K Number
K172352
Device Name
TREFOIL System
Manufacturer
Date Cleared
2017-10-20

(78 days)

Product Code
Regulation Number
872.3640
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The TREFOIL System is used to restore chewing function in fully edentulous mandibles. The three implants of the TREFOIL System are placed between the mental foramina in fully edentulous mandibles in a 1-stage surgical technique combined with an immediate function loading protocol, provided sufficient primary stability for the selected technique is achieved. In cases where sufficient primary stability for two implants or more is not reached, the implants along with the Framework may also be used with an early or delayed loading protocol. The following prerequisites must be fulfilled: - Adequate quantity of bone (minimum height of 13 mm for 11.5 mm implant and 14.5 mm for 13.0 implant and minimum width of 6-7 mm). - Adequate mouth opening (minimum 40 mm) to accommodate the guided surgery instruments. - Implant-supported prosthetics seated directly on dedicated implants
Device Description
The TREFOIL System is a method of placing three dental implants in predetermined positions (between the mental foramina) and using a pre-designed prosthetic bar to act as a screw-retained framework seated on the implants. The TREFOIL System restores chewing function and esthetics in the mandible in completely edentulous patients. The TREFOIL System consists of dental implants, surgical components necessary to place the implants in predetermined positions, and prosthetic components that are included in the prosthetic bar or are used in the dental lab during the creation of the prosthetic bar. The Trefoil Implants are made of CP4 titanium. The implants are parallel walled and have an internal conical abutment connection. The implants have a 13.0 mm threaded portion and are available with both a 4.5 and 6.0 mm collar height. The apex of the implants have cutting chambers allowing for self-tapping. The implant bone interface has the TiUnite implant surface treatment.
More Information

No
The description focuses on the mechanical components and surgical technique of a dental implant system. There is no mention of AI or ML in the intended use, device description, or performance studies.

Yes
The device is used to restore chewing function, which addresses a physiological condition and improves health.

No

The provided text explicitly states the TREFOIL System is "used to restore chewing function in fully edentulous mandibles" and "restores chewing function and esthetics". There is no mention of it being used to diagnose a condition or disease.

No

The device description explicitly states that the TREFOIL System consists of dental implants, surgical components, and prosthetic components, which are all hardware.

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

Here's why:

  • Intended Use: The intended use is to "restore chewing function in fully edentulous mandibles" by placing dental implants and a prosthetic framework. This is a surgical and prosthetic procedure performed directly on the patient's body.
  • Device Description: The device consists of dental implants, surgical components, and prosthetic components. These are physical devices used for implantation and restoration within the body.
  • Lack of IVD Characteristics: IVD devices are used to examine specimens derived from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening. The TREFOIL System does not involve the analysis of such specimens.

Therefore, the TREFOIL System falls under the category of a medical device used for surgical and prosthetic purposes, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The TREFOIL System is used to restore chewing function in fully edentulous mandibles.

The three implants of the TREFOIL System are placed between the mental foramina in fully edentulous mandibles in a 1-stage surgical technique combined with an immediate function loading protocol, provided sufficient primary stability for the selected technique is achieved. In cases where sufficient primary stability for two implants or more is not reached, the implants along with the Framework may also be used with an early or delayed loading protocol.

The following prerequisites must be fulfilled:

  • Adequate quantity of bone (minimum height of 13 mm for 11.5 mm implant and 14.5 mm for 13.0 implant and minimum width of 6-7 mm).
  • Adequate mouth opening (minimum 40 mm) to accommodate the guided surgery instruments.
  • Implant-supported prosthetics seated directly on dedicated implants

Product codes

DZE

Device Description

The TREFOIL System is a method of placing three dental implants in predetermined positions (between the mental foramina) and using a pre-designed prosthetic bar to act as a screw-retained framework seated on the implants. The TREFOIL System restores chewing function and esthetics in the mandible in completely edentulous patients.

The TREFOIL System consists of dental implants, surgical components necessary to place the implants in predetermined positions, and prosthetic components that are included in the prosthetic bar or are used in the dental lab during the creation of the prosthetic bar.

The Trefoil Implants are made of CP4 titanium. The implants are parallel walled and have an internal conical abutment connection. The implants have a 13.0 mm threaded portion and are available with both a 4.5 and 6.0 mm collar height. The apex of the implants have cutting chambers allowing for self-tapping. The implant bone interface has the TiUnite implant surface treatment.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

fully edentulous mandibles

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)

Summary of Non-Clinical Testing:
Since the subject device does not represent a new worst case, data from the predicate device was leveraged in the following aspects of the 510(k).

  • Sterile Device Information
    • The sterilization method for the subject device is the same as the primary predicate (K152836). The sterilization method is Gamma radiation and has been validated in accordance with ANSI/AAMI/ISO 11137. Therefore, no additional testing was required.
  • Device Packaging
    • The packaging for the subject device is the same as the primary predicate (K152836). This is a plastic vial with PVC shrink-wrap cap. Therefore, no additional testing was required.
  • Shelf Life
    • The packaging for the subject device is the same as the primary predicate (K152836) and is labeled with a 5 year expiration date. Real time aging was used to determine the expiration dating. Therefore, no additional testing was required.
  • Biocompatibility
    • The subject device is manufactured from the same material as the primary predicate (K152836), uses the same manufacturing method as the primary predicate, has the same intended use, and the same patient contact type and duration as the primary predicate. Therefore, no additional testing was required.
  • Fatigue Testing
    • The subject device differs from the predicate (K152836) in length only and fatigue testing has been included in K152836. No modification has been made to the implant/abutment connection and no new worst scenario identified. Therefore, no additional fatigue testing was required.

No clinical data was used to support the decision of safety and effectiveness.

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

Not Found

Predicate Device(s)

K152836, K170135

Reference Device(s)

K170135

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 872.3640 Endosseous dental implant.

(a)
Identification. An endosseous dental implant is a prescription device made of a material such as titanium or titanium alloy that is intended to be surgically placed in the bone of the upper or lower jaw arches to provide support for prosthetic devices, such as artificial teeth, in order to restore a patient's chewing function.(b)
Classification. (1) Class II (special controls). The device is classified as class II if it is a root-form endosseous dental implant. The root-form endosseous dental implant is characterized by four geometrically distinct types: Basket, screw, solid cylinder, and hollow cylinder. The guidance document entitled “Class II Special Controls Guidance Document: Root-Form Endosseous Dental Implants and Endosseous Dental Implant Abutments” will serve as the special control. (See § 872.1(e) for the availability of this guidance document.)(2)
Classification. Class II (special controls). The device is classified as class II if it is a blade-form endosseous dental implant. The special controls for this device are:(i) The design characteristics of the device must ensure that the geometry and material composition are consistent with the intended use;
(ii) Mechanical performance (fatigue) testing under simulated physiological conditions to demonstrate maximum load (endurance limit) when the device is subjected to compressive and shear loads;
(iii) Corrosion testing under simulated physiological conditions to demonstrate corrosion potential of each metal or alloy, couple potential for an assembled dissimilar metal implant system, and corrosion rate for an assembled dissimilar metal implant system;
(iv) The device must be demonstrated to be biocompatible;
(v) Sterility testing must demonstrate the sterility of the device;
(vi) Performance testing to evaluate the compatibility of the device in a magnetic resonance (MR) environment;
(vii) Labeling must include a clear description of the technological features, how the device should be used in patients, detailed surgical protocol and restoration procedures, relevant precautions and warnings based on the clinical use of the device, and qualifications and training requirements for device users including technicians and clinicians;
(viii) Patient labeling must contain a description of how the device works, how the device is placed, how the patient needs to care for the implant, possible adverse events and how to report any complications; and
(ix) Documented clinical experience must demonstrate safe and effective use and capture any adverse events observed during clinical use.

0

DEPARTMENT OF HEALTH & HUMAN SERVICES

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 to the right, with the profiles overlapping and connected by flowing lines.

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

October 20, 2017

Nobel Biocare AB Charlemagne Chua Senior Regulatory Affairs Manager Nobel Biocare USA LLC 22715 Savi Ranch Parkway Yorba Linda, California 92887

Re: K172352

Trade/Device Name: TREFOIL System Regulation Number: 21 CFR 872.3640 Regulation Name: Endosseous Dental Implant Regulatory Class: Class II Product Code: DZE Dated: August 2, 2017 Received: August 3, 2017

Dear Charlemagne Chua:

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.

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 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 (DICE) 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 (DICE) 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 -S

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

DEPARTMENT OF HEALTH AND HUMAN SERVICESForm Approved: OMB No. 0910-0120
Food and Drug AdministrationExpiration Date: January 31, 2017
See PRA Statement below.
510(k) Number (if known)K172352
Device NameTREFOIL System
Indications for Use (Describe)The TREFOIL System is used to restore chewing function in fully edentulous mandibles.
The three implants of the TREFOIL System are placed between the mental foramina in fully edentulous mandibles in a 1- stage surgical technique combined with an immediate function loading protocol, provided sufficient primary stability for the selected technique is achieved. In cases where sufficient primary stability for two implants or more is not reached, the implants along with the Framework may also be used with an early or delayed loading protocol.
The following prerequisites must be fulfilled:
- Adequate quantity of bone (minimum height of 13 mm for 11.5 mm implant and 14.5 mm for 13.0 implant and minimum width of 6-7 mm).
- Adequate mouth opening (minimum 40 mm) to accommodate the guided surgery instruments.
- Implant-supported prosthetics seated directly on dedicated implants
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)

PLEASE DO NOT WRITE BELOW THIS LINE – CONTINUE ON A SEPARATE PAGE IF NEEDED.

FOR FDA USE ONLY

Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

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 Drug 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."

FORM FDA 3881 (1/14)Page 1 of 1PSC Publishing Services (301) 443-6740EF
-------------------------------------------------------------------------------

ພອງຣຽວ ອັນນາ ແລະ ແລະ ແລະ ສອນສາ

3

I. SUBMITTER

Nobel Biocare AB Vastra Hamngatan 1 Goteborg, SE-411 17 Sweden

Submitted by Nobel Biocare USA LLC 22715 Savi Ranch Parkway Yorba Linda, CA 92887

Contact Person: Charlemagne Chua, Senior Regulatory Affairs Manager Phone: (714) 282-4800 x 7830 Fax: (714) 998-9348

Date Prepared: October 19, 2017

II. DEVICE

Name of Device: TREFOIL System Common or Usual Name: Endosseous Dental Implant Classification Name: Endosseous Dental Implant (21 CFR 872.3640) Regulatory Class: II Primary Product Code: DZE

III. PREDICATE DEVICE

Primary predicate: Nobel Biocare - TREFOIL System (K152836) This predicate has not been subject to a design-related recall.

Reference predicate: Nobel Biocare - TREFOIL System (K170135) This predicate has not been subject to a design-related recall

IV. DEVICE DESCRIPTION

The TREFOIL System is a method of placing three dental implants in predetermined positions (between the mental foramina) and using a pre-designed prosthetic bar to act as a screw-retained framework seated on the implants. The TREFOIL System restores chewing function and esthetics in the mandible in completely edentulous patients.

The TREFOIL System consists of dental implants, surgical components necessary to place the implants in predetermined positions, and prosthetic components that are included in the prosthetic bar or are used in the dental lab during the creation of the prosthetic bar.

The Trefoil Implants are made of CP4 titanium. The implants are parallel walled and have an internal conical abutment connection. The implants have a 13.0 mm threaded portion and are available with both a 4.5 and 6.0 mm collar height. The apex of the implants have cutting

A.4.

4

chambers allowing for self-tapping. The implant bone interface has the TiUnite implant surface treatment.

V. INDICATIONS FOR USE

The TREFOIL System is used to restore chewing function in fully edentulous mandibles.

The three implants of the Trefoil Implants are placed between the mental foramina in fully edentulous mandibles in a 1-stage surgical technique combined with an immediate function loading protocol, provided sufficient primary stability for the selected technique is achieved. In cases where sufficient primary stability for two implants or more is not reached, the implants along with the Framework may also be used with an early or delayed loading protocol.

The following prerequisites must be fulfilled:

-Adequate quantity of bone (minimum height of 13 mm implant and 14.5 mm for 13.0 implant and minimum width of 6-7 mm).

-Adequate mouth opening (minimum 40 mm) to accommodate the guided surgery instruments. -Implant-supported prosthetics seated directly on dedicated implants

5

Comparison of Technological Characteristics VI.

Comparison of intended use and indication for use statement

TechnologicalSubject DevicePrimary PredicateReference Predicate
characteristicsTREFOIL SystemTREFOIL System (K152836)TREFOIL System (K170135)
Intended useThe TREFOIL System is intended for the
intraoral treatment of totally edentulous
mandibles by providing anchorage of the
framework in order to restore chewing
function and esthetics. By the aid of the
surgical components (guides and templates
etc.) three implants are placed in
predetermined positions, corresponding to
the pre-fabricated prosthetic Framework that
is used.The TREFOIL System is intended for the
intraoral treatment of totally edentulous
mandibles by providing anchorage of the
framework in order to restore chewing function
and esthetics. By the aid of the surgical
components (guides and templates etc.) three
implants are placed in predetermined
positions, corresponding to the pre-fabricated
prosthetic Framework that is used.The TREFOIL System is intended for the
intraoral treatment of totally edentulous
mandibles by providing anchorage of the
framework in order to restore chewing
function and esthetics. By the aid of the
surgical components (guides and templates
etc.) three implants are placed in
predetermined positions, corresponding to
the pre-fabricated prosthetic Framework that
is used.
Indication for
use statementThe TREFOIL System is used to restore
chewing function in fully edentulous
mandibles.The TREFOIL System is used to restore
chewing function in fully edentulous
mandibles.The Trefoil system is used to restore
chewing function in fully edentulous
mandibles.
The three implants of the TREFOIL System
are placed between the mental foramina in
fully edentulous mandibles in a 1-stage
surgical technique combined with an
immediate function loading protocol, provided
sufficient primary stability for the selected
technique is achieved. In cases where
sufficient primary stability for two implants or
more is not reached, the implants along with
the Framework may also be used with an
early or delayed loading protocol.The three implants of the TREFOIL System
are placed between the mental foramina in
fully edentulous mandibles in a 1-stage
surgical technique combined with an
immediate function loading protocol, provided
sufficient primary stability for the selected
technique is achieved. In cases where
sufficient primary stability for two implants or
more is not reached, the implants along with
the Framework may also be used with an early
or delayed loading protocol.The three implants of the Trefoil system are
placed between the mental foramina in fully
edentulous mandibles in a 1-stage surgical
technique combined with an immediate
function loading protocol, provided sufficient
primary stability for the selected technique is
achieved. In cases where sufficient primary
stability of one or more implants is not
reached, the implants along with the bar
may also be used with an early or delayed
loading protocol.
The following prerequisites must be fulfilled:
-Adequate quantity of bone (minimum height
of 13 mm for 11.5 mm implant and 14.5 mm
for 13.0 implant and minimum width of 6-7
mm).
-Adequate mouth opening (minimum 40 mm)
to accommodate the guided surgery
instruments.
-Implant-supported prosthetics seated directly
on dedicated implantsThe following prerequisites must be fulfilled:
  • Adequate quantity of bone (minimum height
    of 13mm and minimum width of 6- 7mm).
  • Adequate mouth opening (minimum 40 mm)
    to accommodate the guided surgery
    instruments.
  • Implant-supported prosthetics seated directly
    on dedicated implants | The following prerequisites must be fulfilled:
  • Adequate quantity of bone (minimum width
    of 7mm; and minimum heights of 13mm for
    11.5 mm implant and 14.5mm for 13.0 mm
    implant).
  • Adequate mouth opening (minimum 40
    mm) to accommodate the guided surgery
    instruments.
  • Implant-supported prosthetics seated
    directly on dedicated implants. | | | |
    | Comparison of Intended use/Indications for Use: The intended use of the TREFOIL System is the same as the primary predicate TREFOIL System. The
    indications for use of the subject device is the primary predicate with the one change. The first bullet in the prerequisite list of the Indications for use | | | | | | |

statement has been modified to reflect the change in implant length and is the same as the reference predicate.

6

Comparison of Implant Technological Characteristics

| Technological

characteristicsSubject DevicePrimary PredicateReference Predicate
Implant Design FeaturesTREFOIL SystemTREFOIL System (K152836)TREFOIL System (K170135)
Implant Body DesignParallel walledParallel walledParallel walled
Implant Tip DesignTapered self cuttingTapered self cuttingTapered self cutting
Implant Thread Length13 mm11.5 mm11.5, 13.0 mm
Implant Diameter4.93 mm4.93 mm4.3, 5.0, 5.5 mm
Collar Diameter4.5 mm4.5 mm4.5 mm
Collar Height4.5, 6.0 mm4.5, 6.0 mm4.5 mm
Connection TypeMorse taper with Internal HexMorse taper with Internal HexMorse taper with Internal Hex
Device MaterialCP titaniumCP titaniumCP titanium
Surface modificationTiUnite (anodic oxidation)TiUnite (anodic oxidation)TiUnite (anodic oxidation)

7

Analysis of Differences Between Subject Device and Predicate

Indications for use

The indications for use of the subject device is the same as the primary predicate with the one change. The first bullet in the prerequisite list of the Indications for use statement has been modified to reflect the change in implant length and is the same as the reference predicate.

Technological characteristics

The subject TREFOIL System is an extension of the primary predicate TREFOIL System (K152836) implant length from 11.5 mm to 13.0 mm. All other technological characteristics are the same. The 13.0 mm length is the same as the reference predicate TREFOIL System (K170135)

Summarv:

  • The only design difference between the subject and primary predicate is the implant ● length. This length is the same as the reference predicate.
  • There is a trade name change to implant name (per K152836). Implant Conical Connect . RP used with TREFOIL System will be called Trefoil Implants CC RP.

VII. PERFORMANCE DATA

Summary of Non-Clinical Testing:

Since the subject device does not represent a new worst case, data from the predicate device was leveraged in the following aspects of the 510(k).

  • -Sterile Device Information
    • The sterilization method for the subject device is the same as the primary o predicate (K152836). The sterilization method is Gamma radiation and has been validated in accordance with ANSI/AAMI/ISO 11137. Therefore, no additional testing was required.
  • Device Packaging -
    • The packaging for the subject device is the same as the primary predicate O (K152836). This is a plastic vial with PVC shrink-wrap cap. Therefore, no additional testing was required.
  • -Shelf Life
    • The packaging for the subject device is the same as the primary predicate O (K152836) and is labeled with a 5 year expiration date. Real time aging was used to determine the expiration dating. Therefore, no additional testing was required.
  • -Biocompatibility
    • O The subject device is manufactured from the same material as the primary predicate (K152836), uses the same manufacturing method as the primary predicate, has the same intended use, and the same patient contact type and duration as the primary predicate. Therefore, no additional testing was required.
  • -Fatigue Testing
    • The subject device differs from the predicate (K152836) in length only and O fatigue testing has been included in K152836. No modification has been made to the implant/abutment connection and no new worst scenario identified. Therefore, no additional fatigue testing was required.

No clinical data was used to support the decision of safety and effectiveness.

Nobel Biocare Traditional 510(k) Notification TREFOIL System October 2017 K172352

8

VIII. CONCLUSIONS

The TREFOIL System was evaluated for substantial equivalence. In cases where the TREFOIL System could be shown to not represent a worst-case with respect to the predicates, data from these predicate devices was leveraged to support the subject device. Based on technological characteristics, the TREFOIL System was shown to be substantially equivalent to the TREFOIL System (K152836).