K Number
K202515
Device Name
NUVO Implant System – NUVO Instrument Kit Cases
Date Cleared
2020-11-24

(84 days)

Product Code
Regulation Number
880.6850
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Indications for Use for Drill Stop Pre-Mounted Kit and Drill Stop Kit: Instrument Kits are intended to be used to enclose other medical devices that are to be sterilized by a health care provider. Instrument Kits are intended to allow sterilization of the enclosed medical devices. Instrument Kits require the use of FDA-cleared wrap to maintain the sterility of the enclosed devices. The Kits are to be enclosed in a sterilization wrap that is FDA-cleared for the indicated cycles, and moist heat using one of the following cycles: Fractionated vacuum (pre-vacuum) - Exposure at 132 °C for 4 minute dry time Gravity displacement -Exposure at 132 °C for 15 minutes, 30-minute dry time. Instrument Kits are intended for sterilization of nonporous loads. The combined weight of the Kit and the associated instruments is 194.90 grams. The weight of the 189.12 grams. Instrument Kits are recommended not to be stacked during sterilization.
Device Description
The subject device kit cases are reusable rigid containers, comprising a case bottom (or base), a removable inner tray, and tray lid (lid). The subject device kits are to be used to organize and protect instruments and accessories that are to be sterilized by the healthcare provider. The subject kit cases are manufactured in polymer. The design of the subject devices include grommets manufactured from polyphenylsulfone that retain the instruments within the tray. The subject device kit cases are provided nonsterile to the end-user.
More Information

No
The device description and intended use clearly describe a reusable rigid container for sterilizing medical instruments. There is no mention of software, algorithms, or any functionality that would suggest the use of AI or ML. The performance studies focus on sterilization and cleaning validation, not algorithmic performance.

No
The device is described as reusable rigid containers intended to organize, protect, and facilitate the sterilization of other medical devices, not to treat or diagnose a condition.

No

The device is described as Instrument Kits intended for sterilizing and organizing other medical devices, which are sterile containers rather than tools for diagnosing medical conditions.

No

The device description clearly states it is a reusable rigid container made of polymer, comprising a case bottom, inner tray, and tray lid. This describes a physical hardware device, not software.

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

Here's why:

  • Intended Use: The intended use clearly states that the device is an "Instrument Kit" used to "enclose other medical devices that are to be sterilized by a health care provider." Its purpose is to facilitate the sterilization and organization of other instruments.
  • Device Description: The description reinforces this, describing it as "reusable rigid containers" for organizing and protecting instruments during sterilization.
  • Lack of IVD Characteristics: There is no mention of the device being used to examine specimens derived from the human body (blood, urine, tissue, etc.) to provide information for diagnosis, monitoring, or treatment.

The device falls under the category of sterilization accessories or instrument containers, which are used in the process of preparing other medical devices for use.

N/A

Intended Use / Indications for Use

Instrument Kits are intended to be used to enclose other medical devices that are to be sterilized by a health care provider. Instrument Kits are intended to allow sterilization of the enclosed medical devices. Instrument Kits require the use of FDA-cleared wrap to maintain the sterility of the enclosed devices. The Kits are to be enclosed in a sterilization wrap that is FDA-cleared for the indicated cycles, and moist heat using one of the following cycles: Fractionated vacuum (pre-vacuum) - Exposure at 132 °C for 4 minute dry time Gravity displacement -Exposure at 132 °C for 132 °C for 15 minutes, 30-minute dry time. Instrument Kits are intended for sterilization of nonporous loads. The combined weight of the Kit and the associated instruments is 194.90 grams. The weight of the 189.12 grams. Instrument Kits are recommended not to be stacked during sterilization.

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

KCT

Device Description

The subject device kit cases are reusable rigid containers, comprising a case bottom (or base), a removable inner tray, and tray lid (lid). The subject device kits are to be used to organize and protect instruments and accessories that are to be sterilized by the healthcare provider. The subject kit cases are manufactured in polymer. The design of the subject devices include grommets manufactured from polyphenylsulfone that retain the instruments within the tray. The subject device kit cases are provided nonsterile to the end-user.

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

health care provider

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)

Standard or Test Method / Purpose of the Testing / Acceptance Criteria / Results

  • Custom / Manual cleaning validation Test Soil: Blood Soil (BLSO) Cleaning Method: Manual Residuals Tested: Hemoglobin and Protein / Visual Inspection: No Visible Soil Hemoglobin Test: Less than 2.2 micrograms/cm2 Protein Test: Less than 6.4 micrograms/cm2 / Passed
  • ANSI/AAMI/ISO 17665-1 ANSI/AAMI/ISO 17665-2 / Sterilization validation, including sterilant penetration and drying time / All Biological Indicators must be incubated for at least 7 days ate 55-60°C. the positive controls for SAL testing must show characteristic growth of the indicator organism. / Passed
  • Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling Guidance for Industry and Food and Drug Administration Staff / Life cycle (simulate usage) testing / The tested samples must withstand 100 cycles of use (cleaning, sterilization and functional testes) without compromising their functionalities / Passed
  • ANSI/AAMI/ISO 10993-5 (Cytotoxicity) / Cytotoxicity testing / Less than 30% cell proliferation inhibition / Passed

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.

K192670

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.

K182865

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

§ 880.6850 Sterilization wrap.

(a)
Identification. A sterilization wrap (pack, sterilization wrapper, bag, or accessories, is a device intended to be used to enclose another medical device that is to be sterilized by a health care provider. It is intended to allow sterilization of the enclosed medical device and also to maintain sterility of the enclosed device until used.(b)
Classification. Class II (performance standards).

0

Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food & 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 24, 2020

JJGC Industria e Comercio de Materiais Dentarios S.A. % Jennifer Jackson Director of Regulatory Affairs Straumann USA, LLC 60 Minuteman Road Andover, Massachusetts 01810

Re: K202515

Trade/Device Name: NUVO Implant System - NUVO Instrument Kit Cases Regulation Number: 21 CFR 880.6850 Regulation Name: Sterilization Wrap Regulatory Class: Class II Product Code: KCT Dated: September 1, 2020 Received: September 1, 2020

Dear Jennifer Jackson:

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.

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

1

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,

Clarence W. Murray, III, Ph.D. Acting Assistant Director DHT4B: Division of Infection Control and Plastic Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Ouality Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known)

K202515

Device Name

NUVO Implant System - NUVO Instrument Kits Cases

Indications for Use (Describe)

Indications for Use for Drill Stop Pre-Mounted Kit and Drill Stop Kit

IInstrument Kits are intended to be used to enclose other medical devices that are to be sterilized by a health care provider. Instrument Kits are intended to allow sterilization of the enclosed medical devices. Instrument Kits require the use of FDA-cleared wrap to maintain the sterility of the enclosed devices. The Kits are to be enclosed in a sterilization wrap that is FDA-cleared for the indicated cycles, and moist heat using one of the following cycles: Fractionated vacuum (pre-vacuum) - Exposure at 132 °C for 4 minute dry time Gravity displacement -Exposure at 132 °C for 15 minutes, 30-minute dry time.

Instrument Kits are intended for sterilization of nonporous loads.

The combined weight of the Kit and the associated instruments is 194.90 grams. The weight of the 189.12 grams. Instrument Kits are recommended not to be stacked during sterilization.

Type of Use (Select one or both, as applicable)
-------------------------------------------------

X Prescription Use (Part 21 CFR 801 Subpart D)

Over-The-Counter Use (21 CFR 801 Subpart C)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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."

3

K202515 510(K) Summary

ADMINISTRATIVE INFORMATION

| Sponsor | JJGC Indústria e Comércio de Materiais Dentários SA
(dba Neodent)
Av. Juscelino Kubitschek de Oliveira, 3291
Curitiba, Parana, Brazil 81270-200
Registration No.: 3008261720
Owner/Operator No.: 10031702 |
|---------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Contact Person | Jennifer M. Jackson, MS
Director of Regulatory Affairs,
Straumann USA
E-mail: jennifer.jackson@straumann.com
Telephone (978) 747-2509 |
| Date Prepared | 24/Nov/2020 |
| Preparer / Alternate
Contact | Mariana Soares Hartmann
Regulatory Affairs Analyst
JJGC Indústria e Comércio de Materiais Dentários SA
E-mail: mariana.hartmann@neodent.com |

DEVICE NAME AND CLASSIFICATION

Trade/ Proprietary NameNUVO Implant System - NUVO Instrument Kit Cases
Common NameInstrument Sterilization Trays
Classification NameSterilization Wrap Containers, Trays, Cassettes & Other
Classification Regulations21 CFR 880.6850, Class II
Product CodeKCT
Classification PanelGeneral Hospital
Reviewing BranchInfection Control Devices Branch
PREDICATE DEVICE INFORMATION

Primary Predicate Device K192670 – Neodent Instrument Kit Cases, JJGC Indústria e Comércio de Materiais Dentários S.A Reference Predicate K182865 - Neodent Instrument Kits, JJGC Indústria e Comércio Device de Materiais Dentários S.A

4

INDICATIONS FOR USE

Indications for Use for Drill Stop Pre-Mounted Kit and Drill Stop Kit:

Instrument Kits are intended to be used to enclose other medical devices that are to be sterilized by a health care provider. Instrument Kits are intended to allow sterilization of the enclosed medical devices. Instrument Kits require the use of FDA-cleared wrap to maintain the sterility of the enclosed devices.

The Kits are to be enclosed in a sterilization wrap that is FDA-cleared for the indicated cycles, and moist heat (steam) sterilized using one of the following cycles:

Fractionated vacuum (pre-vacuum) – Exposure at 132 °C for 4 minutes, 30-minute dry time Gravity displacement - Exposure at 132 °C for 15 minutes, 30-minute dry time.

Instrument Kits are intended for sterilization of nonporous loads.

The combined weight of the Kit and the associated instruments is 194,90 grams. The weight of the empty Kit is 189,12 grams.

Instrument Kits are recommended not to be stacked during sterilization.

SUBJECT DEVICE DESCRIPTION

The subject device kit cases are reusable rigid containers, comprising a case bottom (or base), a removable inner tray, and tray lid (lid). The subject device kits are to be used to organize and protect instruments and accessories that are to be sterilized by the healthcare provider. The subject kit cases are manufactured in polymer. The design of the subject devices include grommets manufactured from polyphenylsulfone that retain the instruments within the tray. The subject device kit cases are provided nonsterile to the end-user.

The dimensions for each part of the model and the overall dimensions are presented in the table below:

| Assembled
Kit Case | Description | Assembled Kit
Case
Dimension
(L x W x H) | Component
Number | Component
Dimension
(L x W x H) |
|-----------------------|--------------------------------|---------------------------------------------------|---------------------|---------------------------------------|
| CD1030001 | Drill Stop Pre-
Mounted Kit | 195 x 90 x 34,
mm | 703279 (Lid) | 195 x 90 x 16 mm |
| | | | 703278 (Tray) | 180 x 76 x 23 mm |
| | | | 212.197 (Base) | 188 x 84 x 32 mm |
| CD1030002 | Drill Stop Kit | 195 x 90 x 34,
mm | 703279 (Lid) | 195 x 90 x 16 mm |
| | | | 703278 (Tray) | 180 x 76 x 23 mm |
| | | | 212.197 (Base) | 188 x 84 x 32 mm |

Note: The instrument and accessory devices that are sterilized and stored within the subject Kit Cases are not themselves subject devices of this submission.

5

TECHNOLOGICAL CHARACTERISTIC COMPARISON

SUBJECT DEVICEPRIMARY PREDICATE DEVICE
NUVO Instrument Kit Cases
JJGC Indústria e Comércio de Materiais
Dentários S.A.K192670
Neodent Instrument Kit Cases JJGC
Indústria e Comércio de Materiais
Dentários S.A.COMPARISON
Indications
for Use
StatementIndications for Use for Drill Stop Pre-Mounted Kit and Drill Stop Kit:
Instrument Kit Cases are intended to be used to enclose other medical devices that are to be sterilized by a health care provider. Instrument Kit Cases are intended to allow sterilization of the enclosed medical devices. Instrument Kit Cases require the use of FDA cleared wrap to maintain the sterility of the enclosed devices.
The kits are to be enclosed in a sterilization wrap that is FDA-cleared for the indicated cycles, and moist heat (steam) sterilized using one of the following cycles:
Fractionated vacuum (pre-vacuum) — Exposure at 132 °C for 4 minutes, 20-minute dry time.
Gravity displacement — Exposure at 132 °C for 15 minutes, 45-minute dry time.
Instrument Kit Cases are intended for sterilization of non-porous loads. The combined weight of the GM Surgical Kit Case and the associated instruments is 613.1 g. The weight of the empty Kit Case is 510 grams.
Instrument Kit Cases should not to be stacked during sterilization.Indications for Use for GM Surgical Kit Case:
Neodent Instrument Kit Cases are intended to be used to enclose other medical devices that are to be sterilized by a health care provider. Neodent Instrument Kit Cases are intended to allow sterilization of the enclosed medical devices. Neodent Instrument Kit Cases require the use of FDA cleared wrap to maintain the sterility of the enclosed devices.
The kits are to be enclosed in a sterilization wrap that is FDA-cleared for the indicated cycles, and moist heat (steam) sterilized using one of the following cycles:
Fractionated vacuum (pre-vacuum) — Exposure at 132 °C for 4 minutes, 20-minute dry time.
Gravity displacement — Exposure at 132 °C for 15 minutes, 40-minute dry time.
Neodent Instrument Kit Cases are intended for sterilization of non-porous loads.
The combined weight of the GM Surgical Kit Case and the associated instruments is 613.1 g. The weight of the empty Kit Case is 510 grams. Neodent Instrument Kit Cases should not to be stacked during sterilization.
Indications for Use for GM Helix Compact Surgical Kit Case:
Neodent Instrument Kit Cases are intended to be used to enclose other medical devices that are to be sterilized by a health care provider. Neodent Instrument Kit Cases are intended to allow sterilization of the enclosed medical devices. Neodent Instrument Kit Cases require the use of FDA cleared wrap to maintain the sterility of the enclosed devices.
The kits are to be enclosed in a sterilization wrap that is FDA-cleared for the indicated cycles, and moist heat (steam) sterilized using one of the following cycles:
Fractionated vacuum (pre-vacuum) — Exposure at 132 °C for 4 minutes, 20-minute dry time
Gravity displacement — Exposure at 132 °C for 15 minutes, 20-minute dry time.
Neodent Instrument Kit Cases are intended for sterilization of non-porous loads.
The combined weight of the GM Helix Compact Surgical Kit Case and the associated instruments is 308.2 g. The weight of the empty Kit Case is 231 grams. Neodent Instrument Kit Cases should not to be stacked during sterilization.Similar
SUBJECT DEVICEPRIMARY PREDICATE DEVICE
NUVO Instrument Kit Cases
JJGC Indústria e Comércio de Materiais
Dentários S.A.K192670
Neodent Instrument Kit Cases
JJGC Indústria e Comércio de Materiais
Dentários S.A.COMPARISON
Intended
UseThe kit is used for the safe storage of
surgical instruments, as well as for support
during sterilization.The GM Helix Compact Surgical Kit Case is
suitable for safe storage of surgical and
prosthetic
instruments, organizing
the
instruments in the sequence in which they will
be used, as well as for sterilization of such
instruments.Similar
DesignRigid polysulfone polymer base and
removable inner tray with a
polyphenylsulfone lid.
Retention grommets of polyphenylsulfone.Rigid polysulfone polymer base and
removable inner tray with a
polyphenylsulfone lid.
Retention grommets of medical grade
silicone.Similar
PerforatedYes; allows moist heat (steam) penetration
to achieve sterilizationYes; allows moist heat (steam) penetration
to achieve sterilizationIdentical
ReusableYesYesIdentical
Overall
dimensionsCD1030001: 195 L x 90 W x 34 H, mm110.288: 264 L x 163 W x 54 H, mmSimilar
CD1030002: 195 L x 90 W x 34 H, mm110.297: 195 L x 90 W x 64 H, mm
Volume to
Vent RatioCD1030001: 46.8 cm³/ cm² (18.4 in³/in²)110.288: 98.04 cm³/cm² (38.6 in³/in²)Similar
CD1030002: 46.8 cm³/ cm² (18.4 in³/in²)110.297: 63.5 cm³/cm² (25.0 in³/in²)
Useful LifeYes, reusable up to 100 cyclesYes, reusable up to 100 cyclesIdentical
BiocompatibilityThe assessment to Biocompatibility was
performed per ISO 10993-1 and testing was
performed using methods described in
AAMI/ANSI/ISO
10993-5.
The
results
indicate that the subject devices are
biocompatible.The assessment to Biocompatibility was
performed per ISO 10993-1 and testing was
performed using methods described in
AAMI/ANSI/ISO 10993-5. The results indicate
that the subject devices are biocompatible.Identical
Sterilization
MethodMoist heat (steam) to a SAL of 10-6Moist heat (steam) to a SAL of 10-6Identical
CyclesGravity displacementGravity displacementIdentical
SUBJECT DEVICEPRIMARY PREDICATE DEVICE
Neodent Instrument Kit Cases
JJGC Indústria e Comércio de Materiais
Dentários S.A.K192670
Neodent Instrument Kit Cases
JJGC Indústria e Comércio de Materiais
Dentários S.A.COMPARISON
ParametersGravity
Sterilization temperature: 132 °C
Sterilization time: 15 minutes;
Drying time: 45 minutes
Pre-Vacuum
Sterilization temperature: 132 °C
Sterilization time: 4 minutes;
Drying time: 20 minutes.Gravity
Sterilization temperature: 132 °C
Sterilization time: 15 minutes;
Drying time: 40 minutes (model number
110.288) or 20 minutes (model number
110.297)
Pre-Vacuum
Sterilization temperature: 132 °C
Sterilization time: 4 minutes;
Drying time: 20 minutes.Similar
Sterile BarrierSterilization wrap, FDA-cleared for
indicated method and cyclesSterilization pouch, FDA-cleared for indicated
method and cyclesIdentical

6

7

The subject devices and the primary predicate device per K192670 have the same intended use and have similar Indications for Use Statements. The subject devices and the primary predicate devices are reusable rigid containers used to organize and protect dental surgical instruments that are sterilized by the healthcare provider. The subject device and the primary predicate device components are perforated to allow for penetration of the moist heat (steam) sterilant and require the use of an FDA-cleared wrap or pouch to maintain sterility.

The subject devices and the primary predicate device include components manufactured from polyphenylsulfone and polysulfone. The subject device is provided in two different configurations and same size, whereas the primary predicate device is provided in four two different size and configurations. The overall dimensions of the subject device are similar to the range of overall dimensions cleared for the predicate devices. The subject device and the predicate devices are to be used according to the validated labeling (sterilization processes and cycles).

SUMMARY OF NON-CLINICAL PERFORMANCE DATA

Standard or Test MethodPurpose of the TestingAcceptance CriteriaResults
CustomManual cleaning validation Test Soil: Blood Soil (BLSO) Cleaning Method: Manual Residuals Tested: Hemoglobin and ProteinVisual Inspection: No Visible Soil Hemoglobin Test: