Push-Button Chuck,
Motor coupling,
Thermal safety system | Contra-Angle,
Push-Button Chuck,
Motor coupling,
Thermal safety system |
| Gear ratio | 1:4.2 | 1:5, 1:1, 2:1, 10:1 | 1:1, 20:1. 1:2,7 |
| Maximum
motor/drive speed | 40,000 rpm | 40,000 rpm | 50,000 rpm |
| Materials | Stainless Steel,
Titanium | Unknown | Stainless steel |
| Motor coupling | Compliant with ISO
3964 | Compliant with ISO
3964 | Compliant with ISO
3964 |
| Source of power | Air-motor,
Electronic-micromotor | Air-motor,
Electronic-micromotor | Air-motor,
Electronic-micromotor |
| Light | Glass Rod (Fiberoptic) | With light type/Without
light type | With light
type/Without light type |
| Dimension | Head Diameter: 9.6mm
Head Height: 14.5mm
Length: 96.2mm | Head Height: 12.3 mm
or 13.7mm | Unknown |
| Weight | 66.5 g | Unknown | Unknown |
| Performance | Compliant with ISO
7785-2 | Compliant with ISO
7785-2 | Compliant with ISO
7785-2 |
| -Eccentricity | 0.016 mm | Unknown | Unknown |
| -Force for bur
extraction | 25.3N | Unknown | Unknown |
| Sterilization | Sterilized by user
(Autoclave) | Sterilized by user
(Autoclave) | Sterilized by user
(Autoclave) |
| Thermal safety | Air/Water spray,
compliant with
ISO7785-2 | Air/Water spray,
compliant with
ISO7785-2 | Air/Water spray,
compliant with
ISO7785-2 |
| -Air/Water Spray
port | 4-port | Single or 5-port | Single or 3-port |
| -Coolant
Water
Type | Water spray/Water jet | Water spray | Water spray |
| -Flow Rate | More than 50 ml/min | More than 50 ml/min | More than 50 ml/min |
| -Water
pressure
setting range | 2 bar | 0.5-2 bar | Unknown |
| -Chip air pressure
setting range | 2 bar | 1.5-3bar | Unknown |
| Lubricant | PANA Spray (510(k)
number is K052700) | W&H Service oil F1 | W&H Service oil F1 |
| Bur | FG burs | FG burs, contra-angle
burs | FG burs, contra-angle
burs |
| -Maximum
bur
length | 25 mm | 25mm (FG burs), 34mm
(contra-angle burs) | 34mm (WS-56E
contra-angle burs), 45
mm (WS-75 E/KM,
contra-angle bur), 25
mm (WS-92 E/3, FG
bur) |

Comnarison table

510(k) Summary: Page 3 of 6

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510(k) Summary: Page 4 of 6

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NSK

Note*: The models for "the A-DEC/W&H SYNEA HANDPIECE ATTACHMENT" are used as the predicate device for the Ti-Max Z45 in the submission.

As shown in the comparison table, the indications for use of the TI-MAX Z45 is similar to the SYNEA HANDPIECE (K070663). As described above, the principle of operation and design features of the TI-MAX Z45 are identical to those of the predicates. However, the dimensions and materials of the TI-MAX Z45 are different from the predicates. The gear ratio of the TI-MAX Z45 is also different from that of the predicates. Therefore, the maximum rotation speed at the chuck is different between the Ti-MAX Z45 and the predicates. In addition, the number of the air/water spray port is different between the TI-MAX Z45 and the predicates. In order to evaluate that those differences do not affect safety and effectiveness of the TI-MAX Z45, bench testing was performed. Bench testing demonstrated that the TI-MAX Z45 met the requirement of ISO7785-2 which was used for evaluation of the predicate devices. Based on above result, the TI-MAX Z45 is substantially equivalent to the predicates and does not raise any new safety and effectiveness concern.

510(k) Summary: Page 5 of 6

Powerts: Partrers

5

k. Bench Testing

The bench tests were performed in order to ensure the safety and effectiveness of the TI-MAX Z45, verify conformity to ISO 7785-2 and demonstrate substantial equivalence to the predicates.

All TI-MAX Z45 samples were compliant with ISO 7785-2 and demonstrated substantial equivalence to the predicates.

ﻨﺴﺘ Conclusion

The indications for use of the TI-MAX Z45 is similar to the SYNEA HANDPIECE (K070663). In addition, the principle of operation and design features of the TI-MAX Z45 are identical to those of the predicates. However, the dimensions and materials of the TI-MAX Z45 are different from the predicates. The gear ratio of the TI-MAX Z45 is also different from that of the predicates. Therefore, the maximum rotation speed at the chuck is different between the TI-MAX Z45 and the predicates. In addition, the number of the air/water spray port is different between the TI-MAX Z45 and the predicates. Although there are those differences in characteristics between the TI-MAX Z45 and the predicates, a number of performance testing indicated that the Ti-MAX Z45 met the requirement of the recognized consensus or voluntary standard. Based on above result, we conclude the TI-MAX Z45 is substantially equivalent to the predicates and does not raise any new safety and effectiveness concern.

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510(k) Summary: Page 6 of 6

6

DEPARTMENT OF HEALTH & HUMAN SERVICES

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Public Health Service

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

February 28, 2013

Nakanishi, Incorporated C/O Fumiaki Kanai, Ph.D. President and Chief Executive Officer MIC International 4-1-17 Hongo, Bunkyo-ku Tokyo, Japan 113-0033

Re: K121901

Trade/Device Name: TI-MAX Z45 Regulation Number: 21 CFR 872.4200 Regulation Name: Dental Handpiece and Accessories Regulatory Class: I Product Code: EGS Dated: February 5, 2013 Received: February 11: 2013

Dear Dr. Kanai:

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, Orug 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 contractlie ality 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.

7

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/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/ResourcesforYou/Industry/default.htm.

Sincerely vours.

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for

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

Enclosure

8

Indications for Use

K121901 510(k) Number (If known):

Device Name: TI-MAX Z45

Indications for Use

TI-MAX Z45 is powered by either an air-motor or electronic micromotor for use in general dentistry.

The device is intended for cutting and grinding teeth, cavity preparations, tooth and crown preparations, finishing and trimming teeth and filling materials, and removal of crowns and filling materials.

Prescription Use
(Per 21 CFR 801 Subpart D)

![x mark](data:image/png;base64,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

AND/OR

Over-the Counter Use (21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Mary S. Runner -S 013:02.28 07:38:56

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

510(k) Number;