K Number
K163613
Device Name
Bluephase Style 20i
Date Cleared
2017-04-04

(103 days)

Product Code
Regulation Number
872.6070
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
With its "Polywave" broadband spectrum, Bluephase® Style 20i is suitable for the polymerization of all light curing dental materials curing in the wavelength range of 385-515 nm. These materials include restoratives, bases, liners, fissure sealants, temporaries, as well as luting materials for brackets and indirect restorations, such as ceramic inlays.
Device Description
Bluephase® Style 20i is an LED polymerization light that produces energy-rich blue plight. It is used for the polymerization of light-curing dental materials immediately at the dental unit. It consists of 1 Polywave LED in the probe. - The handpiece has the shape of a pen Operational notes: 2 programs (Turbo, High Power) Light source: Polywave LED Power source: Li-Po battery
More Information

No
The document describes a standard LED polymerization light for dental materials and does not mention any AI or ML components or functionalities.

Yes
The device is used for the polymerization of light-curing dental materials, which is a therapeutic process in dentistry.

No
The device is an LED polymerization light used for curing dental materials, not for diagnosis.

No

The device description explicitly states it is an "LED polymerization light" and describes physical components like a handpiece, probe, and battery, indicating it is a hardware device with integrated software for controlling its function.

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

Here's why:

  • Intended Use: The intended use clearly states that the device is used for the "polymerization of all light curing dental materials". This is a process performed on materials used in the mouth, not a test performed on biological samples to diagnose a condition.
  • Device Description: The description details an LED polymerization light used "immediately at the dental unit". This further reinforces its use in a clinical dental setting for treating patients, not for laboratory testing of samples.
  • Lack of IVD Characteristics: The document does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Providing diagnostic information
    • Using reagents or assays
    • Measuring analytes

The device is a dental tool used for a specific procedure (curing dental materials), not for diagnosing diseases or conditions.

N/A

Intended Use / Indications for Use

With its "Polywave" broadband spectrum, Bluephase Style 20i is suitable for the polymerization of all light curing dental materials curing in the wavelength range of 385-515 nm. These materials include restoratives, bases, liners, fissure sealants, temporaries, as well as luting materials for brackets and indirect restorations, such as ceramic inlays.

Product codes

EBZ

Device Description

Bluephase® Style 20i is an LED polymerization light that produces energy-rich blue plight. It is used for the polymerization of light-curing dental materials immediately at the dental unit. It consists of 1 Polywave LED in the probe.

  • The handpiece has the shape of a pen
    Operational notes: 2 programs (Turbo, High Power)

Light source: Polywave LED

Power source: Li-Po battery

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

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

The product has been tested to IEC 60601-1:2005 and IEC 60601-1-2:2007 and meets the requirements for Electrical Safety, including US National Deviations, and Electromagnetic Compatibility. The Bluephase Style 20i was bench tested to assure the switch-off temperature of the heat sink functioned properly and found to meet the design specifications.

Key Metrics

Not Found

Predicate Device(s)

Bluephase 20i - K091020

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

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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Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is a stylized image of three human profiles facing right, stacked on top of each other, with a wing-like shape extending from the top profile.

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

April 4, 2017

Ivoclar Vivadent, AG % Donna Hartnett Director QA/ Regulatory Affairs Ivoclar Vivadent, Inc 175 Pineview Drive Amherst, New York 14228

Re: K163613

Trade/Device Name: Bluephase Style 20i Regulation Number: 21 CFR 872.6070 Regulation Name: Ultraviolet Activator For Polymerization Regulatory Class: Class II Product Code: EBZ Dated: January 4, 2017 Received: January 5, 2017

Dear Donna Hartnett:

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,
Susan Runner 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

Indications for Use

510(k) Number (if known)

Device Name Bluephase® Style 20i

Indications for Use (Describe)

With its "Polywave" broadband spectrum, Bluephase Style 20i is suitable for the polymerization of all light curing dental materials curing in the wavelength range of 385-515 nm. These materials include restoratives, bases, liners, fissure sealants, temporaries, as well as luting materials for brackets and indirect restorations, such as ceramic inlays.

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)

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Bluephase® Style 20i

Image /page/3/Picture/2 description: The image shows the logo for Ivoclar Vivadent, a dental company. The logo features the company name in a stylized font, with "Ivoclar" in a darker blue and "Vivadent" in a lighter blue. Above the company name is a series of green and blue dots, arranged in an arc. Below the company name is the company's slogan, "passion vision innovation", in a smaller, sans-serif font.

Contact:Donna Marie Hartnett
Company:Ivoclar Vivadent, AG
Bendererstrasse 2, Schaan, FL-9494, Liechtenstein
+423-235-3535
Date Prepared:December 19, 2016
Proprietary Name:Bluephase® Style 20i
Classification Name:Activator, Ultraviolet, for Poymerization 872.6070
(Classification Code EBZ)
Predicate Device:Bluephase 20i - K091020

Device Description: Bluephase® Style 20i is an LED polymerization light that produces energy-rich blue plight. It is used for the polymerization of light-curing dental materials immediately at the dental unit. It consists of 1 Polywave LED in the probe.

  • The handpiece has the shape of a pen
    Operational notes: 2 programs (Turbo, High Power)

Light source: Polywave LED

Power source: Li-Po battery

Indications for Use:

With its "Polywave" broadband spectrum, Bluephase® Style 20i is suitable for the polymerization of all light-curing dental materials curing in the wavelength range of 385-515 nm. These materials include restoratives, bonding agents/adhesives, bases, liners, fissure sealants, temporaries, as well as luting materials for brackets and indirect restorations, such as ceramic inlays.

Comparison to Predicate: Both dental curing lights are indicated for light curing of dental restoratives including bonding agents/adhesives, liners, fissure sealants, temporaries, as well as luting materials for brackets and indirect restorations, such as ceramic inlays. In the case of Bluephase® Style 20i, the design has 2 programs (Turbo, High Power).

4

Bluephase® Style 20i

Image /page/4/Picture/2 description: The image shows the logo for Ivoclar Vivadent. The logo is in blue and green, with the words "Ivoclar Vivadent" in a stylized font. Above the company name are a series of green and blue dots that form an arc. Below the company name are the words "passion vision innovation" in black.

Indications for UsePredicate device K091020Bluephase® Style 20i
IndicationsFor light curing polymerization of light-
curing dental materials curing in the
wavelength range of 385–515 nm.
These materials include restoratives,
bonding agents/
adhesives, bases, liners, fissure
sealants, temporary
materials as well as luting materials for
brackets and
indirect restorations such as ceramic
inlays.With its "Polywave"
broadband spectrum,
Bluephase Style 20i is
suitable for the polymerization
of all light-curing dental
materials curing in the
wavelength range of 385-515
nm. These materials include
restoratives, bonding
agents/adhesives, bases,
liners, fissure sealants,
temporaries, as well as luting
materials for brackets and
indirect restorations, such as
ceramic inlays.
Summary IndicationsBluephase® Style 20i is an LED polymerization light that produces
energy-rich blue light. It is used for the polymerization of light-curing
dental materials immediately at the dental unit. This is achieved using
the same technology as the predicate device Bluephase® 20i.
Furthermore, Bluephase® Style 20i features 2 programs instead of the 4
programs that are part of the predicates design.
Therefore, Bluephase® Style 20i is substantially equivalent to the
predicate device, Bluephase 20i® Plus.
Working Principle
Step-by-step:
  1. Disinfect contaminated surfaces of
    the curing light
    as well as light probes and anti-glare
    cones before
    each use.
  2. Make sure that the stipulated light
    intensity permits adequate
    polymerization. For that purpose,
    check the light probe for contamination
    and damage, as well as
    the light intensity at regular intervals.
  3. Select curing program and time
  4. Start: Once the selected curing time
    has elapsed,
    the curing program is automatically
    terminated. | Step-by-step:
  5. Disinfect contaminated
    surfaces of the curing light
    as well as light probes and
    anti-glare cones before
    each use.
  6. Make sure that the
    stipulated light intensity
    permits adequate
    polymerization. For that
    purpose, check the light probe
    for contamination and
    damage, as well as the light
    intensity at regular intervals.
  7. Select curing program and
    time
  8. Start: Once the selected
    curing time has elapsed,
    the curing program is
    automatically terminated. |
    | Summary Working
    Principle | No difference. | |
    | Summary Material
    Composition | No difference | |
    | Power Output | ☐650 mW/cm² (5 sec) then ramps to
    1,200 mW/cm² (10, 15, or 20 sec)
    ☐ Low – 650 mW/cm² (10, 15, or
    20 sec)
    ☐ High 1,200 mW/cm²(10, 15, or 20
    sec)
    ☐Turbo 2,000 mW/cm² (5 sec) | ☐ High 1,200 mW/cm² (10, 15,
    or 20 sec)
    ☐Turbo 2,000 mW/cm² (5
    Sec) |
    | Design styling | Wand Style | Gun style |
    | Electrical Safety | The product has been tested to IEC
    60601-1:2005 and IEC 60601-1-2:2007 | This product has been tested
    to IEC 60601-1-: 2005 and
    IEC 60601-1-2: 2007 |
    | Summary of Electrical
    Safety | Bluephase® Style 20i conforms to the current version of the same
    standards as the predicate device. | |

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Bluephase® Style 20i

Image /page/5/Picture/2 description: The image shows the logo for Ivoclar Vivadent. The logo is blue and green, with the words "ivoclar vivadent" in a stylized font. Above the words is a series of green and blue dots. Below the words is the tagline "passion vision innovation" in a smaller font.

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Bluephase® Style 20i

Image /page/6/Picture/2 description: The image is a logo for Ivoclar Vivadent. The words "Ivoclar Vivadent" are in blue, with "Ivoclar" on top of "Vivadent". Above the words are green and blue dots in an arc shape. Below the words is the phrase "passion vision innovation" in black.

Summary of Safety Testing:

The product has been tested to IEC 60601-1:2005 and IEC 60601-1-2:2007 and meets the requirements for Electrical Safety, including US National Deviations, and Electromagnetic Compatibility. The Bluephase Style 20i was bench tested to assure the switch-off temperature of the heat sink functioned properly and found to meet the design specifications.

Software Validation:

Bluephase Style 20i software/firmware has been fully validated and the device software meets its Design Specifications. FDA Guidance Document "Guidance for the Content of Premarket Submission for Software Contained in Medical Devices (May 11, 2005) has been followed in connection with the design of this device.

Biocompatibility:

The Bluephase Style 20i has been evaluated for biocompatibility and compared to the predicate device. No new issues of biocompatibility are related to the subject device as the construction materials are substantially the same.

Infection Control:

The device is sold in a non-sterile condition. Prior to use and after use sterilization of the light probe is recommended. The sterilization cycle recommended in the Instructions for Use have been validated according to DIN EN 556-1: Sterilization of a Medical Device and ISO 17665-2:2009. The curing light also is sold with plastic sleeves for infection control.

Conclusion:

Bluephase® Style 20i is a LED polymerization light that is used for the polymerization of lightcuring dental materials. This is achieved using the same operating principle and performance as the one used in Bluephase® 20i. Furthermore, Bluephase® Style 20i comes in a new wand shape design. The working steps and indications for use are the same as with Bluephase® 20i.

Therefore, Bluephase® Style 20i is substantially equivalent to the predicate device, Bluephase® 20i.