K Number
K162677
Device Name
L- OVC
Manufacturer
Date Cleared
2016-12-21

(86 days)

Product Code
Regulation Number
872.6660
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
L-OVC is intended for restoration of permanent teeth with a single unit crown.
Device Description
The L-OVC is a ceramic crown, and includes an anatomic occlusal layer made of lithium disilicate, a thin priming/bonding layer that assists with bonding the occlusal layer to the sub-layer of uncured hybrid ceramic that allows for customization of the L-OVC to the specific tooth preparation. The customized L-OVC is bonded to the prepared natural tooth. The L-OVC is for restoring structurally compromised posterior teeth in cases normally restored with an onlay or a partial crown in a single dental visit. The L-OVC is selected based on tooth location and size and therefore no impressions are necessary. The L-OVC is provided in designs for the upper and lower first and second premolars and second molars, and each design is provided in five (5) sizes (extra-small (XS), small (S), medium (M), large (L), and extra-large (XL)). The L-OVC is made from lithium disilicate and high-strength ceramic composite resin. The L-OVC is provided nonsterile for singlepatient, single-use only. Accessories to the L-OVC device include the L-OVC Replica, a replica of the ceramic occlusal portion of the L-OVC. The L-OVC Replica is used to confirm that sufficient occlusal clearance was obtained during tooth preparation and to provide direct visualization of the overall 3D position of the L-OVC on the prepared tooth and the relationship with adjacent and opposing dentition. The L-OVC Replica is manufactured from a thermoplastic elastomer resin. L-OVC Wedges are accessories provided in four configurations (small right, large left and large right), and are placed interproximally to create a working surface and to block out undercuts of the preparation. The Wedges are manufactured from polyacetal resin. The Selector Keys are accessories that allow the clinician to measure the mesial-distal distance in order to choose the appropriate size L-OVC for the restoration, and are used during the curing of the uncured resin to prevent disturbing the placement of the crown. The Selector Keys are manufactured from polycarbonate resin. All accessories are provided nonsterile for singlepatient, single-use only. The Class I accessories are provided for informational purposes only.
More Information

No
The device description and performance studies focus on the material properties and mechanical performance of a ceramic crown and its accessories. There is no mention of software, algorithms, or data processing that would indicate the use of AI/ML.

Yes
The device, a ceramic crown, is intended for the restoration of permanent teeth, which is a therapeutic intervention to treat structurally compromised teeth.

No

The device, L-OVC, is a ceramic crown intended for the restoration of permanent teeth. While some accessories assist in fit and selection (e.g., L-OVC Replica for clearance confirmation, Selector Keys for size measurement), their primary function is to facilitate the placement and customization of the restorative device, not to diagnose a disease or condition. Its purpose is treatment, not diagnosis.

No

The device description clearly states that the L-OVC is a ceramic crown made of physical materials (lithium disilicate, ceramic composite resin) and includes physical accessories (Replica, Wedges, Selector Keys). It is a physical medical device, not software.

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

Here's why:

  • Intended Use: The intended use is "restoration of permanent teeth with a single unit crown." This is a direct treatment or restoration of a physical structure within the body (a tooth).
  • Device Description: The device is a ceramic crown designed to be bonded to a prepared natural tooth. It's a physical implant/restoration.
  • Lack of Diagnostic Function: The device does not perform any tests on samples taken from the body (like blood, urine, tissue, etc.) to provide information for diagnosis, monitoring, or screening.
  • Accessories: The accessories (Replica, Wedges, Selector Keys) are tools used for fitting, placement, and preparation related to the physical crown, not for diagnostic testing.

IVD devices are specifically designed to examine specimens derived from the human body to provide information about a physiological state, health, disease, or congenital abnormality. The L-OVC device does not fit this description.

N/A

Intended Use / Indications for Use

L-OVC is intended for restoration of permanent teeth with a single unit crown.

Product codes

EIH

Device Description

The L-OVC is a ceramic crown, and includes an anatomic occlusal layer made of lithium disilicate, a thin priming/bonding layer that assists with bonding the occlusal layer to the sub-layer of uncured hybrid ceramic that allows for customization of the L-OVC to the specific tooth preparation. The customized L-OVC is bonded to the prepared natural tooth. The L-OVC is for restoring structurally compromised posterior teeth in cases normally restored with an onlay or a partial crown in a single dental visit. The L-OVC is selected based on tooth location and size and therefore no impressions are necessary. The L-OVC is provided in designs for the upper and lower first and second premolars and second molars, and each design is provided in five (5) sizes (extra-small (XS), small (S), medium (M), large (L), and extra-large (XL)). The L-OVC is made from lithium disilicate and high-strength ceramic composite resin. The L-OVC is provided nonsterile for singlepatient, single-use only.

Accessories to the L-OVC device include the L-OVC Replica, a replica of the ceramic occlusal portion of the L-OVC. The L-OVC Replica is used to confirm that sufficient occlusal clearance was obtained during tooth preparation and to provide direct visualization of the overall 3D position of the L-OVC on the prepared tooth and the relationship with adjacent and opposing dentition. The L-OVC Replica is manufactured from a thermoplastic elastomer resin. L-OVC Wedges are accessories provided in four configurations (small right, large left and large right), and are placed interproximally to create a working surface and to block out undercuts of the preparation. The Wedges are manufactured from polyacetal resin. The Selector Keys are accessories that allow the clinician to measure the mesial-distal distance in order to choose the appropriate size L-OVC for the restoration, and are used during the curing of the uncured resin to prevent disturbing the placement of the crown. The Selector Keys are manufactured from polycarbonate resin. All accessories are provided nonsterile for singlepatient, single-use only. The Class I accessories are provided for informational purposes only.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Permanent teeth, specifically upper and lower first and second premolars and second molars.

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)

Non-clinical testing data submitted, referenced, or relied upon to demonstrate substantial equivalence included: biocompatibility evaluation according to ISO 10993-1, 10993-5, 10993-6, 10993-10, 10993-11, and 10993-12; ceramic material flexural strength, solubility, and radioactivity characterization according to ISO 6872; and shelf life testing according to ASTM F1980.

No clinical data were included in this submission.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

K143694

Reference Device(s)

K100512, K090826, K123397

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 872.6660 Porcelain powder for clinical use.

(a)
Identification. Porcelain powder for clinical use is a device consisting of a mixture of kaolin, felspar, quartz, or other substances intended for use in the production of artificial teeth in fixed or removable dentures, of jacket crowns, facings, and veneers. The device is used in prosthetic dentistry by heating the powder mixture to a high temperature in an oven to produce a hard prosthesis with a glass-like finish.(b)
Classification. Class II.

0

Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo features a stylized caduceus symbol, which is a staff with two snakes entwined around it. The symbol is placed to the right of the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA", which is arranged in a circular fashion around the symbol.

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

December 21, 2016

Rhondium, Ltd % Kevin Thomas Vice President and Director Of Regulatory Affairs Paxmed International, LLC 12264 El Camino Real, Suite 400 San Diego, California 92130

Re: K162677

Trade/Device Name: L-OVC Regulation Number: 21 CFR 872.6660 Regulation Name: Porcelain Powder for Clinical Use Regulatory Class: Class II Product Code: EIH Dated: October 5, 2016 Received: October 6, 2016

Dear Kevin Thomas:

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 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

1

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.

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

DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known)

K162677

Device Name

L-OVC

Indications for Use (Describe)

L-OVC is intended for restoration of permanent teeth with a single unit crown.

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

X 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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Form Approved: OMB No. 0910-0120 Expiration Date: January 31, 2017 See PRA Statement below.

3

510(k) Summary Rhondium, Ltd L-OVC

December 15, 2016

ADMINISTRATIVE INFORMATION

| Manufacturer Name | Rhondium, Ltd
4 Sheffield Street
Katikati, 3129, New Zealand | | |
|---------------------------|-----------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------|--|
| | Telephone: | +64 7 549 5566 | |
| | Fax: | +64 7 549 5566 | |
| Official Contact | Greer Fricker
Regulatory Manager | | |
| Representative/Consultant | Kevin A. Thomas, PhD
Floyd G. Larson, MS, MBA
PaxMed International, LLC
12264 El Camino Real, Suite 400
San Diego, CA 92130 | | |
| | Telephone: | +1 (858) 792-1235 | |
| | Fax: | +1 (858) 792-1236 | |
| | Email: | kthomas@paxmed.com
flarson@paxmed.com | |

DEVICE NAME AND CLASSIFICATION

Trade/Proprietary NameL-OVC
Common NamePorcelain powder
Classification NamePorcelain powder for clinical use
Classification Regulations21 CFR 872.6660, Class II
Product CodeEIH
Classification Panel:Dental Products Panel
Reviewing Branch:Dental Devices Branch

PREDICATE DEVICE INFORMATION

Primary Predicate K143694, Rhondium One-Visit-Crown (OVC), Rhondium, Ltd

Reference Predicates K100512, NobelProcera IPS e.max Crown, Nobel Biocare AB K090826, Monobond Plus, Ivoclar Vivadent, Inc. K123397, Multilink Automix, Ivoclar Vivadent, AG

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INDICATIONS FOR USE

L-OVC is intended for restoration of permanent teeth with a single unit crown.

DEVICE DESCRIPTION

The L-OVC is a ceramic crown, and includes an anatomic occlusal layer made of lithium disilicate, a thin priming/bonding layer that assists with bonding the occlusal layer to the sub-layer of uncured hybrid ceramic that allows for customization of the L-OVC to the specific tooth preparation. The customized L-OVC is bonded to the prepared natural tooth. The L-OVC is for restoring structurally compromised posterior teeth in cases normally restored with an onlay or a partial crown in a single dental visit. The L-OVC is selected based on tooth location and size and therefore no impressions are necessary. The L-OVC is provided in designs for the upper and lower first and second premolars and second molars, and each design is provided in five (5) sizes (extra-small (XS), small (S), medium (M), large (L), and extra-large (XL)). The L-OVC is made from lithium disilicate and high-strength ceramic composite resin. The L-OVC is provided nonsterile for singlepatient, single-use only.

Accessories to the L-OVC device include the L-OVC Replica, a replica of the ceramic occlusal portion of the L-OVC. The L-OVC Replica is used to confirm that sufficient occlusal clearance was obtained during tooth preparation and to provide direct visualization of the overall 3D position of the L-OVC on the prepared tooth and the relationship with adjacent and opposing dentition. The L-OVC Replica is manufactured from a thermoplastic elastomer resin. L-OVC Wedges are accessories provided in four configurations (small right, large left and large right), and are placed interproximally to create a working surface and to block out undercuts of the preparation. The Wedges are manufactured from polyacetal resin. The Selector Keys are accessories that allow the clinician to measure the mesial-distal distance in order to choose the appropriate size L-OVC for the restoration, and are used during the curing of the uncured resin to prevent disturbing the placement of the crown. The Selector Keys are manufactured from polycarbonate resin. All accessories are provided nonsterile for singlepatient, single-use only. The Class I accessories are provided for informational purposes only.

PERFORMANCE DATA

Non-clinical testing data submitted, referenced, or relied upon to demonstrate substantial equivalence included: biocompatibility evaluation according to ISO 10993-1, 10993-5, 10993-6, 10993-10, 10993-11, and 10993-12; ceramic material flexural strength, solubility, and radioactivity characterization according to ISO 6872; and shelf life testing according to ASTM F1980.

No clinical data were included in this submission.

EQUIVALENCE TO MARKETED DEVICE

The subject device is substantially equivalent in indications and design principles to the predicate devices shown above. Below is a summary table comparing the Indications for Use statements and the technological characteristics of the subject device and the predicate devices.

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Comparison of Subject Device and Predicate Device Characteristics
Subject DevicePrimary Predicate DeviceReference Predicate Devices
ComparisonL-OVC
Rhondium LtdK143694
One-Visit-Crown (OVC)
Rhondium LtdK100512
NobelProcera IPS e.max
Crown
Nobel Biocare ABK090826
Monobond Plus
Ivoclar Vivadent, Inc.K123397
Multilink Automix
Ivoclar Vivadent, AG
Indications for
UseL-OVC is intended for
restoration of permanent teeth
with a single unit crown.Rhondium One-Visit-Crown
is intended for restoration of
permanent teeth with a single
unit crown.The NobelProcera IPS e.max
Crown is indicated for use as
core structures of crowns that
will be cemented to natural or
artificial tooth abutments in
the treatment of partially
edentulous patients as an aid
in prosthetic rehabilitation.Monobond Plus serves as
bonding agent and is used to
create a durable chemical
bond between luting
composites and glass/oxide
ceramic, metal, composite and
fiber-reinforced composite
restorations.Multilink Automix is used for
the permanent cementation of
indirect restorations where a
strong bond is desired: inlays,
onlays, crowns, bridges and
root posts made of:
• Metal and metal ceramics
• All-ceramics, in particular
opaque zirconium oxide
ceramics
• Composites and fibre-
reinforced composites
DescriptionPreformed single tooth crown
for one visit restorationPreformed single tooth crown
for one visit restorationLithium disilicate ceramic
intended for the fabrication of
crownsPrimer to promote adhesive
bonding between luting
composites and indirect
restorative materials (glass
and oxide ceramics, metal,
composites, fiber-reinforced
composites)Self-curing luting composite
with light-curing option for
adhesive luting of indirect
restorations made of metal,
metal-ceramic, all-ceramic
and composite
Teeth to be
RestoredUpper and lower premolars
and molarsUpper and lower premolars
and molarsn/an/an/a
Specific Crown
DesignsN=8
Upper Premolar, Upper Molar
Lower Premolar, Lower
Molar
Each in Left and Right
designsN=8
Upper Premolar, Upper Molar
Lower Premolar, Lower
Molar
Each in Left and Right
designsn/an/an/a
Crown SizesEach design in 5 sizes:
XS, S, M, L, XLEach design in 6 sizes:
XS, S, M, L, XL, XXLn/an/an/a
MaterialsCrown occlusal layer:
lithium disilicate ceramic
Primer/assist bonding:
Monobond Plus (K090826)
Multilink Automix (K123397)
Sub-layer bonded to prepared
tooth:
Light-cured polymer
composite resinCrown occlusal layer:
Light-cured polymer
composite resin (Ceramage,
K050401)
Primer/assist bonding:
Complete Unfilled Resin
(K052501)
Sub-layer bonded to prepared
tooth:
Light-cured polymer
composite resinLithium disilicate ceramicSilane methacrylate,
phosphoric acid methacrylate,
and sulfide methacrylateMonomer matrix (60%):
dimethacrylate and HEMA
(2-hydroxyethyl methacrylate)
Inorganic fillers (40%):
barium glass, ytterbium
trifluoride, spheroid mixed
oxide
Crown
Provisional
(Trial) MaterialThermoplastic elastomerVinyl polysiloxanen/an/an/a

The subject device and the primary predicate K143694 have similar Indications for Use statements.

The subject device and the primary predicate device have similar indications for use, the same intended use, and essentially the same designs for the individual crown components. The subject device comprises four materials: lithium disilicate substantially equivalent to the reference predicate K100512, polymer composite resin used in the same way as in the primary predicate K143694, and materials similar to those of the reference predicates K090826 and K123397. The subject device and the primary predicate device K143694 are provided in a range of designs and sizes to restore the premolars and molars of the upper and lower jaw. For the specific teeth that each device is designed to restore, both the subject device and the primary predicate device K143694 provide preformed anatomic occlusal surfaces.

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The subject device priming/bonding layer, which assists with bonding the occlusal layer to the sub-laver, consists of the reference predicate materials Monobond Plus (K090826) and Multilink Automix (K123397). The Monobond Plus and Multilink Automix materials are used in the subject device for their cleared indications and according to the manufacturer's instructions for use.

The subject device and the primary predicate device K143694 also both incorporate light-cured resin material as a sub-layer to conform to the shape of the prepared tooth, and to provide a customizable, single visit crown restoration. The subject device sub-layer (the crown surface bonded to the prepared tooth) is manufactured from a layer of uncured polymer composite resin to allow for customization and to assist with a cohesive fit of the crown to the prepared tooth. This is the same material used for the same purpose in the primary predicate K143694.

The design of the subject device occlusal layer and the design of the primary predicate device K143694 are essentially the same, except that the subject device has chamfered surfaces (on the apical aspects) and a slightly increased thickness. The chamfered surfaces and slightly increased thickness of the subject device occlusal layer are accommodated by the natural tooth preparation and the thickness of the uncured hybrid ceramic sub-layer. The subject device occlusal layer is made of lithium disilicate, the same intended use as the reference predicate device K100512. Performance testing of the subject device lithium disilicate material also was provided in this submission to support a determination of substantial equivalence.

The L-OVC accessory devices are substantially equivalent in terms of design and function to the predicate K 143694 accessory devices. The designs of the subject device L-OVC Replica are very similar to those of the predicate OVC Replica. The material for the L OVC Replica is different than that of the OVC Replica. To support a determination of substantial equivalence, biocompatibility testing of the L-OVC Replica material was provided in this submission.

CONCLUSION

The subject device and the predicate devices have the same intended use, have similar technological characteristics, and are made of similar materials. The subject device and the primary predicate devices encompass the same range of physical dimensions. The subject device and the predicate devices are packaged in similar materials and are provided nonsterile for single-patient, single-use only.

The data included in this submission demonstrate substantial equivalence to the predicate devices listed above.