K Number
K163064
Device Name
Demi Ultra
Manufacturer
Date Cleared
2017-07-18

(258 days)

Product Code
Regulation Number
872.6070
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Demi Ultra is a Light Emitting Diode (LED) visible light curing device used for the polymerization of light-cured materials by dental professionals.
Device Description
The Demi Ultra is a Light Emitting Diode (LED) visible light curing device used for the polymerization of light-cured materials by dental professionals. The Demi Ultra consists of a handpiece, LED light curing attachment, and charging dock. The aluminum and plastic molded handpiece contains two (2) ultracapacitors (electric double-layer capacitors), printed circuit boards containing the electronics and user interface buttons, receptacle for retaining the LED light curing attachment, and receptacle for interfacing with the charging dock. The LED light curing attachment contains the curing LED, clear lens and two (2) copper head spreaders, all over molded in plastic. The charging dock contains printed circuit boards containing electronics to support charging the handpiece and built-in LED radiometer functionality. For the handpiece, a digital circuit and microprocessor is utilized to control three (3) different curing modes (5, 10 and 20 seconds). Each mode specifies LED curing output and optional audible beep timing. The handpiece uses one button to activate the LED curing output and another to select the curing time mode. For the charging dock, a digital circuit and microprocessor is utilized to monitor the charging of the handpiece ultracapacitors, as well as respond to light at the radiometer input by illuminating lights on a radiometer meter. Demi Ultra is required to be used with an FDA cleared barrier sleeve.
More Information

Not Found

No
The description details a device with a digital circuit and microprocessor controlling fixed curing modes based on user input. There is no mention of adaptive learning, pattern recognition, or any other characteristic typically associated with AI/ML.

No
The device is used for the polymerization of light-cured materials by dental professionals, which is a supportive function in a dental procedure rather than a direct therapeutic intervention.

No

This device is described as a light curing device used for the polymerization of light-cured dental materials. It does not perform any diagnostic functions. While it has an LED radiometer functionality, this is for checking the device's light output, not for diagnosing a patient's condition.

No

The device description explicitly details hardware components such as a handpiece, LED light curing attachment, charging dock, ultracapacitors, printed circuit boards, and an LED. While it mentions software validation, the device is fundamentally a hardware device with embedded software for control and functionality.

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

Here's why:

  • Intended Use: The intended use is for the polymerization of light-cured materials by dental professionals. This is a direct treatment or procedure performed on a patient, not a test performed on a sample taken from a patient.
  • Device Description: The description details a light-curing device used in a dental setting. It does not mention any components or functions related to analyzing biological samples.
  • Lack of IVD Characteristics: The description does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Providing diagnostic information about a patient's health status
    • Using reagents or assays

The Demi Ultra is a therapeutic device used in a clinical setting for a dental procedure.

N/A

Intended Use / Indications for Use

The Demi Ultra is a Light Emitting Diode (LED) visible light curing device used for the polymerization of light-cured materials by dental professionals.

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

EBZ

Device Description

The Demi Ultra is a Light Emitting Diode (LED) visible light curing device used for the polymerization of light-cured materials by dental professionals. The Demi Ultra consists of a handpiece, LED light curing attachment, and charging dock. The aluminum and plastic molded handpiece contains two (2) ultracapacitors (electric double-layer capacitors), printed circuit boards containing the electronics and user interface buttons, receptacle for retaining the LED light curing attachment, and receptacle for interfacing with the charging dock. The LED light curing attachment contains the curing LED, clear lens and two (2) copper head spreaders, all over molded in plastic. The charging dock contains printed circuit boards containing electronics to support charging the handpiece and built-in LED radiometer functionality. For the handpiece, a digital circuit and microprocessor is utilized to control three (3) different curing modes (5, 10 and 20 seconds). Each mode specifies LED curing output and optional audible beep timing. The handpiece uses one button to activate the LED curing output and another to select the curing time mode. For the charging dock, a digital circuit and microprocessor is utilized to monitor the charging of the handpiece ultracapacitors, as well as respond to light at the radiometer input by illuminating lights on a radiometer meter. Demi Ultra is required to be used with an FDA cleared barrier sleeve.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Visible light

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Dental professionals

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 following performance tests were completed during the product lifecycle:
Depth of Cure Irradiance with Light Intensity and Peak Wavelength per ISO 10650:2015 and ANSI/ADA 48-2:2010
Charge Time and Run Time
Biocompatibility per ISO 10993
Electromagnetic Compatibility (EMC) and Electrical Safety Testing per IEC 60601
Software Validation
A cleaning validation study on manual cleaning efficacy was performed on the worst case use conditions following the FDA Guidance: Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling
The nonclinical performance testing demonstrates that the Demi Ultra performs as well as the predicate device Demi Ultra.

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.

Demi Ultra (K123468)

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

§ 872.6070 Ultraviolet activator for polymerization.

(a)
Identification. An ultraviolet activator for polymerization is a device that produces ultraviolet radiation intended to polymerize (set) resinous dental pit and fissure sealants or restorative materials by transmission of light through a rod.(b)
Classification. Class II.

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

July 18, 2017

Kerr Corporation % Mohammad Ansari Regulatory Affairs Specialist II Sybron Dental Specialties 1717 W. Collins Ave Orange, California 92867

Re: K163064

Trade/Device Name: Demi Ultra Regulation Number: 21 CFR 872.6070 Regulation Name: Ultraviolet Activator For Polymerization Regulatory Class: Class II Product Code: EBZ Dated: June 27, 2017 Received: June 28, 2017

Dear Mohammad Ansari:

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

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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,

Mary S. Runner -A for Lori Wiggins Acting 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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Indications for Use

510(k) Number (if known) (Not yet assigned) K163064

Device Name

Demi Ultra

Indications for Use (Describe)

The Demi Ultra is a Light Emitting Diode (LED) visible light curing device used for the polymerization of light-cured materials by dental professionals.

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)

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510(k) SUMMARY FOR DEMI ULTRA

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Demi Ultra K163064

    1. Submitter Information: Sybron Dental Specialties 1717 W. Collins Ave. Orange CA, 92687
Contact Person:Mohammad Saad Ansari
Telephone Number:714-516-7334
Fax Number:909-962-5694
Date Prepared:July 13, 2017
    1. Device Name:
Classification NameUltraviolet activator for polymerization
Proprietary NameDemi Ultra
FDA CDRH PanelDental
Product CodeEBZ
Regulation Number872.6070
Class #II
    1. Predicate Device:
      The proposed Demi Ultra is substantially equivalent to the legally marketed device Demi Ultra (K123468) cleared on March 20, 2013, product code EBZ.
    1. Description of Device:
      The Demi Ultra is a Light Emitting Diode (LED) visible light curing device used for the polymerization of light-cured materials by dental professionals. The Demi Ultra consists of a handpiece, LED light curing attachment, and charging dock. The aluminum and plastic molded handpiece contains two (2) ultracapacitors (electric double-layer capacitors), printed circuit boards containing the electronics and user interface buttons, receptacle for retaining the LED light curing attachment, and receptacle for interfacing with the charging dock. The LED light curing attachment contains the curing LED, clear lens and two (2) copper head spreaders, all over molded in plastic. The charging dock contains printed circuit boards containing electronics to support charging the handpiece and built-in LED radiometer functionality. For the handpiece, a digital circuit and microprocessor is utilized to control three (3) different curing modes (5, 10 and 20 seconds). Each mode specifies LED curing output and optional audible beep timing. The

4

handpiece uses one button to activate the LED curing output and another to select the curing time mode. For the charging dock, a digital circuit and microprocessor is utilized to monitor the charging of the handpiece ultracapacitors, as well as respond to light at the radiometer input by illuminating lights on a radiometer meter. Demi Ultra is required to be used with an FDA cleared barrier sleeve.

  • న. Statement of Intended Use:
    The Demi Ultra is a Light Emitting Diode (LED) visible light curing device used for the polymerization of light-cured materials by dental professionals.

  • Indications For Use 6.
    The Demi Ultra is a Light Emitting Diode (LED) visible light curing device used for the polymerization of light-cured materials by dental professionals.

    1. Summary of Non-Clinical Performance Data:
      The technological characteristics of Demi Ultra are identical to the predicate Demi Ultra (K123468). The following performance tests were completed during the product lifecycle:

Depth of Cure Irradiance with Light Intensity and Peak Wavelength per ISO 10650:2015 and ANSI/ADA 48-2:2010 Charge Time and Run Time Biocompatibility per ISO 10993 Electromagnetic Compatibility (EMC) and Electrical Safety Testing per IEC 60601 Software Validation

A cleaning validation study on manual cleaning efficacy was performed on the worst case use conditions following the FDA Guidance: Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling

| Element | Predicate
Demi Ultra | Proposed
Demi Ultra |
|------------------------|---------------------------------|---------------------------------|
| 510(k) number | K123468 | K163064 |
| Trade Name | Demi Ultra | Demi Ultra |
| Product Classification | Class 2 | Class 2 |
| Product Code | EBZ | EBZ |
| Cordless | Yes | Yes |
| Light Source | LED | LED |
| Handpiece power source | 2 Ultracapacitors | 2 Ultracapacitors |
| AC supply connection | 100-240V AC, 1.0-0.5A, 50-60 Hz | 100-240V AC, 1.0-0.5A, 50-60 Hz |
| Operating time | 4 minutes | 4 minutes, 10 seconds |
| Recharge Time | 35 seconds, 60 seconds | 40 seconds, 70 seconds |
| Built-in radiometer | Yes | Yes |
| Microprocessor control | Yes (8-bit uc) | Yes (8-bit uc) |

    1. Summary of Technological Characteristics:

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3
ElementPredicate
Demi UltraProposed
Demi Ultra
Power status indicatorYesYes
Standard light guide8mm tapered8mm tapered
Reusable light guideYesYes
User replaceable
power sourceNoNo
Handpiece digital
displayNo (LED indicators)No (LED indicators)
User selectable
(operational) curing
modes(5, 10 & 20 seconds)(5, 10 & 20 seconds)
Cooling fanNoNo
Audible beepYesYes
Continuous curingYesYes
Handpiece MaterialValox 357UValox 357U
Charging Base
MaterialValox 357UValox 357U
LED Light
Attachment (LLA)HX215HPHX420HP
Light ShieldLexan 243R or Lexan 143Sumitomo SD2173M
Peak wavelength450-470 nm450-470 nm
Wavelength range @
50% (spectrum)438-485 nm438-485 nm
Typical output
intensity: 400-500
nm, using 8mm turbo
light guide1100mW/cm2 pulsed to
1330mW/cm21100mW/cm2 pulsed to 1330mW/cm2

9. Clinical Performance Data

Design Validation activities were performed as required per 21CFR820.30

10. Conclusion as to Substantial Equivalence

The modifications made to Demi Ultra do not affect the intended use of the device, indications for use, or alter the fundamental scientific technology of the device. The technological characteristics of the subject device Demi Ultra are very similar to the predicate Demi Ultra (K123468). The proposed Demi Ultra has similarities in select performance characteristics and all design features as compared to the predicate. The nonclinical performance testing demonstrates that the Demi Ultra performs as well as the predicate device Demi Ultra. Demi Ultra is indicated to be used with a FDA cleared barrier sleeve. Based on biocompatibility studies, identical intended use and indications for use, and performance characteristics, the Demi Ultra is substantially equivalent to the predicate Demi Ultra (K123468).