K Number
K170692
Device Name
Respire Pink Series with DentiTrac
Date Cleared
2017-05-26

(80 days)

Product Code
Regulation Number
872.5570
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Respire Pink Series intraoral appliances are intended to treat snoring and mild to moderate Obstructive Sleep Apnea (OSA) in adult patients 18 years of age or older. Optionally, the DentiTrac® micro-recorder may be incorporated into a Respire Pink Series device. The micro-recorder is intended to measure patient compliance to oral appliance therapy in combination with the DentiTrac® system.
Device Description
The Respire Pink Series with DentiTrac® refers to two devices: Respire Pink Series-Herbst and the Respire Pink Series-Herbst-EF, herein referred to collectively as Respire Pink Series. These devices function as mandibular advancement splints which hold the jaw in a forward position. The forward jaw placement moves the tongue and pharyngeal tissue into a position to help maintain an open airway, which allows the passage of more air per breath and helps in the treatment of snoring and mild to moderate Obstructive Sleep Apnea (OSA). Respire Pink Series appliances are customizable devices which are produced according to the individual patient anatomy and prescription. The Respire Pink Series-Herbst consists of full hard acrylic upper and lower fitting surfaces, and the Respire Pink Series-Herbst-EF consists of hard acrylic fitting side plates and chrome (BEGO Wironit®) upper palatal and lower lingual plates. The Herbst hardware on the side of the device allows for forward and lateral jaw movement while restricting backward jaw movement, and allows the patient to open and close the mouth. The Herbst hardware contains an expansion screw for mandibular position adjustment, and is attached to the appliance using medical grade stainless steel fixing elements and screws. This submission is to provide clinicians the option to incorporate a Braebon DentiTrac® micro-recorder into a Respire Pink Series device. The micro-recorder is encapsulated in Loctite epoxy and fully encased into the device acrylic, and is not patient contacting. The micro-recorder is utilized to track patient compliance to prescribed oral appliance therapy by collecting data for wear-time through oral temperature, movement tracking, and head position. The data can be uploaded to a cloud-based web application using the DeniTrac® system which allows clinicians to review the patient data. The inclusion of the microrecorder provides additional treatment information to clinicians without effecting the operating principles of the Respire Pink Series devices.
More Information

No
The summary describes a mechanical oral appliance and a data logger for compliance tracking. There is no mention of AI or ML in the device description, intended use, or performance studies.

Yes
The device is intended to treat snoring and mild to moderate Obstructive Sleep Apnea (OSA) in adult patients, and its function involves physically manipulating the jaw and pharyngeal tissue to help maintain an open airway, which directly addresses a medical condition.

No.

The device is intended to treat snoring and mild to moderate Obstructive Sleep Apnea (OSA) and to measure patient compliance to oral appliance therapy. It does not diagnose medical conditions.

No

The device is primarily a physical intraoral appliance (mandibular advancement splint) with optional hardware (micro-recorder) incorporated. While it utilizes software for data collection and analysis, the core device is not software-only.

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

Here's why:

  • Intended Use: The primary intended use is to treat snoring and mild to moderate Obstructive Sleep Apnea (OSA) by physically repositioning the jaw. The optional micro-recorder measures patient compliance (wear time), not a biological sample or physiological state for diagnosis.
  • Device Description: The device is a physical appliance that mechanically alters the airway. While it collects data, this data is related to the device's usage, not a diagnostic measurement from a biological sample.
  • No mention of biological samples: The description does not indicate that the device interacts with or analyzes any biological samples (blood, urine, tissue, etc.), which is a key characteristic of IVDs.
  • No diagnostic claims: The device is intended for treatment and compliance monitoring, not for diagnosing a disease or condition.

The DentiTrac® micro-recorder, while collecting data, is focused on monitoring the use of the oral appliance, not on providing diagnostic information about the patient's underlying condition.

N/A

Intended Use / Indications for Use

The Respire Pink Series intraoral appliances are intended to treat snoring and mild to moderate Obstructive Sleep Apnea (OSA) in adult patients 18 years of age or older.

Optionally, the DentiTrac® micro-recorder may be incorporated into a Respire Pink Series device. The micro-recorder is intended to measure patient compliance to oral appliance therapy in combination with the DentiTrac® system.

Product codes

PLC

Device Description

The Respire Pink Series with DentiTrac® refers to two devices: Respire Pink Series-Herbst and the Respire Pink Series-Herbst-EF, herein referred to collectively as Respire Pink Series. These devices function as mandibular advancement splints which hold the jaw in a forward position. The forward jaw placement moves the tongue and pharyngeal tissue into a position to help maintain an open airway, which allows the passage of more air per breath and helps in the treatment of snoring and mild to moderate Obstructive Sleep Apnea (OSA). Respire Pink Series appliances are customizable devices which are produced according to the individual patient anatomy and prescription.

The Respire Pink Series-Herbst consists of full hard acrylic upper and lower fitting surfaces, and the Respire Pink Series-Herbst-EF consists of hard acrylic fitting side plates and chrome (BEGO Wironit®) upper palatal and lower lingual plates. The Herbst hardware on the side of the device allows for forward and lateral jaw movement while restricting backward jaw movement, and allows the patient to open and close the mouth. The Herbst hardware contains an expansion screw for mandibular position adjustment, and is attached to the appliance using medical grade stainless steel fixing elements and screws.

This submission is to provide clinicians the option to incorporate a Braebon DentiTrac® micro-recorder into a Respire Pink Series device. The micro-recorder is encapsulated in Loctite epoxy and fully encased into the device acrylic, and is not patient contacting. The micro-recorder is utilized to track patient compliance to prescribed oral appliance therapy by collecting data for wear-time through oral temperature, movement tracking, and head position. The data can be uploaded to a cloud-based web application using the DeniTrac® system which allows clinicians to review the patient data. The inclusion of the microrecorder provides additional treatment information to clinicians without effecting the operating principles of the Respire Pink Series devices.

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

adult patients 18 years of age or older.

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 performance testing:

The addition of the DentiTrac® micro-recorder does not adversely affect the original design, therefore, not introducing any new issues of concern. A risk assessment shows that risks are mitigated to acceptable levels, and performance testing related to the DentiTrac® microrecorder confirms that EMC and electrical safety, biocompatibility, and software elements were evaluated. DentiTrac® performance testing is located in the Braebon DentiTrac® Master File MAF 2557. Process validation concerning the incorporation and functionality of the DentiTrac® micro-recorder is certified by Braebon. Respire Medical performs 100% visual and functional inspections throughout the production process to ensure that the device meets manufacturing specifications for the Respire Pink Series device and specifications for the incorporation of the DentiTrac® micro-recorder.

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

Not Found

Predicate Device(s)

K150369, K131138, K150572

Reference Device(s)

K131138, K150572

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 872.5570 Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea.

(a)
Identification. Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea are devices that are worn during sleep to reduce the incidence of snoring and to treat obstructive sleep apnea. The devices are designed to increase the patency of the airway and to decrease air turbulence and airway obstruction. The classification includes palatal lifting devices, tongue retaining devices, and mandibular repositioning devices.(b)
Classification. Class II (special controls). The special control for these devices is the FDA guidance document entitled “Class II Special Controls Guidance Document: Intraoral Devices for Snoring and/or Obstructive Sleep Apnea; Guidance for Industry and FDA.”

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Image /page/0/Picture/2 description: The image is a circular seal for the Department of Health & Human Services - USA. The seal features the department's logo, which is a stylized representation of three human profiles facing right, stacked on top of each other. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged around the upper half of the circle, following its curvature.

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

May 26, 2017

Respire Medical Holding Mr. Jonathan Sandler Ouality Assurance Manager 18 Bridge Street. Suite 4i Brooklyn. New York 11201

Re: K170692

Trade/Device Name: Respire Pink Series With DentiTrac® Regulation Number: 21 CFR 872.5570 Regulation Name: Intraoral Devices For Snoring And Intraoral Devices For Snoring And Obstructive Sleep Apnea Regulatory Class: Class II Product Code: PLC Dated: March 7, 2017 Received: March 7, 2017

Dear Jonathan Sandler:

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

1

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 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" (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.

Lori A. Wiggins -S6

for

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) K170692

Device Name Respire Pink Series with DentiTrac®

Indications for Use (Describe)

The Respire Pink Series intraoral appliances are intended to treat snoring and mild to moderate Obstructive Sleep Apnea (OSA) in adult patients 18 years of age or older.

Optionally, the DentiTrac® micro-recorder may be incorporated into a Respire Pink Series device. The micro-recorder is intended to measure patient compliance to oral appliance therapy in combination with the DentiTrac® system.

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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Image /page/3/Picture/0 description: The image shows the logo for Respire Medical. The logo features a stylized figure with outstretched arms above a green and white structure, all enclosed within a circle. Below the circle, the words "Respire Medical" are written in an elegant, cursive font.

510(k) Summary

510(k) Submission Number: K170692

Submitter

Respire Medical 18 Bridge Street, Suite 4J Brooklyn, NY 11201 Phone: 718-643-7326

Official Contact:

Jonathan Sandler Quality Assurance Manager Phone: 718-360-9209 Email: Jonathan@respiremedical.com

Date Prepared:

May 16, 2017

Device Identification

Proprietary Name:Respire Pink Series with DentiTrac®
Common Name:Device, Anti-Snoring
Classification Name:Intraoral devices for snoring and intraoral devices for snoring
and obstructive sleep apnea
Device Classification:Class II
Product Code:PLC
Regulation Number:21 CFR 872.5570

Predicate Devices

CandidatePredicateManufacturer510(k) Number
Respire Pink Series
with DentiTrac®SomnoDent® with Micro-RecorderSomnoMed, Inc.K150369
Respire Pink Series-HerbstRespire Medical, LLCK131138
Respire Pink Series-Herbst-EFRespire Medical, LLCK150572

The primary predicate device used for substantial equivalence is the SomnoMed SomnoDent® with Micro-Recorder. The reference predicate devices are the Respire Pink Series-Herbst devices which includes both the standard Respire Pink Series-Herbst device and the Respire Pink Series-Herbst-EF.

Device Description

The Respire Pink Series with DentiTrac® refers to two devices: Respire Pink Series-Herbst and the Respire Pink Series-Herbst-EF, herein referred to collectively as Respire Pink Series. These devices function as mandibular advancement splints which hold the jaw in a forward

4

Image /page/4/Picture/0 description: The image shows the logo for Respire Medical. The logo features a person with their arms outstretched above a green structure, all enclosed in a circle. Below the circle, the words "Respire Medical" are written in an elegant, cursive font.

position. The forward jaw placement moves the tongue and pharyngeal tissue into a position to help maintain an open airway, which allows the passage of more air per breath and helps in the treatment of snoring and mild to moderate Obstructive Sleep Apnea (OSA). Respire Pink Series appliances are customizable devices which are produced according to the individual patient anatomy and prescription.

The Respire Pink Series-Herbst consists of full hard acrylic upper and lower fitting surfaces, and the Respire Pink Series-Herbst-EF consists of hard acrylic fitting side plates and chrome (BEGO Wironit®) upper palatal and lower lingual plates. The Herbst hardware on the side of the device allows for forward and lateral jaw movement while restricting backward jaw movement, and allows the patient to open and close the mouth. The Herbst hardware contains an expansion screw for mandibular position adjustment, and is attached to the appliance using medical grade stainless steel fixing elements and screws.

This submission is to provide clinicians the option to incorporate a Braebon DentiTrac® micro-recorder into a Respire Pink Series device. The micro-recorder is encapsulated in Loctite epoxy and fully encased into the device acrylic, and is not patient contacting. The micro-recorder is utilized to track patient compliance to prescribed oral appliance therapy by collecting data for wear-time through oral temperature, movement tracking, and head position. The data can be uploaded to a cloud-based web application using the DeniTrac® system which allows clinicians to review the patient data. The inclusion of the microrecorder provides additional treatment information to clinicians without effecting the operating principles of the Respire Pink Series devices.

Image /page/4/Picture/4 description: The image shows two figures of the Respire Pink Series with DentiTrac. Figure 1 shows a front view of the dental device, which is pink and has metal components. Figure 2 shows a side view of the same device, highlighting the DentiTrac component.

Intended Use

The Respire Pink Series intraoral appliances are intended to treat snoring and mild to moderate Obstructive Sleep Apnea (OSA) in adult patients 18 years of age or older.

Optionally, the DentiTrac® micro-recorder may be incorporated into a Respire Pink Series device. The micro-recorder is intended to measure patient compliance to oral appliance therapy in combination with the DentiTrac® system.

5

Image /page/5/Picture/0 description: The image shows the logo for Respire Medical. The logo features a circular emblem with a stylized figure with outstretched arms above a green structure, possibly representing a medical facility or a person in a relaxed pose. Below the emblem, the words "Respire Medical" are written in an elegant, cursive font, emphasizing the brand's name and suggesting a focus on respiratory health or well-being.

Comparison to Predicate Devices:

SubstantialProposed:Primary Predicate:Reference Predicate:
Equivalence TopicRespire Pink Series withSomnoMedRespire Pink Series-
DentiTrac®SomnoDent® withHerbst / Pink Series-
Micro-RecorderHerbst-EF
510(k)N/AK150369K131138 /
K150572 (EF)
Company NameRespire MedicalSomnoMedRespire Medical
Device NameDevice, Anti-SnoringDevice, Anti-SnoringDevice, Anti-Snoring
Indications for UseThe Respire Pink Series intraoral
appliances are indented to treatThe SomnoDent Intraoral devices
are intended for the treatment ofThe Respire Pink Series-Herbst is
indicated to treat mild to
Statementsnoring and mild to moderatenight time snoring and mild tomoderate OSA.
Obstructive Sleep Apnea (OSA) inmoderate obstructive sleep
adult patients 18 years of age or
older.apnea in patients 18 years of age
or olderThe Respire Pink Series-Herbst-EF
is indicated to treat mild to
moderate OSA.
Optionally, the DentiTrac micro-
recorder may be incorporatedOptionally, if the DentiTrac micro-
recorder is completely embedded
into a Respire Pink Series device.into the SomnoDent device, the
The micro-recorder is intended tomicro-recorder is intended to
measure patient compliance to
oral appliance therapy inmeasure patient compliance to
oral device/appliance therapy in
combination with the DentiTraccombination with the DentiTrac
Intended Usesystem.System.
Intended as anYesYesYes
intraoral device
Intended to reduceYesYesYes
snoring or help
alleviate snoring
Intended for nightYesYesYes
time use
Indicated for singleYesYesYes
patient multiuse
Indicated for use atYesYesYes
home or sleep
laboratories
Design
Separate upper andYesYesYes
lower tray pieces
Works by mandibularYesYesYes
advancement
Can be adjusted orYesYesYes
refit
Lower jaw adjustmentYesYesYes
using supplied
components
Permits patient toYesYesYes
breathe through
mouth
Upper and lower trays
disengage for easy
removalYesYesYes
Cleaned and inspected
daily by patientYesYesYes
Materials
Advancement
mechanism: surgical
grade stainless steelYesYesYes
Acrylic fitting surfaceYesYesYes
Acrylic/Wironit®
fitting surfacesYes (EF)NoYes (EF)
Micro-Recorder
embedded into
deviceYesYesNo

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Image /page/6/Picture/0 description: The image shows the logo for Respire Medical. The logo features a circle with a person with their arms raised above a green bridge. Below the circle is the text "Respire Medical" in a cursive font.

Performance Testing

Non-clinical performance testing:

The addition of the DentiTrac® micro-recorder does not adversely affect the original design, therefore, not introducing any new issues of concern. A risk assessment shows that risks are mitigated to acceptable levels, and performance testing related to the DentiTrac® microrecorder confirms that EMC and electrical safety, biocompatibility, and software elements were evaluated. DentiTrac® performance testing is located in the Braebon DentiTrac® Master File MAF 2557. Process validation concerning the incorporation and functionality of the DentiTrac® micro-recorder is certified by Braebon. Respire Medical performs 100% visual and functional inspections throughout the production process to ensure that the device meets manufacturing specifications for the Respire Pink Series device and specifications for the incorporation of the DentiTrac® micro-recorder.

Discussion of Similarities and Differences Between the Subject and Predicate Devices

The Respire Pink Series predicate devices (K131138 and K150572) are identical to the Respire Pink Series with DentiTrac® candidate device apart from the addition of the DentiTrac® micro-recorder. The general characteristics and specifications are unchanged in that each devices utilizes the same materials, manufacturing procedures, principles of operation, and overall design. The DentiTrac® micro-recorder used in the Respire Pink Series with DentiTrac® is identical to that which is used in the SomnoDent® (K150369) predicate device, and the indications for use are similar between the two devices. However, the age population has been added which is not present on K131138 and K150572 predicates.

Conclusion

Based on the similarities in the indications for use, technology, biocompatibility assessment, and non-clinical performance testing, Respire Pink Series with DentiTrac® is substantially equivalent to the SomnoMed SomnoDent® with Micro-Recorder and the Respire Pink Series predicate devices.