K Number
K191634
Device Name
Scan Abutments and Comfort Caps
Manufacturer
Date Cleared
2019-11-04

(138 days)

Product Code
Regulation Number
872.3630
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Dentium Prosthetics are intended for use as an aid in prosthetic rehabilitation.
Device Description
The purpose of this submission is to expand the Dentium Prosthetics to include the Scan Abutments and Comfort Caps. Scan Abutments are used provisionally as an accessory to endosseous dental implant during healing period to prepare gingival tissue for acceptance of a final abutments are designed to aid in soft tissue contouring the healing period after implant placement, creating an emergence profile for the final abutment. Comfort Caps are used provisionally as an accessory to protect the dental abutment before final prosthesis. They have the design feature that enable to transmit position and angulation data of implant when taking a digital impression using an intra-oral scanner. The Scan Abutments and Comfort Caps are prefabricated and made of Ti-6AI-4V ELI (ASTM F136) or PEEK(ASTM F2026). Scan Abutments are compatible with Dentium Implant(k041368 Implantium and k160965 SuperLine or K153268 NR Line) and Comfort Caps are compatible with Dentium Prosthetics(K052957 Implantium and K172640 SuperLine or K153268 NR Line)
More Information

No
The device description and performance studies focus on the physical properties and compatibility of the Scan Abutments and Comfort Caps, which are passive components used for digital impression taking and tissue contouring. There is no mention of any software, algorithms, or data processing that would indicate the use of AI/ML.

No.
The device components (Scan Abutments and Comfort Caps) are accessories used provisionally with dental implants and abutments to aid in soft tissue contouring, protection, and digital impression taking for prosthetic rehabilitation, rather than directly treating a disease or condition.

No

Explanation: The device is described as an aid in prosthetic rehabilitation, specifically for tissue contouring during healing and protecting dental abutments. Its function is to transmit position and angulation data for digital impressions, which is a tool for prosthesis creation, not for diagnosing medical conditions.

No

The device description clearly states the device is comprised of physical components (Scan Abutments and Comfort Caps) made of materials like Ti-6AI-4V ELI and PEEK, and the performance studies focus on sterilization and biocompatibility of these materials.

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

Here's why:

  • Intended Use: The intended use is "as an aid in prosthetic rehabilitation." This describes a device used in a surgical or restorative procedure, not for testing samples from the human body to diagnose or monitor a condition.
  • Device Description: The description details physical components (Scan Abutments and Comfort Caps) used in conjunction with dental implants to prepare tissue and protect abutments. It mentions their function in transmitting positional data for digital impressions, which is a mechanical/digital process, not a biological or chemical test.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), detecting analytes, or providing diagnostic information about a patient's health status.

IVD devices are specifically designed to perform tests on samples taken from the human body to provide information for diagnosis, monitoring, or screening. This device's function is entirely related to the physical placement and preparation for dental prosthetics.

N/A

Intended Use / Indications for Use

Dentium Prosthetics are intended for use as an aid in prosthetic rehabilitation.

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

NHA

Device Description

The purpose of this submission is to expand the Dentium Prosthetics to include the Scan Abutments and Comfort Caps.

Scan Abutments are used provisionally as an accessory to endosseous dental implant during healing period to prepare gingival tissue for acceptance of a final abutments are designed to aid in soft tissue contouring the healing period after implant placement, creating an emergence profile for the final abutment.

Comfort Caps are used provisionally as an accessory to protect the dental abutment before final prosthesis.

They have the design feature that enable to transmit position and angulation data of implant when taking a digital impression using an intra-oral scanner.

The Scan Abutments and Comfort Caps are prefabricated and made of Ti-6AI-4V ELI (ASTM F136) or PEEK(ASTM F2026). Scan Abutments are compatible with Dentium Implant(K041368 Implantium and K160965 SuperLine or K153268 NR Line) and Comfort Caps are compatible with Dentium Prosthetics(K052957 Implantium and K172640 SuperLine or K153268 NR Line)

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)

Non-clinical testing data submitted, referenced, or relied upon to demonstrate substantial equivalence included:

· Steam sterilization validation according to ISO 17665-1 and ISO 17665-2, demonstrating a sterility assurance level (SAL) of 10t6.

· Biocompatibility of Ti-6Al-4V ELI (ASTM F136) demonstrated by the referenced Dentium submission, K172640, using the same materials and manufacturing processes as the subject device.

And cytotoxicity testing of PEEK (ASTM F2026) has been performed according to ISO 10993-5.

No clinical data were included in this submission.

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

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K172640, K153268, K171142

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

K173374, K172160

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 872.3630 Endosseous dental implant abutment.

(a)
Identification. An endosseous dental implant abutment is a premanufactured prosthetic component directly connected to the endosseous dental implant and is intended for use as an aid in prosthetic rehabilitation.(b)
Classification. Class II (special controls). 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.)

0

Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

November 19, 2019

Dentium Co., Ltd. Byung-sun Kim RA Team Manager 150, Eondong-ro, Giheung-gu Yongin-si, 446-914 REPUBLIC OF KOREA

Re: K191634

Trade/Device Name: Scan Abutments and Comfort Caps Regulation Number: 21 CFR 872.3630 Regulation Name: Endosseous dental implant abutment Regulatory Class: Class II Product Code: NHA Dated: September 18, 2019 Received: September 20, 2019

Dear Byung-sun Kim:

This letter corrects our substantially equivalent letter of November 4, 2019.

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.

Andrew I. Steen -S

for

Srinivas Nandkumar, Ph.D. Acting Director DHT1B: Division of Dental Devices OHT1: Office of Ophthalmic, Anesthesia, Respiratory, ENT and Dental Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K191634

Device Name Scan Abutments and Comfort Caps

Indications for Use (Describe)Dentium Prosthetics are intended for use as an aid in prosthetic rehabilitation.
------------------------------------------------------------------------------------------------------------------
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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3

510(k) Summary

06/10/2019

1. Company

Submitter
NameDentium Co., Ltd.
Address150, Eondong-ro, Giheung-gu, Yongin-si, Gyeonggi-do, Korea (16985)
Phone/FaxTel. +82-70-7098-8806, Fax. +82-31-8019-9131
Contact personByungsun Kim / RA
bskim@dentium.com
Summary Date06/10/2019

2. Device Name

Proprietary name:Scan Abutments and Comfort Caps
Regulation number:21 CFR 872.3630
Regulation Description:Endosseous dental implant abutment
Product code:NHA
Device class:Class II
Classification Panel:Dental Products Panel
Reviewing Branch:Dental Devices Branch

3. Predicate Device

Primary Predicate for Scan Abutment
K172640Dentium Implantium® & SuperLine® Prosthetics
K153268NR Line Implant System

Primary Predicate for Comfort Cap K171142 Healing Cap Multi-Unit Titanium

4

Reference Devices

K173374TSV BellaTek Encode Healing Abutments
K172160Southern Implants PEEK Abutments

4. Indication for use

Dentium Prosthetics are intended for use as an aid in prosthetic rehabilitation.

5. Description

The purpose of this submission is to expand the Dentium Prosthetics to include the Scan Abutments and Comfort Caps.

Scan Abutments are used provisionally as an accessory to endosseous dental implant during healing period to prepare gingival tissue for acceptance of a final abutments are designed to aid in soft tissue contouring the healing period after implant placement, creating an emergence profile for the final abutment.

Comfort Caps are used provisionally as an accessory to protect the dental abutment before final prosthesis.

They have the design feature that enable to transmit position and angulation data of implant when taking a digital impression using an intra-oral scanner.

The Scan Abutments and Comfort Caps are prefabricated and made of Ti-6AI-4V ELI (ASTM F136) or PEEK(ASTM F2026). Scan Abutments are compatible with Dentium Implant(K041368 Implantium and K160965 SuperLine or K153268 NR Line) and Comfort Caps are compatible with Dentium Prosthetics(K052957 Implantium and K172640 SuperLine or K153268 NR Line)

6. Performance Data

Non-clinical testing data submitted, referenced, or relied upon to demonstrate substantial equivalence included:

· Steam sterilization validation according to ISO 17665-1 and ISO 17665-2, demonstrating a sterility assurance level (SAL) of 10t6.

· Biocompatibility of Ti-6Al-4V ELI (ASTM F136) demonstrated by the referenced Dentium submission, K172640, using the same materials and manufacturing processes as the subject device.

5

And cytotoxicity testing of PEEK (ASTM F2026) has been performed according to ISO 10993-5.

No clinical data were included in this submission.

7. Technological Characteristics

The following comparison table of the technological characteristics of the subject device and the predicate devices outlines and provides the similarities and the substantial equivalency of the subject device and the predicate.

7.1 Scan Abutment - Implantium & SuperLine

Subject devicePrimary PredicateReference Predicate
Device nameScan AbutmentDentium Implantium® &
SuperLine® Prosthetics
(Healing Abutment)Southern Implants
PEEK Abutments
ManufacturerDentium Co., Ltd.Dentium Co., Ltd.Biomet 3iSouthern Implants (Pty)
Ltd
510(k) NumberNew DeviceK172640K173374K172160
Indication for
useDentium Prosthetics are
intended for use as an aid
in prosthetic
rehabilitation.Dentium Prosthetics are
intended for use as an aid
in prosthetic
rehabilitation.The TSVTM BellaTek®
Encode® Healing
Abutments are intended
for use as an accessory to
endosseous dental
implants during
endosseous and gingival
healing to prepare
gingival tissue for
acceptance of a final
abutment and restoration.The Southern Implants
PEEK Abutments are
premanufactured
prosthetic components
directly connected to
endosseous dental
implants and are intended
for provisional use up to
180 days as an aid in
prosthetic rehabilitation.
MaterialsTi-4Al-6V ELI,
PEEKTi-6Al-4V ELI
(ASTM F136)Ti-6Al-4V ELI
(ASTM F136)PEEK
(ASTM F2026)
FormPreformedPreformedPreformedPreformed
SterilizationNon-sterileNon-sterileSterileSterile
UsePrescriptionPrescriptionPrescriptionPrescription
Single Use OnlyYesYesYesYes

Comparison of Characteristics

510(k) Summary

6

Design
Diameter4.09 ~ 6.41mm4.04 ~ 9.64 mm3.8, 5.0, 5.6, 6.0, 6.8 mm6 x 9, 8 x 11
Length8.4 ~ 14.4 mm8.89 ~ 14.51 mmGingival Height
3.0, 5.0, 7.0 mm5.0 ~ 6.0 mm
Connection typeInternalInternalInternalInternal
Scanning featureMachined marking-Machined marking-
Surface treatmentNoneNoneNoneNone

The subject device Scan Abutment is substantially equivalent to the predicate K172640(Healing Abutment) in indication for use, manufacture, function, design and implant/abutment interface.

The intended use of the subject device as a healing abutment with scanning feature machined marking to transmit position and angulation data of implant when taking a digital impression using an intra-oral scanner is equivalent to the reference predicate K173374.

The subject device is made of Ti-6A1-4V ELI (ASTM F136) or PEEK (ASTM F2026). Ti-6A1-4V ELI and PEEK are commonly used in endosseous dental implant abutments. The Ti-6AI-4V ELI is identical to the material used for Dentium components cleared previously in K172640 and PEEK is identical to the material cleared previously in K172160.

7.2 Scan Abutment - NR Line

Comparison of Characteristics

Subject devicePrimary PredicateReference Predicate
Device nameScan AbutmentNR Line Implant System
(Healing Abutment)TSV BellaTek Encode
Healing AbutmentsSouthern Implants
PEEK Abutments
ManufacturerDentium Co., Ltd.Dentium Co., Ltd.Biomet 3iSouthern Implants (Pty)
Ltd
510(k) NumberNew DeviceK153268K173374K172160
Indication for
useDentium Prosthetics are
intended for use as an aid
in prosthetic
rehabilitation.Dentium Prosthetics are
intended for use as an aid
in prosthetic
rehabilitation.The TSVTM BellaTek®
Encode® Healing
Abutments are intended
for use as an accessory to
endosseous dental
implants during
endosseous and gingival
healing to prepare
gingival tissue forThe Southern Implants
PEEK Abutments are
premanufactured
prosthetic components
directly connected to
endosseous dental
implants and are intended
for provisional use up to
180 days as an aid in

7

| | | acceptance of a final
abutment and restoration. | prosthetic rehabilitation. | |
|----------------------|------------------------|----------------------------------------------------|-------------------------------------|----------------------|
| Materials | Ti-4Al-6V ELI,
PEEK | Ti-6Al-4V ELI
(ASTM F136) | Ti-6Al-4V ELI
(ASTM F136) | PEEK
(ASTM F2026) |
| Form | Preformed | Preformed | Preformed | Preformed |
| Sterilization | Non-sterile | Non-sterile | Sterile | Sterile |
| Use | Prescription | Prescription | Prescription | Prescription |
| Single Use Only | Yes | Yes | Yes | Yes |
| Design | | | | |
| Diameter | 4.09 ~ 6.41mm | 3.7 ~ 9.5 mm | 3.8, 5.0, 5.6, 6.0, 6.8 mm | 6 x 9, 8 x 11 |
| Length | 9.12 ~ 15.12 mm | 8.6 ~ 12.1 mm | Gingival Height
3.0, 5.0, 7.0 mm | 5.0 ~ 6.0 mm |
| Connection
type | Internal | Internal | Internal | Internal |
| Surface
treatment | None | None | None | None |

The subject device Scan Abutment is substantially equivalent to the predicate K153268 (Healing Abutment) in indication for use, manufacture, function, design and implant/abutment interface.

The intended use of the subject device as a healing abutment with scanning feature machined marking to transmit position and angulation data of implant when taking a digital impression using an intra-oral scanner is equivalent to the reference predicate K173374.

The subject device is made of Ti-6A1-4V ELI (ASTM F136) or PEEK (ASTM F2026). Ti-6A1-4V ELI and PEEK are commonly used in endosseous dental implant abutments. The Ti-6AI-4V ELI is identical to the material used for Dentium components cleared previously in K153268 and PEEK is identical to the material cleared previously in K172160.

6.3 Comfort Cap

Comparison of Characteristics
-----------------------------------
Subject devicePrimary PredicateReference Predicate
Device nameComfort CapHealing Cap Multi-Unit
TitaniumSouthern Implants
PEEK Abutments
ManufacturerDentium Co., Ltd.Nobel Biocare ABSouthern Implants (Pty) Ltd
510(k) NumberNew DeviceK171142K172160
Indication forDentium Prosthetics areThe Healing Cap Multi-unitThe Southern Implants

510(k) Summary

8

| use | intended for use as an aid in
prosthetic rehabilitation. | Titanium is a
premanufactured prosthetic
component to be directly
connected to the dental
abutment during soft tissue
healing to protect the
internal connection of
the abutments and prepare
the soft tissue for the
prosthetic procedure.
Maximum intra-oral use is
180-days. | PEEK Abutments are
premanufactured
prosthetic components
directly connected to
endosseous dental
implants and are intended
for provisional use up to 180
days as an aid in prosthetic
rehabilitation. |
|----------------------|-------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Materials | Ti-4Al-6V ELI, PEEK | Ti-6Al-4V ELI
(ASTM F136) | PEEK
(ASTM F2026) |
| Form | Preformed | Preformed | Preformed |
| Sterilization | Non-sterile | Sterile | Sterile |
| Use | Prescription | Prescription | Prescription |
| Single Use Only | Yes | Yes | Yes |
| Design | | | |
| Diameter | 4.5, 5.0, 5.5 mm | 5.0, 6.0, 6.9 mm | 6 x 9, 8 x 11 |
| Length | 5.0 mm | 4.1, 5.5 mm | 5.0 ~ 6.0 mm |
| Surface
treatment | None | None | None |

The subject device Comfort Cap is substantially equivalent to the predicate K171142 in indication for use, manufacture, function and design. The intended use of subject and predicate device is to protect the dental abutment before final prosthesis.

The subject device is made of Ti-6A1-4V ELI (ASTM F136) or PEEK (ASTM F2026). Ti-6A1-4V ELI and PEEK are commonly used in endosseous dental implant abutments. The Ti-6AI-4V ELI is identical to the material cleared previously in K171142 and PEEK is identical to the material cleared previously in K172160.

8. Conclusion

The subject device and the primary predicate device have indication for use, have similar technological characteristics, and are made of same materials. The subject device and primary predicate device encompass the equivalent range of physical dimensions, including diameter and length.