(238 days)
No
The document describes a ceramic dental implant and its associated components, focusing on material properties, mechanical testing, biocompatibility, and clinical performance. There is no mention of AI or ML technology in the intended use, device description, or performance studies.
Yes
The device, a dental implant, is clearly indicated for the restoration of single tooth gaps and in edentulous or partially edentulous jaws, which directly addresses a medical condition (edentulism) by replacing missing teeth. This functional restoration aligns with the definition of a therapeutic device designed to treat or alleviate a medical condition.
No.
The device is an implant for restoration of single and multiple missing teeth and is not used for diagnosis.
No
The device description clearly outlines physical components made of ceramic, PEEK, and PMMA, indicating it is a hardware medical device.
Based on the provided text, this device is not an IVD (In Vitro Diagnostic).
Here's why:
- Intended Use: The intended use clearly describes a device for surgical implantation and prosthetic restoration in the jaw. This is a therapeutic and restorative purpose, not a diagnostic one.
- Device Description: The description details the materials and design of a dental implant and its associated components, all of which are physical devices intended for placement within the body.
- Lack of Diagnostic Elements: There is no mention of the device being used to analyze samples from the human body (like blood, urine, tissue, etc.) to provide information about a disease or condition.
- Performance Studies: The performance studies focus on mechanical strength, biocompatibility, sterilization, and clinical survival rates of the implant, which are relevant to a surgically implanted device, not an IVD.
IVD devices are specifically designed to perform tests on samples taken from the body to diagnose, monitor, or screen for diseases or conditions. This device is designed to be placed within the body to replace missing teeth.
N/A
Intended Use / Indications for Use
The Straumann® PURE Ceramic Implant (Monotype) is indicated for restoration in single tooth gaps and in an edentulous or partially edentulous jaw. The prosthetic restorations used are single crowns, fixed partial or full dentures, which are connected to the implants through the corresponding components.
The ø3.3 mm reduced diameter implants are recommended for central and lateral incisors only.
The Straumann® PURE Ceramic Implant Protective Cap is intended to protect the Straumann® PURE Ceramic Implant (Monotype) during the healing phase after implant placement for up to 6 months.
Temporary copings are intended to serve as a base for temporary crown or bridge restoration for the Straumann® PURE Ceramic Implant (Monotype) for up to 30 days.
Product codes (comma separated list FDA assigned to the subject device)
DZE, NHA
Device Description
The Straumann® PURE Ceramic Implant (Monotype) is made of 100% yttrium-stabilized zirconia. The endosteal region presents macro- and micro-roughness to support osseointegration (ZLA® surface). The implant has a 1.8 mm high machined neck. The implant features a monotype design where the ceramic abutment for final restoration is already built in. Straumann® PURE Ceramic Implant (Monotype) prosthetic components are identified with RD (Regular Diameter) corresponding to the neck diameter of 4.8 mm, and ND (Narrow Diameter) corresponding to the neck diameter of 3.5 mm.
The Protective Caps are manufactured from polyetheretherketone (PEEK Classix).
The temporary copings are manufactured from polymethylmethacrylate (PMMA).
Mentions image processing
Not Found
Mentions AI, DNN, or ML
Not Found
Input Imaging Modality
Not Found
Anatomical Site
oral endosteal implantation in the upper and lower jaw
Indicated Patient Age Range
Not Found
Intended User / Care Setting
Not Found
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)
Dynamic fatigue, static strength, insertion torque and surface characterization tests were conducted according to the FDA guidance document "Guidance for Industry and FDA Staff – Class II Special Controls Guidance Document: Root-form Endosseous Dental Implants and Endosseous Dental Abutments" and showed that the Straumann® PURE Ceramic implants were equivalent to the predicate devices. Specifically, the fatigue strength of the Ø3.3 mm Straumann® PURE ceramic implant was equivalent to the Ø3.6 mm predicate device's fatigue strength. The insertion torque values of the Straumann® PURE Ceramic Ø3.3 mm implant were measured and compared to the values of a predicate reference device (Straumann® NNC implant, K111357).
MRI testing was performed to support the MRI statements in Straumann® PURE Ceramic labeling.
The Straumann® PURE Ceramic Implants are manufactured from yttrium-stabilized zirconium oxide (Y-TZP). The material conforms to ISO 13356:2008, Implants for surgery – Ceramic materials based on yttria-stabilized tetragonal zirconia (Y-TZP). In addition to prior proven biocompatibility of implant material used, including a toxicological evaluation report and conformance to ISO13356, the following testing was performed:
- Cytotoxicity according to ISO 10993-5:2009, Biological evaluation of medical devices -. Part 5: Test for in vitro cytotoxicity.
- . Chemical Analysis (organic and inorganic) according to ISO 10993-18:2009, Biological evaluation of medical devices – Part 18: Chemical characterization of materials.
- . A rabbit study comparing unaged ceramic implants with aged implants.
All of the testing above, along with a literature review, confirmed the biocompatibility of the Straumann® PURE Ceramic implants.
Sterilization validation of the Straumann® PURE Ceramic implants, in accordance with DIN EN 556-1:2002 (equivalent to ANSI AAMI ST67:2011), Sterilization of medical devices – Requirements for medical devices to be designated "STERILE" – Part 1: requirements for terminally sterilized devices, was completed. The sterilization process for the provisional components as recommended in labeling was also validated according to applicable recommendations in the FDA Guidance document "Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling, issued on March 17, 2015". Straumann performed accelerated and real time aging testing to support the labeled shelf life.
Clinical study results support the equivalence of the Straumann® PURE Ceramic implants to predicate devices. Among the 41 ITT patients with complete follow-up through two years, 40 survived to at least two years (point estimate of 97.6%), which exceeded the acceptance criteria of 85% in the protocol.
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.
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.
K033922, K062129, K123784, K111357, K072071, K080286
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
§ 872.3640 Endosseous dental implant.
(a)
Identification. An endosseous dental implant is a prescription device made of a material such as titanium or titanium alloy that is intended to be surgically placed in the bone of the upper or lower jaw arches to provide support for prosthetic devices, such as artificial teeth, in order to restore a patient's chewing function.(b)
Classification. (1) Class II (special controls). The device is classified as class II if it is a root-form endosseous dental implant. The root-form endosseous dental implant is characterized by four geometrically distinct types: Basket, screw, solid cylinder, and hollow cylinder. The guidance document entitled “Class II Special Controls Guidance Document: Root-Form Endosseous Dental Implants and Endosseous Dental Implant Abutments” will serve as the special control. (See § 872.1(e) for the availability of this guidance document.)(2)
Classification. Class II (special controls). The device is classified as class II if it is a blade-form endosseous dental implant. The special controls for this device are:(i) The design characteristics of the device must ensure that the geometry and material composition are consistent with the intended use;
(ii) Mechanical performance (fatigue) testing under simulated physiological conditions to demonstrate maximum load (endurance limit) when the device is subjected to compressive and shear loads;
(iii) Corrosion testing under simulated physiological conditions to demonstrate corrosion potential of each metal or alloy, couple potential for an assembled dissimilar metal implant system, and corrosion rate for an assembled dissimilar metal implant system;
(iv) The device must be demonstrated to be biocompatible;
(v) Sterility testing must demonstrate the sterility of the device;
(vi) Performance testing to evaluate the compatibility of the device in a magnetic resonance (MR) environment;
(vii) Labeling must include a clear description of the technological features, how the device should be used in patients, detailed surgical protocol and restoration procedures, relevant precautions and warnings based on the clinical use of the device, and qualifications and training requirements for device users including technicians and clinicians;
(viii) Patient labeling must contain a description of how the device works, how the device is placed, how the patient needs to care for the implant, possible adverse events and how to report any complications; and
(ix) Documented clinical experience must demonstrate safe and effective use and capture any adverse events observed during clinical use.
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 image of three human profiles facing right, with three curved lines above them. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular pattern around the image.
Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002
January 11, 2016
Straumann USA Ms. Nandini Murthy Regulatory Consultant 60 Minuteman Road Andover, Massachusetts 01810
Re: K151328
Trade/Device Name: PURE Ceramic Implants Regulation Number: 21 CFR 872.3640 Regulation Name: Endosseous Dental Implant Regulatory Class: II Product Code: DZE, NHA Dated: December 8, 2015 Received: December 9, 2015
Dear Ms. Murthy:
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
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 devicerelated adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (OS) 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 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/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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/ResourcesforYou/Industry/default.htm.
Sincerely yours, Tina Kiang S
for Erin I. Keith, M.S. Director Division of Anesthesiology. General Hospital. Respiratory. Infection Control, and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health
Enclosure
2
DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Indications for Use
Form Approved: OMB No. 0910-0120 Expiration Date: January 31, 2017 See PRA Statement on last page
510(k) Number (if known) K151328
Device Name
PURE Ceramic Implants
Indications for Use (Describe)
The Straumann® PURE Ceramic Implant (Monotype) is indicated for restoration in single tooth gaps and in an edentulous or partially edentulous jaw. The prosthetic restorations used are single crowns, fixed partial or full dentures, which are connected to the implants through the corresponding components.
The ø3.3 mm reduced diameter implants are recommended for central and lateral incisors only.
The Straumann® PURE Ceramic Implant Protective Cap is intended to protect the Straumann® PURE Ceramic Implant (Monotype) during the healing phase after implant placement for up to 6 months.
Temporary copings are intended to serve as a base for temporary crown or bridge restoration for the Straumann® PURE Ceramic Implant (Monotype) for up to 30 days.
Type of Use (Select one or both, as applicable)
区 Prescription Use (Part 21 CFR 801 Subpart D) Subpart C)
□ Over-The-Counter Use (21 CFR 801
PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON A SEPARATE PAGE IF NEEDED.
FOR FDA USE ONLY
Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)
This section applies only to requirements of the Paperwork Reduction Act of 1995. DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW. The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to: Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff
"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number
3
510(k) Summary
1.1 Submitter's Contact Information
Straumann USA, LLC (on behalf of Institut Straumann AG)
60 Minuteman Road
Andover, MA 01810
Phone Number: | 1-978-747-2509 |
---|---|
--------------- | ---------------- |
Fax Number: 1-978-747-0023
Contact Person: Jennifer Jackson
Date of Submission: January 11, 2016
1.2 Name of the Device: PURE Ceramic Implants
Trade Name: | Straumann® PURE Ceramic Implants |
---|---|
------------- | ---------------------------------- |
- Common Name: Endosseous Dental Implant
- Classification Name: Endosseous Dental Implant
- Regulation Number: §872.3640
- Classification: Class II
- Product codes: DZE, NHA
Straumann® PURE Ceramic Protective Caps 1.2.1
- Straumann® PURE Ceramic Protective Caps Trade Name:
- Endosseous Dental Implant Abutment Common Name:
1.2.2 Straumann® PURE Ceramic Temporary Copings
- Straumann® PURE Ceramic Temporary Copings Trade Name:
- Common Name: Endosseous Dental Implant Abutment
4
Predicate Device 1.3
1.3.1 Primary Predicate Device
- K120793, Z-Look3 Evo SLM .
1.3.2 Reference Predicate Device(s)
- . K033922, Modification to ITI Dental Implant System
- . K062129, P.004 Implants
- K123784, Straumann® Dental Implant System .
- . K111357, Narrow Neck CrossFit (NNC) Ø3.3 mm Dental Implant System
- K072071, Straumann P.004 Cementable Abutments ●
- K080286, Straumann P.004 NC Cementable Abutments .
Device Description 1.4
1.4.1 PURE Ceramic Implants
The Straumann® PURE Ceramic Implant (Monotype) is made of 100% yttrium-stabilized zirconia. The endosteal region presents macro- and micro-roughness to support osseointegration (ZLA® surface). The implant has a 1.8 mm high machined neck. The implant features a monotype design where the ceramic abutment for final restoration is already built in. Straumann® PURE Ceramic Implant (Monotype) prosthetic components are identified with RD (Regular Diameter) corresponding to the neck diameter of 4.8 mm, and ND (Narrow Diameter) corresponding to the neck diameter of 3.5 mm.
The full range of size ranges of the PURE Ceramic implants are provided in Table 1 below.
5
K151328 |
---|
Straumann® PURE Ceramic Implants |
Implant Overview | Straumann® PURE Ceramic Implant Ø3.3 ND | Straumann® PURE Ceramic Implant Ø4.1 RD | |||
---|---|---|---|---|---|
Prosthetic Platform | ND | ND | RD | RD | |
Abutment height | AH 4 mm | AH 5.5 mm | AH 4 mm | AH 5.5 mm | |
Shoulder diameter | Ø3.5 mm | Ø3.5 mm | Ø4.8 mm | Ø4.8 mm | |
Image: Four Straumann PURE Ceramic Implants | |||||
Endosteal diameter | Ø3.3 mm | Ø3.3 mm | Ø4.1 mm | Ø4.1 mm | |
Length | 8 mm | 031.001S | 031.011S | 031.021S | 031.031S |
10 mm | 031.002S | 031.012S | 031.022S | 031.032S | |
12 mm | 031.003S | 031.013S | 031.023S | 031.033S | |
14 mm | 031.004S | 031.014S | 031.024S | 031.034S |
Table 1 – Full range of Straumann® PURE Ceramic Implants
1.4.2 Straumann® PURE Ceramic Protective Caps
The Protective Caps are manufactured from polyetheretherketone (PEEK Classix). The full range of Protective Caps is provided in Table 2.
Protective Cap Overview | AH 4 mm | AH 5.5 mm |
---|---|---|
Image: AH 4 mm | Image: AH 5.5 mm | |
For Ø3.3 (ND) | 031.320 | 031.321 |
For Ø4.1 (RD) | 031.330 | 031.331 |
Table 2 – Full range of Straumann® PURE Ceramic Implant Protective Caps
Straumann® PURE Ceramic Temporary Copings 1.4.3
The temporary copings are manufactured from polymethylmethacrylate (PMMA). The full range of temporary copings is provided in Table 3.
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K151328 Straumann® PURE Ceramic Implants
Temporary Coping Overview | For Crowns | For Bridges |
---|---|---|
Image: crown | Image: bridge | |
For Ø3.3 (ND) | 031.300 | 031.301 |
For Ø4.1 (RD) | 031.310 | 031.311 |
Table 3 – Full range of Straumann® PURE Ceramic Implant temporary copings
1.5 Intended Use
Straumann® PURE Ceramic Implants 1.5.1
The Straumann® PURE Ceramic Implant (Monotype) is suitable for oral endosteal implantation in the upper and lower jaw and for the functional and esthetic oral rehabilitation of edentulous and partially edentulous patients (unless specific indications and limitations are specified).
1.6 Indications for Use
1.6.1 Straumann® PURE Ceramic Implants
The Straumann® PURE Ceramic Implant (Monotype) is indicated for restoration in single tooth gaps and in an edentulous or partially edentulous jaw. The prosthetic restorations used are single crowns, fixed partial or full dentures, which are connected to the implants through the corresponding components.
The Ø3.3 mm reduced diameter implants are recommended for central and lateral incisors only.
Straumann® PURE Ceramic Protective Caps 1.6.2
The Straumann® PURE Ceramic Implant Protective Cap is intended to protect the Straumann® PURE Ceramic Implant (Monotype) during the healing phase after implant placement for up to 6 months.
1.6.3 Straumann® PURE Ceramic Temporary Copings
Temporary copings are intended to serve as a base for temporary crown or bridge restoration for the Straumann® PURE Ceramic Implant (Monotype) for up to 30 days.
Straumann USA, LLC
7
1.7 Technological Characteristics
The Straumann® PURE Ceramic Implant is a one-piece monotype implant and therefore does not have an internal connection. Table 4 below provides for a comparison of key technological characteristics and indications between the Straumann® PURE Ceramic Implant and the primary predicate device. The indications are substantially equivalent to the primary predicate, as any differences relate to placement limitation due to reduced diameter implant size and the addition of protective cap and temporary coping device components.
| Features | Straumann® PURE Ceramic Implants
(K151328) | Predicate Z-Look3 Evo SLM
(K120793) |
|--------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Indications for
use | The Straumann® PURE Ceramic Implant
(Monotype) is indicated for restoration in single
tooth gaps and in an edentulous or partially
edentulous jaw. The prosthetic restorations used
are single crowns, fixed partial or full dentures,
which are connected to the implants through the
corresponding components.
The ø3.3 mm reduced diameter implants are
recommended for central and lateral incisors
only.
The Straumann® PURE Ceramic Implant
Protective Cap is intended to protect the
Straumann® PURE Ceramic Implant (Monotype)
during the healing phase after implant placement
for up to 6 months.
Temporary copings are intended to serve as a
base for temporary crown or bridge restoration
for the Straumann® PURE Ceramic Implant
(Monotype) for up to 30 days. | Z-look3 evo slm implants are designed
for surgical implantation into the upper
and lower jaw for the attachment of
prosthodontic appliances to replace
missing teeth. The z-look3 evo slm
implant system is also suitable for
patients with metal allergies and the
chronic diseases resulting from them. |
| Material | Y-TZP | Y-TZP |
| Implant Design | Cylindrical Monotype | Cylindrical Monotype |
| Apical Diameter | Ø3.3 and Ø4.1 mm | Ø3.6, Ø4.0, and Ø5.0 mm |
| Length | 8, 10, 12, and 14 mm | 8, 10, 11.5, and 13 mm |
| Implant/Abutment
connection | None (Monotype) | None (Monotype) |
Table 4 – Comparison of Straumann® PURE Ceramic Implants to Predicate Z-Look3 Evo SLM
1.8 Performance Testing
Dynamic fatigue, static strength, insertion torque and surface characterization tests were conducted according to the FDA guidance document "Guidance for Industry and FDA Staff – Class II Special Controls Guidance Document: Root-form Endosseous Dental Implants and Endosseous Dental Abutments" and showed that the Straumann® PURE Ceramic implants were equivalent to the predicate devices. Specifically, the fatigue strength of the Ø3.3 mm Straumann® PURE ceramic implant was equivalent to the Ø3.6 mm predicate device's fatigue strength. The insertion torque values of the Straumann® PURE Ceramic Ø3.3 mm implant were
8
measured and compared to the values of a predicate reference device (Straumann® NNC implant, K111357).
MRI testing was performed to support the MRI statements in Straumann® PURE Ceramic labeling.
The Straumann® PURE Ceramic Implants are manufactured from yttrium-stabilized zirconium oxide (Y-TZP). The material conforms to ISO 13356:2008, Implants for surgery – Ceramic materials based on yttria-stabilized tetragonal zirconia (Y-TZP). In addition to prior proven biocompatibility of implant material used, including a toxicological evaluation report and conformance to ISO13356, the following testing was performed:
- Cytotoxicity according to ISO 10993-5:2009, Biological evaluation of medical devices -. Part 5: Test for in vitro cytotoxicity.
- . Chemical Analysis (organic and inorganic) according to ISO 10993-18:2009, Biological evaluation of medical devices – Part 18: Chemical characterization of materials.
- . A rabbit study comparing unaged ceramic implants with aged implants.
All of the testing above, along with a literature review, confirmed the biocompatibility of the Straumann® PURE Ceramic implants.
Sterilization validation of the Straumann® PURE Ceramic implants, in accordance with DIN EN 556-1:2002 (equivalent to ANSI AAMI ST67:2011), Sterilization of medical devices – Requirements for medical devices to be designated "STERILE" – Part 1: requirements for terminally sterilized devices, was completed. The sterilization process for the provisional components as recommended in labeling was also validated according to applicable recommendations in the FDA Guidance document "Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling, issued on March 17, 2015". Straumann performed accelerated and real time aging testing to support the labeled shelf life.
Clinical study results support the equivalence of the Straumann® PURE Ceramic implants to predicate devices. Among the 41 ITT patients with complete follow-up through two years, 40 survived to at least two years (point estimate of 97.6%), which exceeded the acceptance criteria of 85% in the protocol.
Conclusion 1.9
The documentation submitted in this premarket notification demonstrates that the Straumann® PURE Ceramic Implants are substantially equivalent to the predicate devices.