K Number
K131906
Device Name
SCANWAVE PEN (WITH LIGHT GRAY CORD), SCANWAVE PEN (WITH MEDIUM GRAY CORD), SCANWAVE PEN (WITH DARK GRAY CORD), SCANWAVE
Date Cleared
2014-04-11

(289 days)

Product Code
Regulation Number
872.6070
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
SCANWAVE PEN is a source of illumination for the polymerization of light-curing dental materials curing in the wavelength range of 390 nm - 505 nm.
Device Description
SCANWAVE PEN is a Dental Curing Light. More precisely, SCANWAVE PEN is a source of illumination used for the polymerization of light-curing dental materials curing in the wavelength range of 390 nm - 505 nm. SCANWAVE PEN is equipped with a LED (Light Emitting Diode) which permit to polymerize a large range of dental materials present on the market. SCANWAVE PEN is an Electro-medical Device. SCANWAVE PEN is compatible with only ADEC Dental units. The Handpiece contains the electronic command board, the power board and the light source. The rigid protection shield to the Handpiece reduces the light propagation outside the initial site. This accessory is used to protect the eyes of the patient and the user during the Curing Light polymerization act. The O.E.M. Module is a power supply module intended to deliver the electrical source needed for the Handpiece functioning. The O.E.M. Module is integrated in an ADEC Dental Unit. The User Manual contains all needed information for a correct using (description, safety aspects, problems, cleaning, disinfecting and sterilization procedures).
More Information

Not Found

No
The description focuses on the device's function as a light source for polymerization and its electrical and mechanical components. There is no mention of AI, ML, image processing, or data analysis that would suggest the use of such technologies. The performance studies are based on physical measurements (Depth of Cure) and compliance with standards, not algorithmic performance.

No
The device is described as a source of illumination for the polymerization of light-curing dental materials, which are used to harden dental fillings, not to treat a disease or condition itself.

No
The device is a dental curing light used for the polymerization of light-curing dental materials, which is a treatment function, not a diagnostic one.

No

The device description explicitly states it is an "Electro-medical Device" and describes physical components like a LED, Handpiece containing electronic boards and a light source, a rigid protection shield, and an O.E.M. Module (power supply). This indicates it is a hardware device, not software-only.

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

Here's why:

  • Intended Use: The intended use is "a source of illumination for the polymerization of light-curing dental materials". This describes a therapeutic or procedural function, not a diagnostic one.
  • Device Description: The description details a "Dental Curing Light" used to "polymerize a large range of dental materials". This reinforces its role in dental procedures.
  • Lack of Diagnostic Function: There is no mention of the device being used to analyze samples (blood, tissue, etc.) or provide information about a patient's health status or condition.
  • Performance Studies: The performance studies focus on "Polymerization Performance" and "Depth of Cure", which are relevant to the effectiveness of the curing process, not diagnostic accuracy.

IVD devices are specifically designed to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. The SCANWAVE PEN does not fit this definition.

N/A

Intended Use / Indications for Use

SCANWAVE PEN is a source of illumination for the polymerization of light-curing dental materials curing in the wavelength range of 390 nm - 505 nm.

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

EBZ

Device Description

SCANWAVE PEN is an Electro-medical Device. SCANWAVE PEN is compatible with only ADEC Dental units. The Handpiece contains the optic command board, the power board and the light source. The rigid protection shield to the Handpiece reduces the light propagation during the critical phase of curing Light. This accessory is used to protect the eyes of the patient and the user during the curing Light. The O.E.M. Module is a power supply module intended to deliver the electrical source needed for the Handpiece functioning. The User Manual describes all needed information for a correct using (description, safety aspects, problems, cleaning, disinfecting and sterilization procedures).

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Dental (for polymerization of light-curing dental materials)

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Qualified dental practitioners (implied by predicate device indication).

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)

Comparison tests of Depth of Cure have been performed between SCANWAVE PEN and Predicate Devices. The obtained results show that the Depths of Cure of SCANWAVE PEN are substantially equivalent and coherent with the claimed Intended Use.
The aim of the non clinical tests (on test bench) was to demonstrate the Substantial Equivalence of the SCANWAVE PEN and the selected Predicate Devices in terms of Polymerization Performance. The Comparison of the Obtained values of Depth of Cure shows that the depths of Cure of SCANWAVE PEN are substantially equivalent to the values of the Predicate Devices. In conclusion, SCANWAVE PEN and the Predicate Devices are Substantially Equivalent in performance of polymerization point of view.
SCANWAVE PEN has been tested according to a specific standard (Specification No 48). Also, SCANWAVE PEN has been tested according to IEC60601-1 and IEC60601-1-2. The results demonstrate that SCANWAVE PEN is compliant to the applicable standard for Dental Curing Lights.

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.

K072181, K091020

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

§ 872.6070 Ultraviolet activator for polymerization.

(a)
Identification. An ultraviolet activator for polymerization is a device that produces ultraviolet radiation intended to polymerize (set) resinous dental pit and fissure sealants or restorative materials by transmission of light through a rod.(b)
Classification. Class II.

0

Section 006 - 510(k) Summary (SMDA Requirements) Additional Information - March 31, 2014

APR 1 1 2014

This Summary of Safety And Effectiveness is submitted in accordance with 21 CFR 807.92.c.

01 - Administrative Information

Date Prepared: 01- a.

510(k) Submitter 01-b.

June 20, 2013

SATELEC 17, Avenue Gustave Eiffel BP 30216 33708 Merignac Cedex France 011-33-556-340-607 Telephone: 011-33-556-349-292 Fax: E-Mail: philippe.girard@acteongroup.com

01-c. Contact Person:

Rick Rosati SATELEC clo ACTEON, Inc. 124 Gaither Drive, Suite 140 Mt. Laurel, NJ 08054 800-289-6367 Ext: 390 Telephone: 856-222-4726 Fax: E-Mail: rick.rosati@us.acteongroup.com

01- e. Establishment registration number

02 - Device Information

Trade Name of Device: 02-a.

Common Name of Device: 02-b.

Classification Requiation: 02-c.

Medical Device Class: 02-d.

02-e. Panel:

02-f. Product Code:

8044015

SCANWAVE PEN

Ultraviolet Activator for Polymerization

21 CFR 872.6070

ll

Dental

EBZ

Pre-Market Notification 510(k) Submission for SCANWAVE PEN By SATELEC Market Notification of of(k) - Confidential Document - Version 02

Image /page/0/Picture/27 description: The image shows the text "006 - 1". The numbers are written in a simple, sans-serif font. The text is black and the background is white. The text is centered in the image.

Image /page/0/Picture/28 description: The image shows the logo for Satelec Acteon. The word "SATELEC" is in smaller font above the word "ACTEON", which is in a larger, bold font. There is a curved graphic to the left of the word "ACTEON".

Image /page/0/Picture/29 description: The image shows a logo with the letter 'G' at the top. Below the 'G', there is some smaller text that is difficult to read. At the bottom of the logo, the text 'ISO 13485' is visible. The logo appears to be a certification mark related to ISO 13485 standards.

SATELEC . A company of ACTEON Group Gustave Eiffel • BP 30216 • 33708 MERIGNAC cedex • FRANCE • Gustave E-mail: satelec@acteongroup.com . www.acteongroup.com Société pour la Conception des Techniques Electroniques Electroniques , S.A. 5. au captal de 1 309 548 E R.C. Bordeaux 8 782 016 240 × Nº intracommunautaire FR 39.782 016 240

1

Section 006 - 510(k) Summary (SMDA Requirements)

Additional Information - March 31, 2014

03 - Identification of Legally Marketed Predicate Device(s)

The Substantial Equivalence (SE) of SCANWAVE PEN is based on the Predicate Devices identified in the Table 01.

Table 01 - Identification of Legally Marketed Predicate Devices

| Trade Name | Manufacturer | Product
Code | 510(k)
number | Date Cleared |
|--------------------|-----------------------------------|-----------------|------------------|--------------------|
| MINI LED AUTOFOCUS | SATELEC | EBZ | K072181 | September 19, 2007 |
| BLUEPHASE® 20i | IVOCLAR VIVADENT,
Incorporated | EBZ | K091020 | June 12, 2009 |

04 - Intended Use of SCANWAVE PEN

SCANWAVE PEN is a source of illumination for the polymerization of light-curing dental materials curing in the wavelength range of 390 nm - 505 nm.

05 - Description of SCANWAVE PEN

Scientific principles 05-a.

The specific wavelengths of the light source activate the photo-initiators contained in the dental The specific wavelengths of the photo-initiators produces the hardening of the dental material.

Principles of operation 05-b.

SCANWAVE PEN is a Dental Curing Light. More precisely, SCANWAVE PEN is a source of illumination used for the polymentation of light-curing dental materials curing in the wavelength lillumination used for the polymenzation of ight Guiller Children Cambridge of Shitting Diode) which permit to polymerize a large range of dental materials present on the market.

06 - Description of SCANWAVE PEN Design

SCANWAVE PEN is an Electro-medical Device. SCANWAVE PEN is compatible with only ADEC SCANVVAVE PEN Is an Liectromic command board, the power board, the power board and the Dental units. The nanuplece contains the olyonsmit the light delivered by the Handpiece on the light source. The rigid protection shield to the Handpiece reduces the light propage the light course during the ciritial site: The nglo protection shills hise of the patient and the user during the connig Light. This accessory is used to p p ower supply module intended to deliver the electical polymenzation ac. The O.L.M Module is a power buppy the Module is integrated in an ADEC source needed for the Tranqplece Tunctioning of The Call needed information for a correct using (description, safety aspects, problems, cleaning, disinfecting and sterilization procedures).

07 - Identification of the Risk Analysis Method

The risks to health associated to SCANWANVE PEN are managed through the section of 7 of the section of 7 of the The nexs to Treatin associated to SOAWW N it = Premarket Notification [510(k)] Submission = Guidance Document hamed 'Dental Outling Eights' - Fredance Document are covered by Several
March 27, 2006. The Identified risks of the applicable Guidance Document billy, too March 21, 2000: The loomined hold on the signification and biocompatibility tests, labeling, performance tests).

Pre-Market Notification 510(k) Submission for SCANWAVE PEN By SATELEC K131906 - Abbreviated 510(k) - Confidential Document - Version 02

Image /page/1/Picture/18 description: The image shows a logo with the letter 'G' prominently displayed at the top. Below the 'G', there is some smaller text that appears to be 'ISO 13485'. The logo has a textured or slightly distressed appearance, giving it a somewhat vintage or stylized look. The overall impression is that of a certification mark or a company logo related to quality standards.

SATELEC . A company of ACTEON Group Eiffel « BP 30216 • 33708 MERIGNAC cedex » FRANCE Gustave 33 (0) 556 34 06 07 * Fax + 33 (0) 556 34 92 92 E-mail: satelec@acteongroup.com · www.acteongroup.com Société pour la Conception des Techniques Electroniques • S.A.S. au capital de 1 309 548 € R.C. Bordeaux 8 782 016 240 . N. Intractimmunautaire FR 39 782 016 240

Image /page/1/Picture/20 description: The image shows the logo for Satelec Acteon. The word "ACTEON" is in large, bold, sans-serif font, with a curved line extending from the left side of the "A" and going under the word. Above and to the right of "ACTEON" is the word "SATELEC" in a smaller, sans-serif font. The logo appears to be in black and white.

2

Section 006 ~ 510(k) Summary (SMDA Requirements) Additional Information - March 31, 2014

Additional Information – March 31, 2014

08 - Description of the performance aspects

The Depth of Cure performed on Dental Materials (resins) is identified as the intended performances of SCANWAVE PEN. Comparison tests of Depth of Cure have been performed performances of OO/NVW (ve ) Eedicate Devices. The obtained results show that the Depths of between SCANWAVE PEN are substantially equivalent and coherent with the claimed Intended Use.

09 - Intended Use of SCANWAVE PEN compared to the Predicate Device

Table 02 - Indication for Use Comparison

| Trade / Device
name | SCANWAVE PEN | Predicate
Device n°1 | Predicate
Device n°2 |
|------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------|
| Intended Use | SCANWAVE PEN is a
source of illumination
for the polymerization
of light-curing dental
materials curing in the
wavelength range of
390 nm - 505 nm. | The Satelec Mini LED
AutoFocus is intended to
be used by qualified
dental practitioners as an
ultraviolet activator for
polymerization for:
Photo-polymerization in
the 420 - 480 nm
waveband of visible light
cured (VLC) dental
materials.
Photo polymerization in
the 420 - 480 nm
waveband of visible light
cured (VLC) restorative
composite materials, and
Photo-polymerization in
the 420 - 480 nm
waveband of visible light
cured (VLC) orthodontic
brackets, and orthodontic
bonding and sealing
materials | For the
polymerization of
light-curing dental
materials curing in
the wavelength
range of 380-515
nm. |
| Part | 872 - Dental devices | | |
| Regulation
Number | 21 CFR 872.6070 | | |
| Regulation
Name | Ultraviolet Activator for Polymerization | | |
| Regulatory
Class | 11 | | |
| Product Code | FBZ | | |

Pre-Market Notification 510(K) Submission for SCANWAVE PEN By SATELEC Market Notification of o(k) - Confidential Document - Version 02

006 - 3

Image /page/2/Picture/9 description: The image shows the logo for ACTEON SATELEC. The word "ACTEON" is written in large, bold, black letters. Above the right side of the word "ACTEON" is the word "SATELEC" in smaller, black letters. There is a curved line that starts below the left side of the word "ACTEON" and curves up and over the word.

G
ISO 13485

SATELEC . A company of ACTEON Group 17 av. Gustave Eiffel . BP 30216 . 33708 MERIGNAC cedex . FRANCE Tel + 33 (0) 556 34 06 07 · Fax + 33 (0) 556 34 92 92 E mail: satelec@acteongroup.com · www.acteongroup.com Societé pour la Conception des Applications des Techniques Electroniques • S.A.S. au capital de 1 309 548 € R.C. Bordeaux B 782 016 240 · N' intracommunautaire FR 39 782 016 240

3

Section 006 - 510(k) Summary (SMDA Requirements) Additional Information - March 31, 2014

10 – Technological characteristics of SCANWAVE PEN compared to the Predicate Devices

Table 03 – Technological characteristics and performances Comparison

Predicate Device n°1Predicate Device n°2
SCANWAVE PENMINILED
AUTOFOCUSBLUEPHASE® 20i
Handpiece Dimensions
Overall Weight (g)7699143
Overall Size (mm)Ø 24 x 12246 x 197
Light Sources
Quantity / Source4 LED4 LED
Range of
Wavelength (nm)390 to 505385 to 515
Power Source
TypeO.E.M. ModuleMain adapter
Input Voltage (VAC)24100-240
Output Voltage (DC)
5
Handpiece Input Voltage
Input Voltage (VDC)5 V3.7 - 5V
Safety Controls
Safety ControlsActivation of a thermal sensor in case of overheating in the device
(caused by an intensive using)
Material
HandpieceMetallic Body (aluminum)Plastic Body
Optical GuideGlass and metallic partGlass and
plastic part
Optical ProtectorPlastic
Performance Specifications
Typical Irradiance
at 2 mm (mW/cm²)15002000 - 2200
Depth of Cure (mm)
depending of dental
Materials and
Polymerization modes0.5 to 4.50.5 to 4
Standards
Safety & EMC
StandardIEC60601-1 / IEC60601-1-2
Specific Standard
for Dental Curing
LightANSI / ADA Standard No. 48 - Visible Light
Curing Unit - Part 2 - Light Emitting Diode
(LED)ANSI / ADA
Specification No. 48,
Visible Light Curing
Fire aspectsUL94-V0 for Printed Circuit BoardsUnknown

Pre-Market Notification 510(k) Submission for SCANWAVE PEN By SATELEC Market Nothication 070(k) - Confidential Document - Version 02

006 - 4

Image /page/3/Picture/6 description: The image shows the logo for Satelec Acteon. The word "ACTEON" is written in large, bold, black letters. Above and to the right of "ACTEON" is the word "SATELEC" in smaller letters. A curved line is to the left of the word "ACTEON".

Image /page/3/Picture/7 description: The image shows a logo with the letter 'G' in a stylized font. Below the letter 'G', the text 'REGISTERED' is written in a smaller font. Underneath the word 'REGISTERED', the text 'ISO 13485' is written. The logo appears to be a certification mark related to ISO 13485 standards.

SATELEC » A company of ACTEON Group 17 av. Gustave Elffel · BP 30216 · 33708 MERIGNAC cedex · FRANCE 17 - 11 - 13 - 10 - 13 - 10 - 13 - 15 - 12 - 12 - 12 - 12 - 12 - 12 - 12 - 14 - 13 - 14 - 13 - 14 - 13 - 14 - 10 - 10 - 10 - 10 - 10 - 10 - 10 - 10 - 10 - 10 - 10 - 10 - 10 -

4

Section 006 - 510(k) Summary (SMDA Requirements)

Additional Information - March 31, 2014

11 - Determination of substantial equivalence

SCANWAVE PEN and Predicate Devices are identified as Ultraviolet Activators for Polymerization according to Classification Regulation n°21 CFR 872.6070 used for Dental Applications.

Indication for Use Perspective 11-a.

SCANWAVE PEN Indications for Use are Substantially Equivalent to the Predicate Devices.

Design Perspective 11-b.

In Design Perspective:

  • SCANWAVE PEN and the Predicate Device n°1 are Substantially Equivalent in term of ● dimensions.
  • SCANWAVE PEN and Predicate Devices are Substantially Equivalent in term of Light � sources (LED light source).
  • The SCANWAVE PEN and the Predicate Device n°1 are Substantially Equivalent in term ● of Operation Modes and Command.
  • The SCANWAVE PEN and Predicate Devices are Substantially Equivalent in term of . Power Source.
  • The SCANWAVE PEN and Predicate Device n°1 are Substantially Equivalent in term of Design.

Material Perspective 11-c.

In Material Perspective, the Substantial Equivalence document has defined that:

  • The Material of SCANWAVE PEN and Predicate Device n°1 are identical. .
  • The Material potentially in direct contact with the patient of SCANWAVE PEN and . Predicate Device nº1 are identical.

Discussion and conclusion of the non-clinical Tests 11-d.

Polymerization performance:

The aim of the non clinical tests (on test bench) was to demonstrate the Substantial Equivalence The allif of the non official (one selected Predicate Devices in terms of Polymerization of the SCANNVAVE TEN and the belowed values of Depth of Cure shows that the depths of Penomance. The Companson of the Obtailion valuation of the Predicate Devices. In conclusion, Our of SCANNAVE FEN are Gubliantali, CANWAVE PEN and the Predicate Devices are Substantially Equivalent in performance of polymerization point of view.

Specific standard for Dental Curing Lights:

Specific Standard for Boman tested according to a specific standard (Specification No 48) Also, SOANWAVE I EN has boom toologies to the results demonstrate that SCANWAVE PEN is compliant to the applicable standard for Dental Curing Lights.

Discussion and conclusion of the clinical Tests 11-e. Clinical tests are not required to establish the Substantial Equivalence.

12 - Conclusion

SCANWAVE PEN is Substantially Equivalent to the Predicate Devices (K072181, cleared September 19, 2007 and K091020, cleared June 12, 2009).

End of Section

Pre-Market Notification 510(K) Submission for SCANWAVE PEN By SATELEC K131906 - Abbreviated 510(k) - Confidential Document - Version 02

006 - 5

Image /page/4/Picture/28 description: The image shows the logo for Satelec Acteon. The word "ACTEON" is written in large, bold, black letters. Above the word "ACTEON" is the word "SATELEC" in smaller letters. To the left of the word "ACTEON" is a black curved line.

Image /page/4/Picture/29 description: The image shows a logo with the letter 'G' in a stylized font. Below the letter, there is some text that appears to be a registration or identification number, specifically 'CO.13485'. The logo is in black and white and has a slightly distressed or textured appearance.

SATELEC . A company of ACTEON Group Eiffel · BP 30216 · 33708 MERIGNAC cedex · FRANCE et + 33 103 556 34 06 07 + Fax + 33 101 556 34 92 92 E-mail: sarelec@acteoneroup.com · www.acteongroup.com Société pour la Conception des Applications des Techniques · S.A.S. au cap!tal de 1 309 548 € R.C. Bordeaux B 782 016 240 · N' intracommunautaire FR 39 782 016 240

5

Image /page/5/Picture/1 description: The image is a black and white logo for the U.S. Department of Health and Human Services. The logo features the department's name in a circular arrangement around a stylized symbol. The symbol consists of three curved shapes that resemble a human figure embracing or supporting something, representing health and human services.

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

April 11, 2014

Satelec-Acteon Group Rick Rosati Quality Manager 124 Gaither Drive, Suite 140 Mt. Laurel, NJ 08054

Re: K131906

Trade/Device Name: Scanwave pen (with light gray cord), Scanwave pen (with medium gray cord), Scanwave pen (with dark gray cord) Regulation Number: 21 CFR 872.6070 Regulation Name: Ultraviolet Activator for Polymerization Regulatory Class: Class II Product Code: EBZ Dated: March 10, 2014 Received: March 11, 2014

Dear Mr. Rosati:

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.

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

6

Page 2 - Mr. Rick Rosati

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 contact the Division of Small Manufacturers, International and Consumer Assistance at its tollfree number (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. 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 Industry and Consumer Education 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,

Mary S. Runner -S

Erin I. Keith, M.S. Acting Director Division of Anesthesiology, General Hospital, Respiratory, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

7

Section 005 - Indication for Use

Indications for Use

510(k) Number (if known): K131906

Device Name:

SCANWAVE PEN

Indications for Use:

SCANWAVE PEN is a source of illumination for the polymerization of light-curing dental materials curing in the wavelength range of 390 nm - 505 nm.

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

Over-The-Counter Use (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)

Sheena A. Green -S 2014.04.12 20:24:34 -04'00'

Page 1 of 1