(93 days)
Wishbone HA is intended for the following uses:
· Filling of infrabony periodontal defects;
· Filling of periodontal defects in conjunction with products intended for guided tissue regeneration and guided bone regeneration:
· Filling of defects after root resection, apicectomy and cystectomy;
- · Filling of extraction sockets to enhance preservation of the alveolar ridge;
- · Augmentation or reconstructive treatment of the alveolar ridge;
- · Elevation of the maxillary sinus floor;
· Filling of peri-implant defects in conjunction with products intended for guided bone regeneration.
Wishbone HA is a xenograft biomaterial composed of deproteinized hydroxyapatite from bovine origin. It is intended to fill, augment, or reconstruct periodontal defects and/or bony defects of the upper or lower jaw.
Wishbone HA is supplied as a mix of cancellous and cortical particles size 0.25 to 1.0 mm) in a single use thermoformed blister, packaged in a secondary thermoformed blister and sterilized by gamma irradiation.
The device is intended to be used in medical procedures, by a qualified physician (academically trained dentists, periodontists and oral surgeons).
This document is an FDA 510(k) summary for the medical device "Wishbone HA," a bone grafting material. It details the device's characteristics, intended use, and a comparison to a predicate device (Geistlich Bio-Oss), along with performance data to support its substantial equivalence.
Based on the provided text, the document describes performance testing for substantial equivalence of a bone grafting material (Wishbone HA) to a predicate device (Geistlich Bio-Oss). This is not an artificial intelligence (AI) or software-as-a-medical-device (SaMD) study, so many of the requested criteria regarding AI model performance, ground truth, and human reader studies are not applicable.
However, I can extract the relevant information regarding the device's acceptance criteria and the studies performed to demonstrate its equivalence.
Here's a breakdown of the information as it relates to the provided document:
1. A table of acceptance criteria and the reported device performance
The document does not explicitly present a table of acceptance criteria with reported performance in a quantitative manner for specific benchmarks. Instead, it describes various tests performed to demonstrate "substantial equivalence" to a predicate device. The general "acceptance criteria" here appear to be demonstrating equivalence across several key characteristics and performance aspects.
| Acceptance Criteria (Implied by Study Type) | Reported Device Performance |
|---|---|
| Chemical Analysis (Composition, Purity) | Confirmed for Wishbone HA |
| Phase Composition Analysis | Confirmed for Wishbone HA |
| Protein and Organic Content Analysis | Confirmed for Wishbone HA (0% organic compounds) |
| Morphology Analysis | Confirmed for Wishbone HA (Mix of cancellous and cortical granules) |
| Porosity Analysis | Confirmed for Wishbone HA |
| pH Analysis | Confirmed for Wishbone HA |
| Dissolution Analysis | Confirmed for Wishbone HA |
| Mechanical Evaluation | Confirmed for Wishbone HA |
| Biocompatibility in accordance with ISO 10993 series | Test results confirmed Wishbone HA is biocompatible for the stated intended use. |
| In-vivo performance (canine mandibular defect model) | Biocompatibility and regeneration showed similar results to defects treated with the predicate device (Bio-Oss®) at 26 weeks. |
| Viral Inactivation | Manufacturing processes capable of achieving at least a 6-log viral reduction of selected model viruses. |
| Sterilization (SAL of 10^-6 via gamma irradiation) | Validation of sterilization dose conducted following VDmax method; conforms to EN ISO 11137 series. |
| Shelf Life (36 months) | Shelf life study supports 36 months; confirmed packaging integrity and sterility. |
| Packaging integrity and sterility (various ASTM/EN ISO standards) | Confirmed (validation studies conform to listed standards). |
2. Sample size used for the test set and the data provenance
- Non-Clinical Bench Testing: The document states "Wishbone HA was the subject of the full range of physical and chemical bench testing characterization tests." It does not specify sample sizes for each test but implies adequate testing for characterization.
- Non-Clinical Animal Performance Testing: "A pre-clinical GLP study was performed in canine mandibular defect model system in Beagle dogs." The exact number of dogs is not specified, but "Beagle dogs" implies a cohort. This is prospective animal data.
- Biocompatibility Testing: "Wishbone HA was the subject of a range of biocompatibility tests in accordance with ISO 10993 series." No specific sample sizes given, but implies standardized testing.
- Viral Inactivation Studies: "The results of the viral inactivation studies showed that the raw material and device manufacturing processes...". No specific sample size is given.
- Sterilization, Packaging, Shelf Life Studies: Validation studies were performed according to specified standards. No explicit sample sizes are provided, but these studies typically involve specific sample numbers defined by the standards.
Data Provenance: The studies were performed to support an FDA 510(k) submission, suggesting they were conducted in a controlled environment (e.g., GLP for animal studies) by the manufacturer or their designated testing facilities. The canine study is "pre-clinical GLP," indicating a controlled, prospective animal study.
3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts
This section is not applicable as the document describes the substantial equivalence of a physical medical device (bone graft material), not an AI/SaMD product requiring expert ground truth for classification/detection tasks. The "ground truth" here is the physical and chemical properties and biological performance of the device itself and its comparison to a legally marketed predicate. The experts involved would be laboratory scientists, veterinarians (for animal studies), and potentially pathologists for tissue analysis.
4. Adjudication method (e.g. 2+1, 3+1, none) for the test set
This section is not applicable. Adjudication methods like 2+1 or 3+1 refer to a consensus process among human readers, typically for image interpretation in AI/SaMD studies. This document concerns a physical device and its material properties/biological performance, which are evaluated through scientific measurements and observations, not reader consensus.
5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance
This section is not applicable. This is not an AI/SaMD product, so no MRMC studies involving human readers and AI assistance were performed or are relevant.
6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done
This section is not applicable. This is not an algorithm or AI product.
7. The type of ground truth used (expert consensus, pathology, outcomes data, etc)
The "ground truth" for this medical device is established through:
- Physical and Chemical Bench Testing: Direct measurement of material properties (e.g., chemical composition via analytical techniques, porosity, pH).
- Biocompatibility Testing: In vitro and in vivo tests against established ISO standards.
- Animal Performance Testing (Histopathology/Clinical Observations): Evaluation of tissue response, bone regeneration, and local effects in a canine model, likely through histological analysis and other veterinary assessments, compared to the predicate device.
- Sterilization & Packaging Validation: Conformance to recognized international standards (e.g., ISO, ASTM).
Essentially, the ground truth is based on scientific measurements, established international standards, and animal model outcomes.
8. The sample size for the training set
This section is not applicable. This is a physical medical device; there is no "training set" in the context of machine learning or AI.
9. How the ground truth for the training set was established
This section is not applicable. As there is no training set for an AI model, there is no ground truth for it. The "ground truth" for the device itself is established through the robust testing methodologies described above.
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Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health & Human Services logo on the left and the FDA logo on the right. The FDA logo features the letters "FDA" in a blue square, followed by the words "U.S. FOOD & DRUG ADMINISTRATION" in blue text.
August 20, 2021
Wishbone SA Emilie Dory Operations Manager 1, Rue de 1'Expansion Flemalle, Liege 4400 BELGIUM
Re: K211551
Trade/Device Name: Wishbone HA Regulation Number: 21 CFR 872.3930 Regulation Name: Bone Grafting Material Regulatory Class: Class II Product Code: NPM Dated: June 7, 2021 Received: June 8, 2021
Dear Emilie Dory:
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.
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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 Andrew Steen Assistant Director DHT1B: Division of Dental Devices OHT1: Office of Ophthalmic, Anesthesia, Respiratory, ENT and Dental Devices Office of Product Evaluation and Ouality Center for Devices and Radiological Health
Enclosure
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Indications for Use
510(k) Number (if known)
Device Name Wishbone HA
Indications for Use (Describe)
Wishbone HA is intended for the following uses:
· Filling of infrabony periodontal defects;
· Filling of periodontal defects in conjunction with products intended for guided tissue regeneration and guided bone regeneration:
· Filling of defects after root resection, apicectomy and cystectomy;
- · Filling of extraction sockets to enhance preservation of the alveolar ridge;
- · Augmentation or reconstructive treatment of the alveolar ridge;
- · Elevation of the maxillary sinus floor;
· Filling of peri-implant defects in conjunction with products intended for guided bone regeneration.
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)
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510(k) Summary
1. SUBMITTER
| Submitter Name: | Wishbone SA |
|---|---|
| Submitter Address: | 1, Rue de l'Expansion,4400 Flémalle - Belgium |
| Phone Number: | +32484706172 |
| Contact Person: | Emilie Dory |
| Date Prepared: | 20 August 2021 |
| 2. DEVICE | |
| Device Trade Name: | Wishbone HA |
| Common Name: | Bone graft material |
| Classification Name,Number &Product Code: | Bone grafting material21 CFR 872.3930NPM |
| Class: | II |
| Classification Panel: | Dental |
3. PREDICATE DEVICE
K122894, Geistlich Bio-Oss, Geistlich Pharma AG Primary Predicate Device:
4. REFERENCE DEVICE
Reference Device: No reference device was used in this submission
5. DEVICE DESCRIPTION
Wishbone HA is a xenograft biomaterial composed of deproteinized hydroxyapatite from bovine origin. It is intended to fill, augment, or reconstruct periodontal defects and/or bony defects of the upper or lower jaw.
Wishbone HA is supplied as a mix of cancellous and cortical particles size 0.25 to 1.0 mm) in a single use thermoformed blister, packaged in a secondary thermoformed blister and sterilized by gamma irradiation.
The device is intended to be used in medical procedures, by a qualified physician (academically trained dentists, periodontists and oral surgeons).
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6. INDICATIONS FOR USE
Wishbone HA is intended for the following uses:
- Filling of infrabony periodontal defects .
- Filling of periodontal defects in conjunction with products intended for guided tissue . regeneration and guided bone regeneration
- Filling of defects after root resection, apicectomy and cystectomy
- . Filling of extraction sockets to enhance preservation of the alveolar ridge
- . Augmentation or reconstructive treatment of the alveolar ridge
- Elevation of the maxillary sinus floor ●
- Filling of peri-implant defects in conjunction with products intended for quided bone . regeneration.
7. COMPARISON OF TECHNOLOGICAL CHARACTERISTICS WITH PREDICATE DEVICE
| New Device | Primary Predicate Device | |
|---|---|---|
| Device name | Wishbone HA | Geistlich Bio-Oss |
| 510(k) Number | K211551 | K122894 |
| Manufacturer | Wishbone SA | Geistlich Pharma AG |
| Regulation Number | 872.3930 | 872.3930 |
| DeviceClassification Name | Bone grafting material | Bone grafting material |
| Product Code | NPM | NPM |
| Intended Use/Indications for use | • Filling of infrabony periodontal defects;• Filling of periodontal defects in conjunction with products intended for guided tissue regeneration and guided bone regeneration;• Filling of defects after root resection, apicectomy and cystectomy;• Filling of extraction sockets to enhance preservation of the alveolar ridge;• Augmentation or reconstructive treatment of the alveolar ridge• Elevation of the maxillary sinus floor;• Filling of peri-implant defects in conjunction with products intended for guided bone regeneration. | - Augmentation or reconstructive treatment of the alveolar ridge;- Filling of infrabony periodontal defects;- Filling of defects after root resection, apicoectomy, and cystectomy;- Filling of extraction sockets to enhance preservation of the alveolar ridge;- Elevation of the maxillary sinus floor;- Filling of periodontal defects in conjunction with products intended for Guided Tissue Regeneration (GTR) and Guided Bone Regeneration (GBR); and- Filling of peri-implant defects in conjunction with products intended for Guided Bone Regeneration (GBR). |
| Intended patientpopulation | Adults | Adults |
| Mode of action | Conductive bone graft | Conductive bone graft |
| Anatomical sites | Oral, Periodontal | Oral, Periodontal |
| Environment of use | Wishbone HA should only be usedby trained dentists, periodontists ororal surgeons. | Geistlich Bio-Oss® should only beused by trained dentists or oralsurgeons. |
| Sterilization | Gamma irradiation | Gamma irradiation |
| Reusability | Single use only | Single use only |
| Pyrogenicity | Non-pyrogenic | Non-pyrogenic |
| Packaging | Wishbone HA particles arepackaged in a single usethermoformed PETG(Polyethylene TerephthalateGlycol) blister (primary packaging)hermetically sealed with aTyvek®. This package is placed ina secondary thermoformed. | Double sterile barrier systemconsisting of a glass vial and anouter blister. |
| Source of materials | Bovine | Bovine |
| ChemicalComposition | Calcium: 30 - 40 % (w./w.)Phosphorous: 15 - 20 % (w./w.)Sodium: 0.0 - 1.0 % (w./w.)Magnesium: 0.0 - 1.0 % (w./w.)Summed up to 100% by mass: | From the original 510(k):Calcium: 35% - 40% (w./w.)Phosphorous: 13.5% - 18.5%(w./w.)Summed up to 100% by mass**: |
| - Hydroxyapatite $Ca_5(PO_4)_3OH$(CAS® 1306-06-5): ≥97%- $CaCO_3$ (CAS® 471-34-1)- $MgO$ * (CAS® 1309-48-4): ≤2%- $H_2O$ (CAS® 7732-18-5): ≤1%- Organic compounds: 0% | - Hydroxyapatite(Pentacalciumhydroxy-[tri]- phosphate $Ca_5(PO_4)_3(OH)$ )(93.6%),- Calcium carbonate ( $CaO_3$ )(3,4%)- Water (3%)- No organic components (0%) | |
| Crystalline phases | Hydroxyapatite > 95% | Hydroxyapatite |
| Dosage form | Mix of cancellous and corticalgranules | Cancellous granules or porousblock |
| Particle sizes | 0.25 - 1.0 mm | 0.25 - 1.0 mm (small particles)1.0 - 2.0 mm (large particles) |
| Product size (g) | 0.25, 0.5, 1.0, 2.0 | 0.25, 0.5, 2.0, 5.0 (0.25-1.0 mm)0.5, 2.0 (1.0-2.0 mm)For blocks: 1 X 1 X 2 cm (approx.) |
Table 1: Comparison of new device to predicate device
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| Biocompatibility testing | Chemical characterizationToxicological evaluationCytotoxicitySensitizationIntracutaneous Reactivity/IrritationAcute Systemic ToxicityMaterial Mediated PyrogenicityGenotoxicityImplantation | Per ISO 10993-1 for the intended use |
|---|---|---|
| -------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | -------------------------------------- |
- Wishbone HA is composed of only bovine bone without any added components. The magnesium oxide (MgO) is not added to Wishbone HA but rather naturally appears during the sintering process in the form of magnesium oxide crystals.
** Data taken from 510(k) summary of Straumann® Cerabone® (K173594) which uses K122894 Geistlich Bio-Oss as the predicate device.
Equivalences:
The intended use is the same, and the technological characteristics are essentially the same as those of the predicate, K122894, Geistlich Bio-Oss. Both devices are made of deproteinized hydroxyapatite from bovine origin, intended to be implemented as a bone graft matrix in periodontal or bony defects. Both devices are intended to be used by dental health care professionals (e.g. dentists, periodontists and oral surgeons). Both devices are intended for single patient use and sterilized by gamma irradiation.
Differences that are demonstrated to be substantially equivalent:
As indicated in Table 1 above, several differences with respect to technological characteristics were identified between Wishbone HA and the primary predicate, namely the chemical composition, crystalline phases, dosage form, specific surface area and the packaging configuration.
Performance testing was conducted to demonstrate substantial equivalence of Wishbone HA to the predicate device. The test results are summarized below.
8. PERFORMANCE DATA
- Non-Clinical Wishbone HA was the subject of the full range of physical and chemical bench testing characterization tests recommended in the FDA's "Class II Special Controls Guidance Documents: Dental Bone Grafting Devices". These bench tests included chemical analysis, phase composition analysis, protein and organic content analysis, morphology analysis, porosity analysis, pH analysis, dissolution analysis and mechanical evaluation.
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| Non-ClinicalanimalperformanceTesting | A pre-clinical GLP study was performed in canine mandibular defectmodel system in Beagle dogs to evaluate the in-vivo performance of theWishbone HA. In this study the local effects of implantation of WishboneHA in the target locations, as well as bone growth, at subchronic time-points (4, 12 and 26 weeks) were evaluated. |
|---|---|
| By all parameters assessed at the 26 weeks time-point of the study,biocompatibility and regeneration of defects treated with Wishbone HAshowed similar results to defects treated with the predicate device, Bio-Oss®. | |
| Biocompatibility | Wishbone HA was the subject of a range of biocompatibility tests inaccordance with ISO 10993 series. Test results confirmed that WishboneHA is biocompatible for the stated intended use. |
| Animal tissue | The methods of sourcing, collection and handling of the bovine-derivedbones were assessed to demonstrate compliance with relevantrequirements of ISO 22442 series and FDA guidance (2019). WishboneHA is provided free from organic residues. Protein content is routinelycontrolled during the production process. The manufacturing processincludes several steps intended to inactivate viruses. The results of the |
viral inactivation studies showed that the raw material and device manufacturing processes of the Wishbone HA are capable of achieving at least a 6-log viral reduction of selected model viruses which were tested.
- Sterilization Wishbone HA is provided sterile and is intended for single patient use only. Wishbone HA is sterilized with gamma irradiation to meet a and shelf life minimum sterility assurance level (SAL) of 106. Validation of the sterilization dose was conducted following VDmax method.
Shelf life study supports a shelf life of 36 months for Wishbone HA when stored under the recommended environmental conditions. The shelf life studies confirmed that the packaging maintains the integrity of the device and its sterility throughout the shelf life of the device.
Validation studies for sterilization, packaging and shelf life conform to the following standards:
| Standardreference | Standard title |
|---|---|
| EN ISO 11607-1:2020 | Packaging for terminally sterilized medical devices -Part 1: Requirements for materials, sterile barriersystems and packaging systems |
| EN ISO 11607-2:2020 | Packaging for terminally sterilized medical devices -Part 2: Validation requirements for forming, sealingand assembly processes |
| EN ISO 11137-1:2015/A2:2019 | Sterilization of health care products - Radiation - Part1: Requirements for development, validation androutine control of a sterilization process for medicaldevices |
| EN ISO 11137-2:2015 | Sterilization of health care products - Radiation - Part2: Establishing the sterilization dose |
| EN ISO 11137-3:2017 | Sterilization of health care products - Radiation - Part3: Part 3: Guidance on dosimetric aspects ofdevelopment, validation and routine control |
| EN ISO 11737-1:2018 | Sterilization of medical devices - Microbiologicalmethods - Part 1: Determination of a population ofmicroorganisms on products |
| EN ISO 11737-2:2009 | Sterilization of health care products - Microbiologicalmethods - Part 2: Tests of sterility performed in thedefinition, validation and maintenance of a sterilizationprocess |
| EN 868-5:2009 | Packaging for terminally sterilized medical devices -Part 5: Sealable pouches and reels of porousmaterials and plastic film construction - Requirementsand test methods |
| ASTM F88F88M-15 | Standard Test Method for Seal Strength of FlexibleBarrier Materials |
| ASTMF1886F1886M-16 | Standard Test Method for Determining Integrity ofSeals for Flexible Packaging by Visual Inspection |
| ASTM F1929-15 | Standard Test Method for Detecting Seal Leaks inPorous Medical Packaging by Dye Penetration |
| ASTM F1980-16 | Standard Guide for Accelerated Aging of SterileBarrier Systems for Medical Devices |
| ASTM D642-15 | Standard Test Method for Determining CompressiveResistance of Shipping Containers, Components, andUnit Loads |
| ASTM D6344-04(2017) | Standard Test Method for Concentrated Impacts toTransport Packages |
| ASTM D999-08(2015) | Standard Test Methods for Vibration Testing ofShipping Containers |
| ASTM D4169-16 | Standard Practice for Performance Testing of ShippingContainers and Systems |
| ASTM D4332-14 | Standard Practice for Conditioning Containers.Packages, or Packaging Components for Testing |
| ASTM D4728-17 | Standard Test Method for Random Vibration Testing ofShipping Containers |
| ASTM D5276-98(2017) | Standard Test Method for Drop Test of Loaded Containers by Free Fall |
| EN ISO 11140-1:2014 | Sterilization of health care products - Chemical indicators - Part 1: General requirements |
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9. CONCLUSION
The information discussed above and provided in the 510(k) submission demonstrate that the Wishbone HA is substantially equivalent to the predicate.
§ 872.3930 Bone grafting material.
(a)
Identification. Bone grafting material is a material such as hydroxyapatite, tricalcium phosphate, polylactic and polyglycolic acids, or collagen, that is intended to fill, augment, or reconstruct periodontal or bony defects of the oral and maxillofacial region.(b)
Classification. (1) Class II (special controls) for bone grafting materials that do not contain a drug that is a therapeutic biologic. The special control is FDA's “Class II Special Controls Guidance Document: Dental Bone Grafting Material Devices.” (See § 872.1(e) for the availability of this guidance document.)(2) Class III (premarket approval) for bone grafting materials that contain a drug that is a therapeutic biologic. Bone grafting materials that contain a drug that is a therapeutic biologic, such as biological response modifiers, require premarket approval.
(c)
Date premarket approval application (PMA) or notice of product development protocol (PDP) is required. Devices described in paragraph (b)(2) of this section shall have an approved PMA or a declared completed PDP in effect before being placed in commercial distribution.