K Number
K162661
Device Name
SavDenTM MTA Root Canal Filling Materials
Date Cleared
2017-04-25

(211 days)

Product Code
Regulation Number
872.3820
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
- A root end filling material. - For the repair of root canals as an apical plug during apexification. - For repair of root perforations during root canal therapy or as a consequence of internal resorption. - As a pulp capping material. - Pulpotomy of primary teeth in the child (ages >2-12 years) and adolescent (ages >12-21 years) pediatric patient populations.
Device Description
SavDen™ MTA powder consists of fine, hydrophilic particles that set in the presence of water. Hydration of the powder creates a colloidal gel that is solidified to form an impermeable barrier that fully cures over a four-week period.
More Information

Not Found

No
The summary describes a material used for dental procedures and does not mention any computational or algorithmic components, let alone AI/ML.

Yes
The device is used to treat various dental conditions, such as root perforations, internal resorption, pulp capping, and pulpotomy, indicating a therapeutic purpose.

No

The device description and intended use indicate it is a dental material used for repair and filling, not for diagnosing conditions.

No

The device description clearly states it is a powder that sets in the presence of water, forming a physical barrier. This indicates a material-based device, not software.

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

Here's why:

  • Intended Use: The intended uses listed are all related to dental procedures performed directly on the patient (root canal filling, repair, pulp capping, pulpotomy). IVDs are used to examine specimens (like blood, urine, tissue) from the body to provide information about a person's health.
  • Device Description: The device is a material that sets in the presence of water to form a barrier. This is a physical material used in a surgical/dental procedure, not a reagent or instrument used to analyze a biological sample.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples, detecting analytes, or providing diagnostic information based on laboratory testing.

Therefore, this device falls under the category of a dental material used for treatment, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

  • A root end filling material.
  • For the repair of root canals as an apical plug during apexification.
  • For repair of root perforations during root canal therapy or as a consequence of internal resorption.
  • As a pulp capping material.
  • Pulpotomy of primary teeth in the child (ages >2-12 years) and adolescent (ages >12-21 years) pediatric patient populations.

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

KIF

Device Description

SavDen™ MTA powder consists of fine, hydrophilic particles that set in the presence of water. Hydration of the powder creates a colloidal gel that is solidified to form an impermeable barrier that fully cures over a four-week period.

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

child (ages >2-12 years) and adolescent (ages >12-21 years) pediatric patient populations.

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)

A series of safety and performance tests were conducted on the proposed device, SavDen™ MTA Root Canal Filling Materials.

  • Shelf life test
  • Biocompatibility test
    • In Vitro Cytotoxicity Test MTT Assay
    • Skin Sensitization Study (Maximization Test)
    • White Rabbit Intracutaneous Irritation Test
    • Acute Systemic Toxicity Study
    • White Rabbit Pyrogen Test
    • Salmonella Reverse Mutation Test
    • In Vitro Mammalian Cell Gene Mutation Test
    • In Vitro Mammalian Chromosomal Aberration Test
    • Muscle Implant Study
  • Bench Test
    • Setting time
    • Solubility and disintegration
    • Radio-opacity
    • pH test
    • X-ray diffraction testing
  • Animal Test

All the test results demonstrate that SavDen™ MTA Root Canal Filling Materials meets the requirements of its pre-defined acceptance criteria, and is substally equivalent to the predicate device.

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.

K142178

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

§ 872.3820 Root canal filling resin.

(a)
Identification. A root canal filling resin is a device composed of material, such as methylmethacrylate, intended for use during endodontic therapy to fill the root canal of a tooth.(b)
Classification. (1) Class II if chloroform is not used as an ingredient in the device.(2) Class III if chloroform is used as an ingredient in the device.
(c)
Date PMA or notice of completion of a PDP is required. A PMA or a notice of completion of a PDP is required to be filed with the Food and Drug Administration on or before December 26, 1996 for any root canal filling resin described in paragraph (b)(2) of this section that was in commercial distribution before May 28, 1976, or that has, on or before December 26, 1996 been found to be substantially equivalent to a root canal filling resin described in paragraph (b)(2) of this section that was in commercial distribution before May 28, 1976. Any other root canal filling resin shall have an approved PMA or a declared completed PDP in effect before being placed in commercial distribution.

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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 features the department's name in a circular arrangement around a symbol. The symbol is a stylized representation of a human figure, with three faces in profile, suggesting care and service.

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

tYDS Biotech Incorporation Liang-Yu Chang Project Manager Rm. 7, 2F., No. 229, Fuxing 2nd Rd. Zhubei City, Hsinchu County 302 TAIWAN (R.O.C.)

Re: K162661

Trade/Device Name: SavDen™ MTA Root Canal Filling Materials Regulation Number: 21 CFR 872.3820 Regulation Name: Root canal filling resin Regulatory Class: Class II Product Code: KIF Dated: February 24, 2017 Received: February 27, 2017

Dear Liang-Yu Chang:

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. Isting 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.

April 25, 2017

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 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/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/ResourcesforYou/Industry/default.htm.

Sincerely,

Susan Runno DDS, MA

Tina Kiang, Ph.D. Acting Director Division of Anesthesiology, General Hospital, Respiratory, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

Change Control Table, Change History

Change Control Table

VersionDocument AuthorDocument ApproverDate Approved
1.00Name, Title, OfficeName, Title, OfficeMM/DD/YYYY

Complete Change Control Table (all versions) retained in SWIFT Docs.

3

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 below.

510(k) Number (if known)

Device Name

SavDenTM MTA Root Canal Filling Materials

Indications for Use (Describe)

  • A root end filling material.

  • For the repair of root canals as an apical plug during apexification.

  • For repair of root perforations during root canal therapy or as a consequence of internal resorption.

  • As a pulp capping material.

  • Pulpotomy of primary teeth in the child (ages >2-12 years) and adolescent (ages >12-21 years) pediatric patient populations.

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.

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 Druq Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff@fda.hhs.gov

"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."

4

Traditional 510(k), K162661/S002 510 (k) Summary

510(k) Summary

5

Traditional 510(k), K162661/S002 510 (k) Summary

510(k) SUMMARY

5.1Type of Submission:Traditional
5.2Date of Summary:April 25, 2017
5.3Submitter:tYDS Biotech Incorporation
Address:Rm. 7, 2F, No.229, Fuxing 2nd Rd., Zhubei
City, Hsinchu County 302, Taiwan (R.O.C.)
Phone:+886-3-6589590
Fax:+886-2-27362295
Contact:Liang-Yu Chang (alex627324@gmail.com)

5.4 Identification of the Device:

| Proprietary/Trade name: | SavDen™ MTA Root Canal Filling
Materials |
|-------------------------|---------------------------------------------|
| Regulation Description: | Root canal filling resin. |
| Review Panel: | Dental |
| Regulation Number: | 872.3820 |
| Device Class: | II |
| Product Code: | KIF |

5.4 Identification of the Predicate Device:

| Predicate Device Name: | ProRoot MTA White/Gray (Pediatric
Pulpotomy) |
|------------------------|-------------------------------------------------|
| Manufacturer: | Dentsply International Inc. |
| Regulation number: | 872.3820 |
| Device Class: | II |
| Product Code: | KIF |
| 510(k) Number: | K142178 |

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5.5 Intended Use/ Indications for Use of the Device

  • A root end filling material. -
  • For the repair of root canals as an apical plug during apexification. -
  • For repair of root perforations during root canal therapy or as a consequence of internal resorption.
  • -As a pulp capping material.
  • Pulpotomy of primary teeth in the child (ages >2-12 years) and adolescent -(ages >12-21 years) pediatric patient populations.

5.6 Device Description

SavDen™ MTA powder consists of fine, hydrophilic particles that set in the presence of water. Hydration of the powder creates a colloidal gel that is solidified to form an impermeable barrier that fully cures over a four-week period.

5.7 Non-clinical Testing

A series of safety and performance tests were conducted on the proposed device, SavDen™ MTA Root Canal Filling Materials.

  • Shelf life test
  • . Biocompatibility test
    • In Vitro Cytotoxicity Test MTT Assay
    • Skin Sensitization Study (Maximization Test)
    • White Rabbit Intracutaneous Irritation Test
    • Acute Systemic Toxicity Study

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Traditional 510(k), K162661/S002 510 (k) Summary

  • White Rabbit Pyrogen Test
  • Salmonella Reverse Mutation Test
  • In Vitro Mammalian Cell Gene Mutation Test
  • In Vitro Mammalian Chromosomal Aberration Test
  • Muscle Implant Study
  • . Bench Test
    • Setting time
    • Solubility and disintegration
    • Radio-opacity
    • pH test
    • X-ray diffraction testing
  • . Animal Test

All the test results demonstrate that SavDen™ MTA Root Canal Filling Materials meets the requirements of its pre-defined acceptance criteria, and is substally equivalent to the predicate device.

5.8 Clinical Testing

No clinical test data was used to support the decision of substantial equivalence.

5.9 Substantial Equivalence Determination

The SavDen™ MTA Root Canal Filling Materials has the same intended use, principle of operation and technological characteristics with the predicate device (K142178). A series of tests were performed and demonstrated substantial equivalence between the proposed and the predicate device. Differences between the devices cited in this section do not raise any new issues of substantial equivalence.

ItemProposed devicePredicate device
Proprietary NameSavDenTM MTA Root Canal
Filling MaterialsProRoot MTA White/Gray
(Pediatric Pulpotomy)
510(k) No.K142178
Intended UseA root end filling material.
For the repair of root canals as an apical plug during apexification.
For repair of root perforations during root canal therapy or as a consequence of internal resorption.
As a pulp capping material.
Pulpotomy of primary teeth in the child (ages >2-12 years) and adolescent (ages >12-21 years) pediatric patient populations.A root end filling material.
For the repair of root canals as an apical plug during apexification.
For repair of root perforations during root canal therapy or as a consequence of internal resorption.
As a pulp capping material.
Pulpotomy of primary teeth in the child (ages >2-12 years) and adolescent (ages >12-21 years) pediatric patient populations.
Principle of OperationSavDenTM MTA Root Canal Filling Materials is a powder consisting of fine, hydrophilic particles that set in the presence of water. Hydration of the powder creates a colloidal gel that solidifies (Calcium silicate hydrate, C-S-H) to form an impermeable barrier.ProRoot MTA White/Gray is a powder consisting of fine hydrophilic particles that set in the presence of moisture. Hydration of the powder creates a colloidal gel that solidifies to form a strong impermeable barrier.
ComponentPowder: Calcium silicate, Bismuth (III) oxide
Liquid: Sterilized waterPowder: Portland cement, Bismuth (III) oxide
Liquid: Pure water
Materials Ratio
(wt %)Calcium silicate 80%
Bismuth (III) oxide ( $Bi2O3$ ) 20%Portland cement 80%
Bismuth (III) oxide ( $Bi2O3$ ) 20%
Setting RatioLiquid to powder ratio:
$[L]/[P] = 1/4$N/A *
SolubilityNot exceed 3% by massNot exceed 3% by mass
Radio-opacity> 3 mmAl> 3 mmAl
pH Value of
Extractable MatterspH 12.4 ± 0.5pH 12.4 ± 0.5
Product Shelf Life2 years2 years

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Traditional 510(k), K162661/S002 510 (k) Summary

9

  • The predicate device does not disclose the setting ratio. In general, the setting ratio for the predicate device used by dentists is 0.3~0.4 g powder per 0.1 ml liquid.

5.10 Similarity and Differences

The difference between the proposed device and predicate device are component and setting ratio. We define a proposed ratio of 0.4 g powder per 0.1 ml liquid for the proposed device. But the predicate device does not disclose the setting ratio. In general, the setting ratio for the predicate device used by dentists is 0.3~0.4 g powder per 0.1 ml liquid.

We conducted the X-ray diffraction testing using X-Ray Diffraction to analysis the chemical composition of the proposed and predicate device. XRD analysis results revealed the substantial equivalence in the chemical composition of the proposed and predicate device.

The other properties of these two devices are the same. The proposed device has been conducted on safety and performance tests, and the results complied with the test requests. Therefore, the difference between the proposed and the predicate device did not raise any problems of substantial equivalence. The proposed device is substantially equivalent to the predicate device in safety and performance claims.

5.11 Conclusion

After analyzing non-clinical laboratory studies and safety testing data, it can be concluded that SavDen™ MTA Root Canal Filling Materials is substantially equivalent to the predicate device.