K Number
K222144
Device Name
IR SLA Type Implant System
Manufacturer
Date Cleared
2023-06-14

(329 days)

Product Code
Regulation Number
872.3640
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
IR SLA Type Implant System is indicated for use in partially or fully edentulous mandibles and maxillae, in support of single or multiple-unit restorations including; cemented retained, or overdenture restorations, and terminal or intermediate abutment support for fixed bridgework. IR SLA Type Implant System is for one stage surgical procedures. It is intended for delayed loading. IR SLA Type Implant System is intended only for straight placement with no correction of angulation.
Device Description
The IR SLA Type Implant System is a dental implant system made of CP Ti Gr 4, intended to be surgically placed in the bone of the upper or lower jaw arches for loading after a conventional healing period. The implant may be used to replace one or more missing teeth. The system is similar to other commercially available products based on the intended use, the technology used, the claims, the material composition employed and performance characteristics. The system has been treated with S.L.A.
More Information

No
The summary describes a standard dental implant system and does not mention any AI or ML components, image processing, or data sets for training/testing.

Yes
The device is a dental implant system surgically placed to replace missing teeth, which is a therapeutic intervention.

No

Explanation: The device description states it is a "dental implant system" intended to be surgically placed, which is a therapeutic function, not a diagnostic one.

No

The device description explicitly states it is a "dental implant system made of CP Ti Gr 4, intended to be surgically placed in the bone," indicating it is a physical hardware device, not software only.

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

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections.
  • Device Description: The description clearly states that the IR SLA Type Implant System is a dental implant system made of CP Ti Gr 4, intended to be surgically placed in the bone of the jaw.
  • Intended Use: The intended use is to support dental restorations in partially or fully edentulous mandibles and maxillae.

The device is a surgically implanted medical device, not a diagnostic test performed on a sample outside the body.

N/A

Intended Use / Indications for Use

IR SLA Type Implant System is indicated for use in partially or fully edentulous mandibles and maxillae, in support of single or multiple-unit restorations including; cemented retained, or overdenture restorations, and terminal or intermediate abutment support for fixed bridgework. IR SLA Type Implant System is for one stage surgical procedures. It is intended for delayed loading. IR SLA Type Implant System is intended only for straight placement with no correction of angulation.

Product codes

DZE, NHA

Device Description

The IR SLA Type Implant System is a dental implant system made of CP Ti Gr 4, intended to be surgically placed in the bone of the upper or lower jaw arches for loading after a conventional healing period. The implant may be used to replace one or more missing teeth. The system is similar to other commercially available products based on the intended use, the technology used, the claims, the material composition employed and performance characteristics. The system has been treated with S.L.A.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

partially or fully edentulous mandibles and maxillae

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)

The subject device was tested to evaluate its performance as below.

  • Sterilization validation testing for sterile devices (fixtures) has been performed in accordance with ISO 11137, ISO 11737-1 & ISO 11737-2 for gamma sterilization
  • Steam sterilization validation for non-sterile devices (abutments) has been performed in accordance with ISO 17665-1 and 17665-2.
  • Surface characteristics test report Chemical and SEM image analysis have been performed to verify that there is no residual after SLA treatment on the fixtures.
  • Cytotoxicity test performed according to ISO 10993-5:2009
  • Sensitization test performed according to ISO 10993-10:2010
  • LAL Endotoxin lot release testing according to USP
  • Shelf-life testing performed according to ISO 11607

Those tests have been performed to evaluate the substantial equivalence in the surface characteristics compared to the predicate device. The result of the above tests has met the standard, and proved the substantial equivalence with the predicate device. Non-clinical testing consisted of a performance of testing in accordance with the FDA guidance "Class II Special Controls Guidance Document Root-Form Endosseous Dental Implants and Endosseous Dental Implant Abutments." The result of the non-clinical testing demonstrates that the subject device is substantially equivalent to the predicate device.

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

Not Found

Predicate Device(s)

Biotem IR Type Implant System (K171185)

Reference Device(s)

AR N SLA Type Implant System (K190641)

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 872.3640 Endosseous dental implant.

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

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Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). On the left is the seal of the Department of Health & Human Services. To the right of that is the FDA logo in blue, with the words "U.S. FOOD & DRUG" stacked on top of the word "ADMINISTRATION".

Biotem Co., Ltd. % Joyce Kwon CEO Provision Consulting Group, Inc. 100 N Barranca St. Suite 700 West Covina, California 91791

Re: K222144

Trade/Device Name: IR SLA Type Implant System Regulation Number: 21 CFR 872.3640 Regulation Name: Endosseous Dental Implant Regulatory Class: Class II Product Code: DZE, NHA Dated: May 15, 2023 Received: May 16, 2023

Dear Joyce Kwon:

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 mediation-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

Andrew I. Steen Assistant Director DHT1B: Division of Dental and ENT 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) K222144

Device Name IR SLA Type Implant System

Indications for Use (Describe)

IR SLA Type Implant System is indicated for use in partially or fully edentulous mandibles and maxillae, in support of single or multiple-unit restorations including; cemented retained, or overdenture restorations, and terminal or intermediate abutment support for fixed bridgework. IR SLA Type Implant System is for one stage surgical procedures. It is intended for delayed loading. IR SLA Type Implant System is intended only for straight placement with no correction of angulation.

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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Image /page/3/Picture/0 description: The image contains the logo for Provision Consulting Group. The logo features a stylized bird in a teal color, with its wings spread. To the right of the bird is the text "PROVISION" in a bold, sans-serif font, with the words "CONSULTING GROUP" in a smaller font below it. The overall design is clean and professional.

510(k) Summary

510(k) Submitter

Hong Koo Yeo Biotem Co., Ltd. 57, Sasang-ro, 401 beon-gil, Sasang-gu, Busan 46925 Republic of Korea +82-51-908-8257 info@provisionfda.com

Official Correspondent / Contact Person

Joyce Kwon, CEO/Principal Consultant Provision Consulting Group, Inc. 100 N. Barranca St. Suite 700 West Covina, CA 91791 +1-909-493-3276 joyce@provisionfda.com

Date Prepared

June 14,2023

Device Information

  • Trade Name: IR SLA Type Implant System ●
  • Model Name: IR SLA Dental Implant
  • . Common Name: Endosseous dental implant
  • Classification Name: Implant, Endosseous, Root-Form ●
  • Regulation Number: 21 CFR 872.3640 ●
  • . Device Class: Class II
  • Product Code: DZE, NHA ●

Predicate Devices

  • Biotem IR Type Implant System (K171185) ● Endosseous dental implant
    The predicates have not been subject to a design-related recall.

Reference Device

  • · AR N SLA Type Implant System (K190641)

Prior Submission Information

None

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Image /page/4/Picture/0 description: The image shows the logo for Provision Consulting Group. The logo features a stylized green bird on the left side. To the right of the bird are the words "PROVISION" in a larger, bold font, with the words "CONSULTING GROUP" underneath in a smaller font.

Indication for Use

IR SLA Type Implant System is indicated for use in partially or fully edentulous mandibles and maxillae, in support of single or multiple-unit restorations including; cemented retained, or overdenture restorations, and terminal or intermediate abutment support for fixed bridgework. IR SLA Type Implant System is for one stage surgical procedures. It is intended for delayed loading. IR SLA Type Implant System is intended only for straight placement with no correction of angulation.

Device Description

The IR SLA Type Implant System is a dental implant system made of CP Ti Gr 4, intended to be surgically placed in the bone of the upper or lower jaw arches for loading after a conventional healing period. The implant may be used to replace one or more missing teeth. The system is similar to other commercially available products based on the intended use, the technology used, the claims, the material composition employed and performance characteristics. The system has been treated with S.L.A.

Endosseous DiameterEndosseous Length (mm)
Ø 3.58.5, 10.0, 11.5, 13.0, 15.0
Ø 4.17.5, 8.5, 10.0, 11.5, 13.0, 15.0
Ø 4.87.5, 8.5, 10.0, 11.5, 13.0, 15.0
Ø 5.57.5, 8.5, 10.0, 11.5, 13.0, 15.0

Substantial Equivalent Comparison Chart with Predicate Device and Reference Device

Subject DevicePrimary Predicate DeviceReference Device
Device NameIR SLA Type Implant
SystemIR Type Implant SystemAR_N SLA Type
Implant System
510(k) NumberK222144K171185K190641
ManufacturerBiotem Co., Ltd.Biotem Co., Ltd.Biotem Co., Ltd.
Regulation
Number21 CFR 872.364021 CFR 872.364021 CFR 872.3640
Product codeDZE, NHADZE, NHADZE
ClassIIIIII
Indications for
UseIR SLA Type Implant
System is indicated for
use in partially or fully
edentulous mandibles
and maxillae, in support
of single or multiple-unit
restorations including;
cemented retained, screw
retained, or overdenture
restorations, and terminal
or intermediate abutment
support for fixed
bridgework. IR SLA
Type Implant System is
for one stage surgical
procedures. It is intended
for delayed loading. IR
SLA Type Implant
System is intended only
for straight placement
with no correction of
angulation.IR Type Implant System
is indicated for use in
partially or fully
edentulous mandibles
and maxillae, in support
of single or multiple-unit
restorations including;
cemented retained, screw
retained, or overdenture
restorations, and terminal
or intermediate abutment
support for fixed
bridgework. IR Type
Implant System is for
one stage surgical
procedures. It is intended
for delayed loading. IR
Implant System is
intended only for straight
placement with no
correction of angulation.AR_N SLA Type
Implant System is
indicated for use in
partially or fully
edentulous mandibles
and maxillae, in support
of single or multiple-unit
restorations including;
cemented retained, screw
retained, or overdenture
restorations, and terminal
or intermediate abutment
support for fixed
bridgework.
AR_N SLA Type
Implant System is for
two stage surgical
procedures. It is intended
for delayed loading.
DesignInternal Octa TaperedInternal Octa TaperedInternal Hex Submerged
Macro thread
MaterialCP Ti Gr 4 ASTM F67CP Ti Gr 4 ASTM F67CP Ti Gr 4 ASTM F67
SterilizationGamma sterilizationGamma sterilizationGamma sterilization
Fixture Diameter
(mm)Ø 3.5, 4.1, 4.8, 5.5Ø 3.5, 4.1, 4.8, 5.5Ø 3.7, 4.2, 4.6, 5.1, 6.0
Fixture Length
(mm)7.5, 8.5, 10.0, 11.5, 13.0,
15.07.5, 8.5, 10.0, 11.5, 13.0,
15.07.5, 8.5, 10.0, 11.5, 13.0,
15.0
Abutment
Diameter (mm)Ø 4.8, 6.0, 6.5 mmØ 4.8, 6.0, 6.5 mmØ 4.0 - 6.5 mm
Abutment Lengths
(mm)2.0, 3.0, 4.0, 5.5, 6.0, 7.0
mm2.0, 3.0, 4.0, 5.5, 6.0, 7.0
mm1.0 - 10.0 mm
Abutment Angled17°, 30°
AttachmentVarious abutments and
componentsVarious abutments and
componentsVarious abutments and
components
Surface treatmentSLARBMSLA

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Image /page/5/Picture/1 description: The image shows the logo for Provision Consulting Group. The logo features a stylized bird in flight, with its wings spread and feathers detailed. To the right of the bird is the text "PROVISION" in a bold, sans-serif font, with the words "CONSULTING GROUP" in a smaller font size underneath. The overall design is clean and professional.

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Image /page/6/Picture/0 description: The image shows the logo for Provision Consulting Group. The logo features a stylized bird in flight, with the word "PROVISION" in bold letters to the right of the bird. Below "PROVISION" is the text "CONSULTING GROUP" in a smaller font. The logo is simple and professional.

Comparison of Abutments with Predicate Device

Material: Titanium Grade 4 / ASTM F67 Sterilization: Non-Sterile

Closing Screw

Subject DevicePredicate Device (K171185)
SizesProduct CodesProduct Code
Mini/RegularCSI 4000CSI 4000
WideCSI 4805WCSI 4805W

Cover Screw

Subject DevicePredicate Device (K171185)
SizesProduct CodesProduct Code
MiniHAI 48601HAI 48601
Regular
Wide NeckHAI 60701HAI 60701

Healing Abutment

Subject DevicePredicate Device (K171185)
SizesProduct CodesHeightsProduct CodeHeights
HAI 486022HAI 486022
Mini/RegularHAI 486033HAI 486033
HAI 486044HAI 486044
Wide NeckHAI 607022HAI 607022
HAI 607044HAI 607044
HAI 607066HAI 607066

Solid Abutment

Subject DevicePredicate Device (K171185)
SizesProduct CodesHeightsDiameterProduct CodeHeightsDiameter
Mini/RegularSAIS 4835444.8SAIS 4835444.8
SAIS 483555.5SAIS 483555.5
SAIS 483577SAIS 483577

Wild Solid Abutment

SizesSubject DevicePredicate Device (K171185)
Product CodesHeightsDiameterProduct CodeHeightsDiameter
Mini/RegularSAIS 4843444.8SAIS 4843444.8
SAIS 484355.5SAIS 484355.5
SAIS 484377SAIS 484377
Wide NeckSAIS 604EW46.0SAIS 604EW46.0
SAIS 605EW5.5SAIS 605EW5.5
SAIS 607EW7SAIS 607EW7

Cemented Abutment

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Image /page/7/Picture/0 description: The image shows the logo for Provision Consulting Group. The logo features a stylized bird made of green leaves on the left side. To the right of the bird is the text "PROVISION" in a bold, sans-serif font, with the words "CONSULTING GROUP" in a smaller font below it.

Subject DevicePredicate Device (K171185)
SizesProduct CodesHeightsDiameterProduct CodeHeightsDiameter
MiniSAIT 4043444.8SAIT 4043444.8
SAIT 404355.5SAIT 404355.5
SAIT 404377SAIT 404377
RegularSAITB 4043444.8SAITB 4043444.8
SAITB 404355.5SAITB 404355.5
SAITB 404377SAITB 404377
Wide NeckSAITB 604EW46.0SAITB 604EW46.0
SAITB 605EW5.5SAITB 605EW5.5
SAITB 607EW7SAITB 607EW7

COM OCTA PLUS Abutment

Subject DevicePredicate Device (K171185)
SizesProduct CodesCuffDiameterProduct CodeHeightsDiameter
RegularSAITB 4826C24.8SAITB 4826C24.8
SAITB 4846C4SAITB 4846C4

Substantial Equivalence Discussion

The subject device, IR SLA Type Implant System has a substantially equivalent intended use as the identified predicate (K171185). Both are used for mandible and maxilla endosseous dental implant and accessories. The IR SLA Type Implant System has the same basic technology as the predicate device in that they all designed, manufactured and tested in accordance with FDA's Class II Special Controls Guidance Document Root-Form Endosseous Dental Implants and Endosseous Dental Implant Abutments. The subject and predicate devices are identical in size and material except for surface treatment. When compared with predicate devices, no new questions of substantially equivalence have been raised for the IR SLA Type Implant System.

S.L.A. surface is formed by undergoing the process of sandblasting with smaller than 50μm HA (Hydroxy Apa- tite) particles to roughen the machined surface and to form many macropores. After sand blasting and acid etching is done to increase B.I.C (Bone-Implant Contact) and promote cell's activity. With this process, the typical treatment period can be shortened and the patients will be more satisfied with the result.

Non-Clinical Testing

The subject device was tested to evaluate its performance as below.

  • Sterilization validation testing for sterile devices (fixtures) has been performed in ● accordance with ISO 11137, ISO 11737-1 & ISO 11737-2 for gamma sterilization
  • Steam sterilization validation for non-sterile devices (abutments) has been performed in ● accordance with ISO 17665-1 and 17665-2.
  • Surface characteristics test report Chemical and SEM image analysis have been ● performed to verify that there is no residual after SLA treatment on the fixtures.
  • Cytotoxicity test performed according to ISO 10993-5:2009
  • Sensitization test performed according to ISO 10993-10:2010 ●

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Image /page/8/Picture/1 description: The image shows the logo for Provision Consulting Group. The logo features a stylized green bird with outstretched wings on the left. To the right of the bird, the word "PROVISION" is written in a bold, sans-serif font, with the words "CONSULTING GROUP" in a smaller font below it.

  • LAL Endotoxin lot release testing according to USP
  • Shelf-life testing performed according to ISO 11607

Those tests have been performed to evaluate the substantial equivalence in the surface characteristics compared to the predicate device. The result of the above tests has met the standard, and proved the substantial equivalence with the predicate device. Non-clinical testing consisted of a performance of testing in accordance with the FDA guidance "Class II Special Controls Guidance Document Root-Form Endosseous Dental Implants and Endosseous Dental Implant Abutments." The result of the non-clinical testing demonstrates that the subject device is substantially equivalent to the predicate device.

Conclusion

The subject device and the predicate device have the same intended use and have the same technological characteristics. The subject and predicate implants are all made of commercially pure titanium and have the similar surface treatments.

Overall, the IR SLA Type Implant System has the following similarities to the predicate devices:

  • has the same intended use
  • uses the same operating principle ●
  • incorporates the same basic design ●
  • incorporates the same material

Based on the similarities, we conclude that the IR SLA Type Implant System is substantially equivalent to the predicate device.