K Number
K152861
Device Name
Aquasil Ultra + Smart Wetting Impression Material
Date Cleared
2016-03-04

(156 days)

Product Code
Regulation Number
872.3660
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Aquasil® Ultra + Smart Wetting® Impression Material is indicated for all dental impression techniques.
Device Description
Aquasil® Ultra+ Smart Wetting® Impression Material is a quadrafunctional hydrophilic addition reaction silicone elastomeric dental impression material with excellent hydrophilic properties, dimensional accuracy, high tear strength, and resistance to permanent deformation.
More Information

Not Found

No
The summary describes a dental impression material and its physical properties, with no mention of AI or ML.

No
The device, Aquasil® Ultra + Smart Wetting® Impression Material, is an impression material used for taking dental impressions. It does not exert any therapeutic effect on the body but rather helps in the diagnostic or restorative process by creating a mold.

No
The document describes an impression material used for dental impressions, which is used to create models of the mouth. This is a physical reproduction process, not a diagnostic process that aims to identify or determine the nature of a disease or condition.

No

The device description clearly states it is an "addition reaction silicone elastomeric dental impression material," which is a physical 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 is for "all dental impression techniques." This is a physical process of creating a mold of the hard and soft tissues in the mouth.
  • Device Description: The description details a "silicone elastomeric dental impression material." This is a material used to physically capture the shape of the mouth.
  • Lack of IVD Characteristics: The description does not mention any analysis of biological samples (blood, urine, tissue, etc.) or the detection of specific analytes or markers. IVDs are designed to be used in vitro (outside the body) to examine specimens from the human body to provide information for diagnosis, monitoring, or screening.

This device is a dental material used for a physical procedure, not for in vitro diagnostic testing.

N/A

Intended Use / Indications for Use

Aquasil® Ultra + Smart Wetting® Impression Material is indicated for all dental impression techniques.

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

ELW

Device Description

Aquasil® Ultra+ Smart Wetting® Impression Material is a quadrafunctional hydrophilic addition reaction silicone elastomeric dental impression material with excellent hydrophilic properties, dimensional accuracy, high tear strength, and resistance to permanent deformation.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

hard and soft tissue in the mouth

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)

The performance of the Aquasil® Ultra + Smart Wetting® Impression Material satisfactorily met the requirements of the non-clinical bench testing conducted to support substantial equivalence. The results of the biocompatibility testing of Aquasil® Ultra + Smart Wetting® Impression Material are equivalent to the predicate device Aquasil® Ultra Smart Wetting® Impression Material 510(k) cleared under K113406.
The test results of Aquasil Ultra + Smart Wetting® Impression Material LV Base and Catalyst paste, met the requirements of the three recommended biocompatibility tests; as per ISO10993-1:2009; Cytotoxicity, Sensitization (Delayed-type hypersensitivity), and Irritation or intracutaneous reactivity. These results were equivalent to the results from the same tests of Aquasil® Ultra Smart Wetting® Impression Material included in 510(k) cleared under K113406.
The Aquasil® Ultra + Smart Wetting Impression Material meets the requirements of ISO 4823 Dentistry -Elastomeric Impression Materials. Other tests, including Contact Angle and Tear Strength were performed and the results of these activities, combined with the design and intended use comparison with the predicate device, support substantial equivalence.

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.

K113406

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

§ 872.3660 Impression material.

(a)
Identification. Impression material is a device composed of materials such as alginate or polysulfide intended to be placed on a preformed impression tray and used to reproduce the structure of a patient's teeth and gums. The device is intended to provide models for study and for production of restorative prosthetic devices, such as gold inlays and dentures.(b)
Classification. Class II (Special Controls).

0

Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo is circular and contains the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is an emblem featuring a stylized human figure in profile, with three faces overlapping to represent the department's focus on health and human well-being. The emblem is simple and modern in design.

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

March 4, 2016

DENTSPLY International, Inc. Ms. Helen Lewis Director, Corporate Regulatory Affairs Susquehanna Commerce Center 221 West Philadelphia Street York, PA 17405

Re: K152861

Trade/Device Name: Aquasil® Ultra+ Smart Wetting® Impression Material Regulation Number: 21 CFR 872.3660 Regulation Name: Impression Material Regulatory Class: II Product Code: ELW Dated: February 3, 2016 Received: February, 04, 2106

Dear Ms. Lewis:

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 801and Part 809); 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 and Part 809), 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

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

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SECTION 4. INDICATIONS FOR USE STATEMENT

K152861 510(k) Number (if known):

Device Name: Aquasil® Ultra + Smart Wetting® Impression Material

Indications for Use:

Aquasil® Ultra + Smart Wetting® Impression Material is indicated for all dental impression techniques.

Prescription Use X (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)

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Image /page/3/Picture/0 description: The image shows the word "DENTSPLY" in a bold, sans-serif font. The letters are all capitalized and black. The letter "P" has a unique design, with the vertical line extending below the baseline and the curved part of the "P" intersecting with the "L".

DENTSPLY International

World Headquarters Susquehanna Commerce Center 221 West Philadelphia Street PO Box 872 York, PA 17405-0872 (717) 849-4593 Fax (717) 849-4343

SECTION 5. 510(k) SUMMARY

for Aquasil® Ultra + Smart Wetting® Impression Material

    1. Submitter Information:
      DENTSPLY International Susquehanna Commerce Center 221 West Philadelphia Street York, PA 17405
Contact Person:Helen Lewis
Telephone Number:717-487-1332
Fax Number:717-849-4343

Date Prepared: 28 September 2015

2. Device Name:

• Proprietary Name:Aquasil® Ultra + Smart Wetting® Impression Material
--------------------------------------------------------------------------
  • Classification Name: Impression Material ●
  • . CFR Number: 872.3660
  • Device Class: . II
  • Product Code: ELW ●

3. Sponsor's Predicate Device:

  • 510(k) cleared under K113406 Aquasil® Ultra Smart Wetting® Impression Material ●

4. Description of Device:

Aquasil® Ultra+ Smart Wetting® Impression Material is a quadrafunctional hydrophilic addition reaction silicone elastomeric dental impression material with excellent hydrophilic properties, dimensional accuracy, high tear strength, and resistance to permanent deformation.

5. Indications for Use:

Aquasil® Ultra + Smart Wetting® Impression Material is indicated for all dental impression techniques.

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6. Substantial Equivalence:

Technological Characteristics.

The Aquasil® Ultra + Smart Wetting® Impression Material represents a modification to the 510(k) cleared under K113406. The modification to the Aquasil® Ultra Smart Wetting Impression Material XLV (Extra Low Viscosity) is removal of the current surfactant and replaced with a mixture of two other surfactants in the base paste. The modification to the Aquasil® Ultra Smart Wetting® Impression Material LV (Low Viscosity) is removal of the current surfactant and replaced with a mixture of two other surfactants in the base paste. This change allows for a faster wetting of water on the surface of the impression material.

Similarities and Differences between the proposed and the predicate devices
Proposed DevicePredicate Device
Aquasil® Ultra +
Smart Wetting® Impression MaterialAquasil® Ultra
Smart Wetting® Impression Material
K113406
Indications for Use: Aquasil® Ultra + Smart
Wetting® Impression Material is indicated
for all dental impression techniques.
Surfactant-Fluoroaliphatic oxyethylene
adductIndications for Use: Aquasil® Ultra Smart
Wetting® Impression Material is indicated
for all dental impression techniques.
Surfactant-Polyoxyethylene modified
polydimethylsiloxane
Contains:
silicone polymers and cross linkerorganoplatinum complex catalystretarderplatinum calcium carbonatedegassing concentratewetting agentpeppermint oilfillerspigmentsContains:
silicone polymers and cross linkerorganoplatinum complex catalystretarderplatinum calcium carbonatedegassing concentratewetting agentpeppermint oilfillerspigments
Can be self-cured after mixing two separate
partsCan be self-cured after mixing two separate
parts
Two parts are separated and mixed prior to
useTwo parts are separated and mixed prior to
use
Paste/paste systems in dual-barrel syringes
and delivered through auto-mix tipPaste/paste systems in dual-barrel syringes
and delivered through auto-mix tip
High tear strengthHigh tear strength
Can be dispensed from cartridge
dispensing gunCan be dispensed from cartridge
dispensing gun

nd Difforoncos battygan the proposad and the prodicato dovices

7. Non-Clinical Performance Data

The performance of the Aquasil® Ultra + Smart Wetting® Impression Material satisfactorily met the requirements of the non-clinical bench testing conducted to support substantial equivalence. The results of the biocompatibility testing of Aquasil® Ultra + Smart Wetting® Impression Material are equivalent to the predicate device Aquasil® Ultra Smart Wetting® Impression Material 510(k) cleared under K113406.

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The table below displays the necessitated biocompatibility and performance testing from the change in the surfactant.

Physical PropertyResults
Wettability (Contact Angle)Meets Internal DENTSPLY procedure requirements
Mechanical (Compressive Strength, Tear Strength)Meets Internal DENTSPLY procedure requirements
Uncured Base Paste –
Cytotoxicity Study Using the ISO
Elution Method – (Test article
incubated for 10 minutes.)Meets ISO Elution
Method requirements
Uncured Catalyst Paste –
Cytotoxicity Study Using the ISO
Elution MethodMeets ISO Elution Method
requirements
Cured Base/Catalyst – Cytotoxicity
Study Using the ISO Agarose
Overlay MethodMeets ISO Agarose Overlay
Method requirements
ISO Oral Mucosal Irritation Study
in Hamsters –
Collar Method - 24 Hrs.Meets ISO Oral Mucosal
Irritation requirements
ISO Guinea Pig Maximization
Sensitization TestMeets ISO Guinea Pig
Maximization Sensitization
Test requirements
OECD 425 Acute Oral Toxicity
Study in Rats, Limit TestMeets OECD 425 Acute Oral
Toxicity requirements

Biocompatibility Conclusion:

The test results of Aquasil Ultra + Smart Wetting® Impression Material LV Base and Catalyst paste, met the requirements of the three recommended biocompatibility tests; as per ISO10993-1:2009; Cytotoxicity, Sensitization (Delayed-type hypersensitivity), and Irritation or intracutaneous reactivity. These results were equivalent to the results from the same tests of Aquasil® Ultra Smart Wetting® Impression Material included in 510(k) cleared under K113406.

Risk Analysis Activities:

A Risk Management system is employed as part of the Design Control process. This includes, but is not limited to, the development of a Design Failure Modes and Effects Analysis (dFMEA) to evaluate any risks associated with the design of the product. Additionally, a Process FMEA (pFMEA) is developed to specifically address the manufacturing process. The individual risks are evaluated and mitigated, as needed. This may include additional Verification and Validation activities in order to demonstrate that the Design Outputs meet the Design Input requirements. At the conclusion of all Risk Management activities, residual risk for the product is determined.

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Design Control Procedures:

The Design Control procedures that are used at DENTSPLY comply with all requirements outlined in 21 CFR §820.30. These procedures represent an effective Design Control process that addresses Design and Development Planning, Design Inputs, Outputs, Reviews, Verification, Validation, Transfer, and Changes. All of the documents that are generated over the course of the development effort result in the assembly of the Design History File.

Verification & Validation Activities:

All required verification and validation activities, as identified through risk analysis were performed by designated individuals and the results indicate that the design meets all predetermined acceptance criteria. Furthermore, the manufacturing facility is in conformance with the design control procedures requirements outlined in 21 CFR §820.30. The records addressing this compliance are available for review.

8. Conclusion Regarding Substantial Equivalence

The Aquasil® Ultra + Smart Wetting® Impression Material is an Elastomeric Impression Material which is intended to reproduce the hard and soft tissue in the mouth. The Aquasil® Ultra + Smart Wetting® Impression Material has the same intended use, incorporates the same fundamental technology, and has the same indications for use as the predicate Aquasil® Ultra Smart Wetting® Impression Material cleared under premarket notification K113406.

Design control activities have been conducted to verify that the Aquasil® Ultra + Smart Wetting® Impression Material meets the design requirements and intended use. The Aquasil® Ultra + Smart Wetting Impression Material meets the requirements of ISO 4823 Dentistry -Elastomeric Impression Materials. Other tests, including Contact Angle and Tear Strength were performed and the results of these activities, combined with the design and intended use comparison with the predicate device, support substantial equivalence.