K Number
K152064
Device Name
Astringedent Clear
Date Cleared
2015-09-24

(62 days)

Product Code
Regulation Number
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Astringedent Clear is intended for sulcus retraction prior to impression making and to control bleeding and gingival oozing in restorative and operative dentistry used with gingival retraction cord and/or the solution facilitates the insertion of the cord into the sulcus.
Device Description
Astringedent Clear is a 12% w/w aluminum chloride solution in a non-viscous, aqueous vehicle. It leaves no residue or stain, making it ideal for use in the esthetic zone. It is packaged in two configurations: 30 mL IndiSpense, 30 mL bottle packaged with retraction cord. It is used both for obtaining clear dental impressions, as well as operative dental procedures requiring hemostasis and fluid control.
More Information

Not Found

No
The device description and intended use clearly describe a chemical solution for hemostasis and sulcus retraction. There is no mention of any software, algorithms, image processing, or AI/ML terms. The performance studies focus on chemical and physical properties, not algorithmic performance.

No.
The device is a chemical solution used for sulcus retraction and to control bleeding and gingival oozing, which are procedural aids rather than direct therapeutic treatments for a disease or condition.

No

Astringedent Clear is a solution used for sulcus retraction, bleeding control, and gingival oozing in dentistry. Its intended use and mechanism of action involve physical or chemical effects on tissues rather than analyzing or interpreting data to diagnose a condition.

No

The device description clearly states it is a 12% w/w aluminum chloride solution, which is a chemical substance, not software.

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

Here's why:

  • Intended Use: The intended use describes a product used for sulcus retraction and bleeding control during dental procedures. This is a direct application to the patient's oral tissues for a therapeutic or procedural purpose.
  • Device Description: The description confirms it's a solution applied to the oral cavity.
  • Lack of IVD Characteristics: An IVD is a medical device used to perform tests on samples taken from the human body (like blood, urine, tissue) to provide information about a person's health. This device does not involve testing samples from the body.

Therefore, Astringedent Clear is a dental device used for local application and procedural support, not for in vitro diagnostic testing.

N/A

Intended Use / Indications for Use

Astringedent Clear is intended for sulcus retraction prior to impression making and to control bleeding and gingival oozing in restorative and operative dentistry used with gingival retraction cord and/or the solution facilitates the insertion of the cord into the sulcus.

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

MVL

Device Description

Astringedent Clear is a 12% w/w aluminum chloride solution in a non-viscous, aqueous vehicle. It leaves no residue or stain, making it ideal for use in the esthetic zone. It is packaged in two configurations: 30 mL IndiSpense, 30 mL bottle packaged with retraction cord. It is used both for obtaining clear dental impressions, as well as operative dental procedures requiring hemostasis and fluid control.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Dental professional

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Astringdent Clear has been tested for aluminum chloride content, wettability, effect on bonding (shear bond strength), and stability, and met all design input requirements.

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.

K123215

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

N/A

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Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo is a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the top half of the circle. Inside the circle is an abstract image of an eagle with three human profiles incorporated into the design.

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

September 24, 2015

Ultradent Products, Inc. Corey Jaseph, MS, RAC Regulatory Affairs Manager 505 West 10200 South South Jordan, Utah 84095

Re: K152064

Trade/Device Name: Astringedent Clear Regulation Number: None Regulation Name: None Regulatory Class: Unclassified Product Code: MVL Dated: August 27, 2015 Received: August 28, 2015

Dear Ms. Jaseph:

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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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 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/Resourcesfor You/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/ResourcesforYou/Industry/default.htm.

Sincerely vours.

Susan Runner DDS, MA

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

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Section 4: Indications For Use Form FDA-3881

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DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known)

Device Name Astringedent Clear

Indications for Use (Describe)

Astringedent Clear is intended for sulcus retraction prior to impression making and to control bleeding and gingival oozing in restorative and operative dentistry used with gingival retraction cord and/or the solution facilitates the insertion of the cord into the sulcus.

Type of Use (Select one or both, as applicable):

☑ Prescription Use (Part 21 CFR 801 Subpart D)
☐ Over-The-Counter Use (21 CFR 801 Subpart C)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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Image /page/4/Picture/0 description: The image shows a logo in brown color. The logo is a stylized design that appears to be a combination of the letters 'U' and 'R'. The 'U' is formed by a thick, rounded line, and the 'R' is created by a similar line that connects to the 'U' at the top right. There is a trademark symbol in the upper right corner of the logo.

Section 5: Special 510(k) Summary

This summary of the Special 510(k) substantial equivalence information is being submitted in accordance with the requirements of 21 CFR 807.92.

l. Applicant's Name and Address

Ultradent Products, Inc. 505 West 10200 South South Jordan, UT 84095

Contact Person:Ms. Corey Jaseph, MS, RAC
Title:Regulatory Affairs Manager
Telephone:800-552-5512 x4420, 801-553-4420
FAX:801-553-4609

Date Summary Prepared:

II. Name of the Device

Trade Name:Astringedent Clear
Common Name:Retraction Cord
Device Classification:Unclassified
Classification Product Code:MVL
Regulation No.None (pre-amendment)

lll. Predicate Device:

Astringedent Clear is substantially equivalent to Viscostat Clear (K123215), also manufactured by Ultradent Products, Inc.

23 July 2015

IV. Device Description:

Astringedent Clear is a 12% w/w aluminum chloride solution in a non-viscous, aqueous vehicle. It leaves no residue or stain, making it ideal for use in the esthetic zone. It is packaged in two configurations: 30 mL IndiSpense, 30 mL bottle packaged with retraction cord. It is used both for obtaining clear dental impressions, as well as operative dental procedures requiring hemostasis and fluid control.

Image /page/4/Picture/13 description: The image shows the logo for Ultradent Products, Inc. The logo features a stylized "U" and "P" interlocked, followed by the text "ULTRADENT" in a bold, sans-serif font. Below "ULTRADENT" is the text "PRODUCTS, INC." in a smaller font size. The logo is displayed on a white rectangular background with rounded corners, and the colors used are a shade of brown.

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V. Statement of intended use:

Astringedent Clear is intended for sulcus retraction prior to impression making and to control bleeding and gingival oozing in restorative and operative dentistry used with gingival retraction cord and/or the Dento Infusor. The solution facilitate the insertion of the cord into the sulcus.

VI. Comparison of technological characteristics

Astringedent Clear and Viscostat Clear have similar technological characteristics:

| Characteristic | Predicate: Viscostat Clear
(K123215) | Astringedent Clear |
|-----------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Intended Use | Viscostat Clear is intended for sulcus
retraction prior to impression making
and to control bleeding and gingival
oozing in restorative and operative
dentistry used with gingival retraction
cord and/or the Dento Infusor. The
gel facilitates the insertion of the cord
into the sulcus. | Astringedent Clear is intended for sulcus
retraction prior to impression making and to
control bleeding and gingival oozing in
restorative and operative dentistry used with
gingival retraction cord and/or the Dento
Infusor. The solution facilitates the insertion of
the cord into the sulcus. |
| Intended user | Dental professional | Dental professional |
| Chemical
Characteristics | Aluminum chloride gel | Aluminum chloride solution |
| Primary Container | 30 ml Indispense container, 1.2 mL
syringe | 30 ml Indispense container, 30 ml bottle
packaged with retraction cord |
| Physical properties | Clear gel | Clear solution |
| Compatibility | Does not adversely affect bond
strength when used as directed | Does not adversely affect bond strength when
used as directed |
| Time in mouth | 1 - 3 minutes | 1 – 3 minutes |
| Viscosity | Viscous gel | Nonviscous solution |
| Biocompatibility | Device demonstrated to have low
cytotoxicity per ISO 10993-5, ISO
7405 | Device not tested (same active ingredient,
similar formulation) |

Table 5-1: Substantial equivalence comparison

Astringdent Clear has been tested for aluminum chloride content, wettability, effect on bonding (shear bond strength), and stability, and met all design input requirements. Astringedent Clear has the same indications for use, intended user, active ingredient,

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same/similar delivery systems (predicate and modification are delivered in a polypropylene 30 mL Indispense syringe, and the modification is also available in a 30 mL glass bottle packaged with retraction cord), and use time. Astringedent Clear is less viscous than Viscostat Clear, which is intended to allow it to more easily and quickly soak into retraction cord for routine use in ensuring and maintaining hemostasis and sulcular fluid control during retraction.

Both work by using aluminum chloride to cause a contraction of the oral mucosal tissues, resulting in control of routine bleeding and sulcular fluid. Aluminum chloride has been used for many years in this manner for obtaining clear dental impressions and operative dental procedures requiring hemostasis and fluid control, as described in peer-reviewed literature.

Based on the results of design verification testing as outlined above, Ultradent has determined that Astringedent Clear is substantially equivalent to Viscostat Clear.