K Number
K190484
Device Name
BH Medical Dental Barrier Sleeves and Barrier Film
Date Cleared
2019-09-10

(195 days)

Product Code
Regulation Number
878.4370
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
BH Medical Dental Barrier Sleeves and Barrier Film are intended to be used as a disposable barrier for dental instruments and equipment. This device is non-sterile and intended for single patient use only.
Device Description
BH Medical Dental Barrier Sleeves and Barrier Film consist of various sizes and shapes of clear polyethylene covers which are positioned on various small hand-held dental instruments such as hand pieces, curing lights, air/water syringes and similar hand instruments. In other forms, they are used to cover various devices such as dental chairs, dental instrument trays, x-ray heads, and others. The products are sold non-sterile, prepackaged, and are disposable, single use only.
More Information

Not Found

No
The device description and performance studies focus on physical properties and barrier function, with no mention of AI or ML.

No.
The device is described as a disposable barrier for dental instruments and equipment, and its intended use is to cover surfaces to prevent contamination. It does not perform any therapeutic function.

No.
The device is described as a disposable barrier for dental instruments and equipment, designed to cover instruments and devices like dental chairs and X-ray heads. Its intended use is to prevent contamination, not to diagnose medical conditions.

No

The device is described as physical barrier sleeves and film made of polyethylene, which are hardware components, not software.

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

Here's why:

  • Intended Use: The intended use is clearly stated as a "disposable barrier for dental instruments and equipment." This is a physical barrier to prevent contamination, not a device used to examine specimens derived from the human body to provide information for diagnosis, monitoring, or treatment.
  • Device Description: The description details physical covers made of polyethylene. There is no mention of reagents, calibrators, controls, or any components typically associated with in vitro diagnostic tests.
  • Performance Studies: The performance studies focus on physical properties like resistance to penetration, tear resistance, tensile strength, and puncture resistance, as well as biocompatibility. These are relevant for a physical barrier device, not an IVD.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples, detecting analytes, or providing diagnostic information.

Therefore, the BH Medical Dental Barrier Sleeves and Barrier Film are classified as a general medical device used for infection control in a dental setting, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

BH Medical Dental Barrier Sleeves and Barrier Film are intended to be used as a disposable barrier for dental instruments and equipment. This device is non-sterile and intended for single patient use only.

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

PEM

Device Description

BH Medical Dental Barrier Sleeves and Barrier Film consist of various sizes and shapes of clear polyethylene covers which are positioned on various small hand-held dental instruments such as hand pieces, curing lights, air/water syringes and similar hand instruments. In other forms, they are used to cover various devices such as dental chairs, dental instrument trays, x-ray heads, and others. The products are sold non-sterile, prepackaged, and are disposable, single use only.

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 (study type, sample size, AUC, MRMC, standalone performance, key results)

Performance test including resistance to penetration, tear resistance, tensile strength, puncture resistance was performed. Biocompatibility test in accordance with ISO 10993-5, ISO 10993-10 has been performed. Effectiveness of x-ray devices covered with BH Dental Barrier Sleeves was performed to demonstrate the subject device does not impact the function of dental x-ray devices.

The biocompatibility test result indicates that the barrier sleeves do not have the potential cytotoxicity, sensitization and irritation.

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

Not Found

Predicate Device(s)

K151123

Reference Device(s)

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

§ 878.4370 Surgical drape and drape accessories.

(a)
Identification. A surgical drape and drape accessories is a device made of natural or synthetic materials intended to be used as a protective patient covering, such as to isolate a site of surgical incision from microbial and other contamination. The device includes a plastic wound protector that may adhere to the skin around a surgical incision or be placed in a wound to cover its exposed edges, and a latex drape with a self-retaining finger cot that is intended to allow repeated insertion of the surgeon's finger into the rectum during performance of a transurethral prostatectomy.(b)
Classification. Class II (special controls). The device, when it is an ear, nose, and throat surgical drape, a latex sheet drape with self-retaining finger cot, a disposable urological drape, a Kelly pad, an ophthalmic patient drape, an ophthalmic microscope drape, an internal drape retention ring (wound protector), or a surgical drape that does not include an antimicrobial agent, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 878.9.

0

Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: a symbol on the left and the FDA name on the right. The symbol on the left is a stylized image of a human figure, while the FDA name on the right is written in blue letters. The words "U.S. FOOD & DRUG ADMINISTRATION" are written in a clear, sans-serif font.

September 10, 2019

BH Medical Products Co., Ltd. Xiaohua Tao President No.90 Shenjiang Villagers' group, Zhangjiacunwei, Xilin Street, Zhonglou District Changzhou. 213024 Cn

Re: K190484

Trade/Device Name: BH Medical Dental Barrier Sleeves and Barrier Film Regulation Number: 21 CFR 878.4370 Regulation Name: Surgical Drape And Drape Accessories Regulatory Class: Class II Product Code: PEM Dated: August 6, 2019 Received: August 12, 2019

Dear Xiaohua Tao:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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 of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely.

For Elizabeth Claverie, M.S. Assistant Director for THT4B2 Acting Assistant Director for THT4B1 DHT4B: Division of Infection Control and Plastic Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K190484

Device Name

BH Medical Dental Barrier Sleeves and Barrier Film

Indications for Use (Describe)

BH Medical Dental Barrier Sleeves and Barrier Film are intended to be used as a disposable barrier for dental instruments and equipment. This device is non-sterile and intended for single patient use only.

Item #ModelDesigned for
#992514B tray sleevesDental instrument tray, 10 1/2"x14"(360x270mm)
#992515E tray sleevesDental instrument tray, 11 1/2"x16"(410x290mm)
#992516A tray sleevesDental instrument tray, 7 1/2"x10 1/2"(270x190mm)
#992446Headrest CoverDental chair headrest, 11"x9 1/2"(250x280mm)
#992447Headrest CoverDental chair headrest, 14"x9 1/2"(250x360mm)
#992513X-ray head sleevesX-ray head, universal, 15"x26"(660x380mm)
#992481Full chair sleevesDental chair, universal, 29"x80"(2020x730mm)
#992479Half chair sleevesHalf dental chair, universal, 27 1/2"x24"(680x600mm)
#992486Syringe/HVE sleeve without tapeAir/water syringe HVE universal, 2 1/2"x10"(250x60x22mm)
#991372Digital x-ray sensor sleeveDigital x-ray sensor, universal, large, 1 5/8"x8"(210x43mm)
#991371Digital x-ray sensor sleeveDigital x-ray sensor, universal, large, 1 3/8"x8"(210x36mm)
#992492handpiece and pen sleeves-High speedDental high-speed handpiece universal(200x28mm)
#992493handpiece and pen sleeves-Lower speedDental low-speed handpiece universal(200x38mm)
#992499light handle sleeveslight handles, universal, T-shape(154x73mm)
#992508light handle sleeveslight handles, universal, Rectanglar(150x105mm)
#992495light cure sleevesDental curing light, medium,20mm
#992496light cure sleevesDental curing light, large,25mm
#992497light cure sleeves, curved tipDental curing light, medium,(340x53x16mm)
#992498light cure sleeves, curved tipDental curing light, large,(340x84x16mm)
#992582light cure sleeves, pen styleDental curing light, pen type,tip:40x27mm,total:250x50mm
#992583light cure sleeves, pen styleDental curing light, pen type,,tip:55x26mm,total:250x52mm
#992584light cure sleeves, pen styleDental curing light, pen type,tip:40x30mm,total:250x55mm
#991361Barrier envelopes size 0Digital x-ray sensor(Kodak 6100 size 0), inner :36x23mm
#991362Barrier envelopes size 1Digital x-ray sensor(Kodak 6100 size 1), inner :42x26mm
#991363Barrier envelopes size 2Digital x-ray sensor(Kodak 6100 size 2), inner :45x33mm
#991364Barrier envelopes size 3Digital x-ray sensor(Kodak 6100 size 3), inner :56x30mm
#991365Barrier envelopes size 4Digital x-ray sensor(Kodak 6100 size 4), inner :80x60mm
#992489Tubing sleeves roll (2")Dental unit tubing, 2",(50mm)
#992490Tubing sleeves roll (4")Dental unit tubing, 4",(100mm)
#992483Barrier film whiteSurface area that might be touched during procedure
4"x6", white, 10cmx15cmx180m
#992482Barrier film blueSurface area that might be touched during procedure
4"x6", blue, 10cmx15cmx180m
#992585Intraoral Camera SleevesDigital intraoral camera sleeves, DMD Telicam,
228x43x13.5mm
#992586Intraoral Camera SleevesDigital intraoral camera sleeves, Siemens Ceracam/minicam
Ultra, 228x43x24mm
#992587Intraoral Camera SleevesDigital intraoral camera sleeves, Dentsply Acucap
Concept, 228x43x16.6mm
#992588Intraoral Camera SleevesDigital intraoral camera sleeves, Camsight OptumII,
228x25x17mm
#992589Intraoral Camera SleevesDigital intraoral camera sleeves, RF System SS21, 228x57x22mm
#992590Intraoral Camera SleevesDigital intraoral camera sleeves, Suni Sunic-am,228x48x31mm
#992591Intraoral Camera SleevesDigital intraoral camera sleeves, Digital Doc Iris,228x41x19mm
#992592Intraoral Camera SleevesDigital intraoral camera sleeves, Vision Tools Spectra Vu,
228x57x12mm
#992593Intraoral Camera SleevesDigital intraoral camera sleeves, Imagin Hot Rod,
228x50x17.5mm
#992594Intraoral Camera SleevesDigital intraoral camera sleeves, Carestream STV Pro I&II Kodak
1000, 228x35x18mm
#992595Intraoral Camera SleevesDigital intraoral camera sleeves, Video Dental Concepts
Miniscope & Microscope TD-2000,228x53x29mm
#992596Intraoral Camera SleevesDigital intraoral camera sleeves, DMD Telicam Digital Doc
Aurora, 228x35x22mm
#991367Barrier envelopes size 0Digital x-ray sensor (size 0),inner :25x37mm
#991368Barrier envelopes size 1Digital x-ray sensor (size 1),inner :26.5x43mm
#991369Barrier envelopes size 2Digital x-ray sensor (size 2),inner :44x33mm
#991374Sensor sleevesDental instrument tray, 100x43mm
#991373Sensor sleevesDental instrument tray, 250x63mm

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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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Section 5 510(k) Summary

[As Required by 21 CFR 807.92]

Submitter: BH Medical Products Co., Ltd. No.90 Shenjiang Villagers' group, Zhangjiacunwei, Xilin Street, Zhonglou District, Changzhou City, Jiangsu Province, People's Republic of China (Establishment registration number: 3009307523)

Contact Person: Xiaohua TAO President Tel: 86-519-83978705 Fax: 86-519-83978717 Email: tao@bhmedical.com.cn

US Agent: Name : ISMILE DENTAL PRODUCTS INC. Address : 4201 SIERRA POINT DR STE 102 Sacramento California, 95834 UNITED STATES Contact Person: Bryan Shields Tel: (916) 718-0795 Email: bshields@ismiledp.com

Device/Trade Name: BH Medical Dental Barrier Sleeves and Barrier Film Common Name: Dental Barriers and Sleeves Device Panel: General and Plastic Surgery Basis for Submission: New Device Regulation Name: Surgical Drape and Drape Accessories

Device Classification: Class I

Regulation Number: 21 CFR 878.4370 Product Code: PEM

Predicate Device to BH Medical Dental Barrier Sleeves and Barrier Film:

Trade Name: Pac-Dent Barrier Sleeve, Cover-It Barrier Film 510(k) Number: K151123 Manufactured by: Pac-Dent International, Inc.

Device Description:

BH Medical Dental Barrier Sleeves and Barrier Film consist of various sizes and shapes of clear polyethylene covers which are positioned on various small hand-held dental instruments such as hand pieces, curing lights, air/water syringes and similar hand instruments. In other forms, they are used to cover various devices such as dental chairs,

5

dental instrument trays, x-ray heads, and others. The products are sold non-sterile, prepackaged, and are disposable, single use only.

Indications for Use:

BH Medical Dental Barrier Sleeves and Barrier Film are intended to be used as a disposable barrier for dental instruments and equipment. This device is non-sterile and intended for single patient use only.

ItemModelDescriptionDesigned for
1#992514B tray sleevesDental instrument tray, 10 1/2"x14"(360x270mm)
2#992515E tray sleevesDental instrument tray, 11 1/2"x16"(410x290mm)
3#992516A tray sleevesDental instrument tray, 7 1/2"x10
1/2"(270x190mm)
4#992446Headrest CoverDental chair headrest, 11"x9 1/2"(250x280mm)
5#992447Headrest CoverDental chair headrest, 14"x9 1/2"(250x360mm)
6#992513X-ray head sleevesX-ray head, universal, 15"x26"(660x380mm)
7#992481Full chair sleevesDental chair, universal, 29"x80"(2020x730mm)
8#992479Half chair sleevesHalf dental chair, universal, 27
1/2"x24"(680x600mm)
9#992486Syringe/HVE sleeve
without tapeAir/water syringe HVE universal, 2
1/2"x10"(250x60x22mm)
10#991372Digital
x-ray sensor
sleeveDigital x-ray sensor, universal, large, 1
5/8"x8"(210x43mm)
11#991371Digital
x-ray sensor
sleeveDigital x-ray sensor, universal, large, 1
3/8"x8"(210x36mm)
12#992492handpiece and pen
sleeves-High speedDental high-speed handpiece universal(200x28mm)
13#992493handpiece and pen
sleeves-Lower speedDental low-speed handpiece universal(200x38mm)
14#992499light handle sleeveslight handles, universal, T-shape(154x73mm)
15#992508light handle sleeveslight handles, universal, Rectangular(150x105mm)
16#992495light cure sleevesDental curing light, medium,20mm
17#992496light cure sleevesDental curing light, large,25mm
18#992497light cure sleeves,
curved tipDental curing light, medium,(340x53x16mm)
19#992498light cure sleeves,
curved tipDental curing light, large,(340x84x16mm)
20#992582light cure sleeves, pen
styleDental curing light, pen
type, tip:40x27mm, total:250x50mm
21#992583light cure sleeves, pen styleDental curing light, pen type,,tip:55x26mm,total:250x52mm
22#992584light cure sleeves, pen styleDental curing light, pen type,tip:40x30mm,total:250x55mm
23#991361Barrier envelopes size 0Digital x-ray sensor(Kodak 6100 size 0 ),inner :36x23mm
24#991362Barrier envelopes size 1Digital x-ray sensor(Kodak 6100 size 1 ),inner :42x26mm
25#991363Barrier envelopes size 2Digital x-ray sensor(Kodak 6100 size 2 ),inner :45x33mm
26#991364Barrier envelopes size 3Digital x-ray sensor(Kodak 6100 size 3 ),inner :56x30mm
27#991365Barrier envelopes size 4Digital x-ray sensor(Kodak 6100 size 4 ),inner :80x60mm
28#992489Tubing sleeves roll (2")Dental unit tubing, 2",(50mm)
29#992490Tubing sleeves roll (4")Dental unit tubing, 4",(100mm)
30#992483Barrier film whiteSurface area that might be touched during procedure 4"x6", white, 10cmx15cmx180m
31#992482Barrier film blueSurface area that might be touched during procedure 4"x6",blue,10cmx15cmx180m
32#992585Intraoral Camera SleevesDigital intraoral camera sleeves, DMD Telicam,228x43x13.5mm
33#992586Intraoral Camera SleevesDigital intraoral camera sleeves, Siemens Ceracam/minicam Ultra,228x43x24mm
34#992587Intraoral Camera SleevesDigital intraoral camera sleeves, Dentsply Acucap Concept, 228x43x16.6mm
35#992588Intraoral Camera SleevesDigital intraoral camera sleeves, Camsight OptumII, 228x25x17mm
36#992589Intraoral Camera SleevesDigital intraoral camera sleeves, RF System SS21,228x57x22mm
37#992590Intraoral Camera SleevesDigital intraoral camera sleeves, Suni Sunic-am,228x48x31mm
38#992591Intraoral Camera SleevesDigital intraoral camera sleeves, Digital Doc Iris 228x41x19mm
39#992592Intraoral Camera
SleevesDigital intraoral camera sleeves, Vision Tools
Spectra Vu,228x57x12mm
40#992593Intraoral Camera
SleevesDigital intraoral camera sleeves, Imagin Hot
Rod,228x50x17.5mm
41#992594Intraoral Camera
SleevesDigital intraoral camera sleeves, Carestream STV
Pro I&II Kodak 1000,228x35x18mm
42#992595Intraoral Camera
SleevesDigital intraoral camera sleeves, Video Dental
Concepts Miniscope & Microscope TD-
2000,228x53x29mm
43#992596Intraoral Camera
SleevesDigital intraoral camera sleeves, DMD Telicam
Digital Doc Aurara,228x35x22mm
44#991367Barrier envelopes size 0Digital x-ray sensor (size 0),inner :25x37mm
45#991368Barrier envelopes size 1Digital x-ray sensor (size 1),inner :26.5x43mm
46#991369Barrier envelopes size 2Digital x-ray sensor (size 2),inner :44x33mm
47#991374Sensor sleevesDental instrument tray, 100x43mm
48#991373Sensor sleevesDental instrument tray, 250x63mm

Table for the product names and model numbers:

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7

Comparison of Technological Characteristics:

ItemPredicate DeviceSubject DeviceComment
DevicePac-Dent Barrier Sleeve
510(K) Number: K151123BH Medical Dental Barrier
Sleeves and Barrier Film/
Indications for UsePac-Dent Barrier Sleeve are
intended to be used as a barrier to
cover dental instruments. It is
non-sterile and is intended for
single patient use only.BH Medical Dental Barrier
Sleeves and Barrier Film are
intended to be used as a
disposable barrier for dental
instruments and equipment. This
device is non-sterile and intended
for single patient use only.Same
Device
DescriptionPac-Dent Barrier Sleeves consist
of various sizes and shapes of
clear polyethylene covers which
are positioned on various small
hand-held dental instruments such
as handpieces, curing lights,
air/water syringes and similar
hand instruments. In other forms,
they are used to cover various
devices such as dental chairs,BH Medical Dental Barrier
Sleeves and Barrier Film consist
of various sizes and shapes of
clear polyethylene covers which
are positioned on various small
hand-held dental instruments such
as hand pieces, curing lights,
air/water syringes and similar
hand instruments. In other forms,
they are used to cover variousSame
dental instrument trays, x-ray heads, and others.devices such as dental chairs, dental instrument trays, x-ray heads, and others. The products are sold non-sterile, prepackaged, and are disposable, single use only.
Classification
Product CodePEMPEMSame
MaterialPolyethylene filmPolyethylene filmSame
Material
CompositionLLDPE(80%),LDPE(20%),Blue pigment(Item#100B,C101B),Adhesive(Item#C101,C101B)LLDPE(80%),LDPE(20%),Blue pigment(#992482),Adhesive(#992482,#992483)Same
Specifications
and TolerancesPaper backing: some of model;
Film thickness:0.02-0.06mm;
Tolerance: