K Number
K222451
Device Name
SAVE GBR
Manufacturer
Date Cleared
2023-02-07

(176 days)

Product Code
Regulation Number
872.3630
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
SAVE GBR is a metal device intended for use with a dental implant to stabilize and support of bone graft in dentoalveolar bony defect sites.
Device Description
The SAVE GBR consists of Healing Cap, Cover Cap and Spacer. The SAVE GBR are manufactured by Ti-6A1-4V ELI and used with a dental implant to stabilize and support of bone graft in dento-alveolar bony defect sites. The subject device is compatible with the OssBuilder membrane cleared in K172354. The dimension of the device is as below: | No. | Product | Diameter | Length | |-----|-------------|--------------|---------------| | 1 | Healing Cap | Ø4.5 and 5.5 | 6.0 and 7.0mm | | 2 | Cover Cap | Ø4.5 | 4.0mm | | 3 | Spacer | Ø4.5 | 7.2 and 8.2mm | The healing cap and cover cap have same functions and uses but have different design and name. The SAVE GBR are removed from the patient after such time when sufficient bone regeneration is done.
More Information

No
The device is a passive metal implant for stabilizing bone graft, with no mention of software, algorithms, or data processing that would indicate AI/ML.

Yes
The device is intended to stabilize and support bone graft in dentoalveolar bony defect sites, which is a therapeutic action aimed at regenerating bone.

No

The device is described as a metal device intended to physically stabilize and support bone grafts with a dental implant, which is a therapeutic and structural function, not a diagnostic one.

No

The device description explicitly states it is a "metal device" consisting of physical components (Healing Cap, Cover Cap, and Spacer) made of Ti-6A1-4V ELI. The performance studies also focus on physical properties like sterilization, biocompatibility, and MRI compatibility, not software validation.

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

Here's why:

  • Intended Use: The intended use is to "stabilize and support of bone graft in dentoalveolar bony defect sites." This is a direct therapeutic and structural function within the patient's body.
  • Device Description: The device is a "metal device" consisting of physical components (Healing Cap, Cover Cap, Spacer) made of Ti-6A1-4V ELI. It is used with a dental implant and is removed from the patient.
  • Lack of IVD Characteristics: IVDs are used to examine specimens (like blood, urine, or tissue) outside the body to provide information for diagnosis, monitoring, or screening. The SAVE GBR does not interact with biological specimens in this way.

The device is clearly an implantable or temporarily implanted medical device used in a surgical procedure for bone regeneration support.

N/A

Intended Use / Indications for Use

SAVE GBR is a metal device intended for use with a dental implant to stabilize and support of bone graft in dento-alveolar bony defect sites.

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

NHA

Device Description

The SAVE GBR consists of Healing Cap, Cover Cap and Spacer. The SAVE GBR are manufactured by Ti-6A1-4V ELI and used with a dental implant to stabilize and support of bone graft in dento-alveolar bony defect sites.

The subject device is compatible with the OssBuilder membrane cleared in K172354.

The dimension of the device is as below:

No. Product Diameter Length
1 Healing Cap Ø4.5 and 5.5 6.0 and 7.0mm
2 Cover Cap Ø4.5 4.0mm
3 Spacer Ø4.5 7.2 and 8.2mm

The healing cap and cover cap have same functions and uses but have different design and name. The SAVE GBR are removed from the patient after such time when sufficient bone regeneration is done. The compatible fixture with the subject device is as below.

No. Trade Name Product Name Fixture Size K number
1 s-Clean SQ-SL Implant System Regular s-Clean SQ-SL Fixture Ø5.2 x 7.0, 7.5, 9.5, 11.5 and 13.5 K210132

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

dento-alveolar bony defect sites

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 are submitted, referenced, or relied upon to demonstrate substantial equivalence.

Sterilization and Shelf Life:
The sterilization and shelf life test were performed on predicate healing abutment, K171027 and can be leveraged for subject device since both devices have the same material, sterilization method, packaging method, and manufacturing process as the subject device according to ISO11137-1, ISO11137-2 and ISO11737-3.

Bacterial Endotoxin Test according to ANSI/AAMI ST72:2011, USP , and USP for subject device was referenced in K210080.

Since endotoxin testing cannot be conducted on every batch in our company, alternative to batch testing was chosen with the sampling plan used for the in-process testing and/or finished product release, as recommended in the FDA guidance, Pyrogen and Endotoxins Testing: Questions and Answers".

Reverse Engineering
The pores of the Osstem non-resorbable membranes (K172354) which attach to the abutment were measured and compared to the diameters of the subject device in order to demonstrate compatibility.

Biocompatibility Evaluation:
Biocompatibility tests according to ISO 10993-1 performed on the abutments of K210080 can be leveraged for the subject device because both devices have same material and manufacturing process.

MR Environment Condition:
Non-clinical worst-case MRI review was performed to evaluate the GBR System in the MRI environment using scientific rationale and published literature (e.g., Woods, Terry O., Jana G. Delfino, and Sunder Rajan. " Assessment of Magnetically Induced Displacement Force and Torque on Metal Alloys Used in Medical Devices." Journal of Testing and Evaluation 49.2 (2019): 783-795), based on the entire system including all variations (all compatible implant bodies, dental abutments, and fixation screws) and material composition. Rationale addressed parameters per the FDA guidance "Testing and Labeling Medical Devices for Safety in the Magnetic Resonance (MR) Environment," including magnetically induced displacement force and torque

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.

K172354

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.

K171027, K181854, K140600, K210080

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, there is the Department of Health & Human Services logo. To the right of that is the FDA logo, which consists of the letters "FDA" in a blue square, followed by the words "U.S. FOOD & DRUG" in blue, and then the word "ADMINISTRATION" in a smaller font size below.

Dentis Co., Ltd. % April Lee Consultant Withus Group Inc 106 Superior Irvine, California 92620

Re: K222451

Trade/Device Name: SAVE GBR Regulation Number: 21 CFR 872.3630 Regulation Name: Endosseous Dental Implant Abutment Regulatory Class: Class II Product Code: NHA Dated: January 5, 2023 Received: January 6, 2023

Dear April Lee:

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

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

2

Indications for Use

510(k) Number (if known)

Device Name SAVE GBR

Indications for Use (Describe)

SAVE GBR is a metal device intended for use with a dental implant to stabilize and support of bone graft in dentoalveolar bony defect sites.

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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510(k) Summary

Submitter

Dentis Co., Ltd. Gyu Ri Kim 99, Seongseoseo-ro, Dalseo-gu Daegu, 42718 Korea Email: kgr1026@dentis.co.kr Tel. +82-53-589-3541 Fax. +82-53-289-7922

Device Information

  • . Trade Name: SAVE GBR
  • Common Name: GBR System
  • Classification Name: Endosseous Dental Abutment ●
  • . Product Code: NHA
  • Panel: Dental
  • Regulation Number: 872.3630
  • Device Class: Class II
  • Date prepared: 02/07/2023 ●

Predicate Devices:

Primary Predicate K172354, Ossbuilder System by Osstem Implant Co., Ltd

Reference Device K171027, Dentis Dental Implant System by Dentis Co., Ltd. K181854, Ossbuilder System by Osstem Implant Co., Ltd K140600, SMARTbuilder by Osstem Implant Co., Ltd. K210080, Dentis s-Clean s-Line Mini by Dentis Co., Ltd.

Indication for Use:

SAVE GBR is a metal device intended for use with a dental implant to stabilize and support of bone graft in dento-alveolar bony defect sites.

Device Description:

The SAVE GBR consists of Healing Cap, Cover Cap and Spacer. The SAVE GBR are manufactured by Ti-6A1-4V ELI and used with a dental implant to stabilize and support of bone graft in dento-alveolar bony defect sites.

The subject device is compatible with the OssBuilder membrane cleared in K172354.

The dimension of the device is as below:

No.ProductDiameterLength
1Healing CapØ4.5 and 5.56.0 and 7.0mm
2Cover CapØ4.54.0mm
3SpacerØ4.57.2 and 8.2mm

Official Correspondent

Withus Group Inc. April Lee 106 Superior, Irvine, CA 92620 USA Email: withus6664@gmail.com Phone: 1-909-274-9971 Fax: 1-909-460-8122

4

The healing cap and cover cap have same functions and uses but have different design and name. The SAVE GBR are removed from the patient after such time when sufficient bone regeneration is done. The compatible fixture with the subject device is as below.

No.Trade NameProduct NameFixture SizeK number
1s-Clean SQ-SL Implant
System Regulars-Clean SQ-SL FixtureØ5.2 x 7.0, 7.5, 9.5,
11.5 and 13.5K210132

Summaries of Technology Characteristics

The subject device is substantially equivalent to the current cleared devices. They are substantially equivalent in intended use, material and product spec as diameter and length. Comparison demonstrating Substantial Equivalence follows:

1. Healing Cap
Subject DevicePrimary PredicateReference Device
ApplicantDentis Co., Ltd.Osstem Implant Co., LtdOsstem Implant Co., Ltd
Trade NameSAVE GBROssbuilder SystemOssbuilder System
510(k) No.K222451K172354K181854
Classification NameEndosseous Dental AbutmentEndosseous Dental AbutmentEndosseous Dental Abutment
Product CodeNHAJEY, NHADZL, NHA
ClassClass IIClass IIClass II
DescriptionImage: Subject DeviceImage: Primary PredicateImage: Reference Device
MaterialTi-6Al-4V ELI (ASTM F136)Pure Titanium (ASTM F67)Ti-6Al-4V ELI (ASTM F136)
DiameterØ4.5 and Ø5.5Ø4.0 and Ø5.0Ø4.0 and Ø5.0
Length (mm)6.0 and 7.0mm7.0 and 8.0mm7.0 and 8.0mm
SterileGamma SterilizationGamma SterilizationGamma Sterilization
Shelf Life8 years8 years8 years
Indications For Use/
Intended UseSAVE GBR is a metal device
intended for use with a dental
implant to stabilize and
support of bone graft in dento-
alveolar bony defect sites.OssBuilder System is a metal
device intended for use with a
dental implant to stabilize and
support of bone graft in
dento-alveolar bony defect
sites.OssBuilder System is a metal
device intended for use with a
dental implant to stabilize and
support of bone graft in
dento-alveolar bony defect
sites.
FeaturesHealing Cap is used with
internal type of anchor.Healing Cap is used with
internal type of anchor.Healing Cap is used with
internal type of anchor.
Principles of operationUsed with non-resorbable
membrane for bone
regenerationUsed with non-resorbable
membrane for bone
regenerationUsed with non-resorbable
membrane for bone
regeneration
Substantial
Equivalence
ComparisonThe subject healing cap is substantially equivalent in designs, material, indications,
sterilization, shelf life, compatible membrane, and technological characteristics with the
primary device (K172354). The difference between the subject and primary predicate is
material. To support the different material, K181854 was added which is Ti-6Al-4V ELI
(ASTM F136). Therefore, the subject device is substantial equivalent.
  1. Healing Cap

5

  1. Cover Cap
Subject DevicePrimary Device
ApplicantDentis Co., Ltd.Osstem Implant Co., Ltd
Trade NameSAVE GBROssbuilder System
510(k) No.K222451K172354
Classification NameEndosseous Dental AbutmentEndosseous Dental Abutment
Product CodeNHAJEY, NHA
ClassClass IIClass II
DescriptionImage: T shaped device
MaterialTi-6Al-4V ELI (ASTM F136)Ti-6Al-4V ELI (ASTM F136)
DiameterØ4.5Ø4.0
Length (mm)4.0mm4.3mm
SterileGamma SterilizationGamma Sterilization
Shelf Life8 years8 years
Indications For Use/
Intended UseSAVE GBR is a metal device intended for use
with a dental implant to stabilize and support
of bone graft in dento-alveolar bony defect
sites.OssBuilder System is a metal device intended
for use with a dental implant to stabilize and
support of bone graft in dento-alveolar bony
defect sites.
FeatureThe Cover Cap is used with internal type of
Anchor.The Cover Cap is used with internal type of
anchor
Principles of operationUsed with non-resorbable membrane for bone
regenerationUsed with non-resorbable membrane for bone
regeneration
Substantial
Equivalence
ComparisonThe subject cover cap is substantially equivalent in designs, material, indications,
sterilization, shelf life, compatible membrane, and technological characteristics with the
primary predicate (K172354). The difference between the subject and primary predicate is
dimension. The difference of diameter and length is not important to affect the function of
safety. Therefore, the subject device is substantial equivalent.

3. Spacer

Subject DevicePrimary DeviceReference Device
ApplicantDentis Co., Ltd.Osstem Implant Co., LtdOsstem Implant Co., Ltd
Trade NameSAVE GBROssbuilder SystemOssbuilder System
510(k) No.K222451K172354K140600
Classification NameEndosseous Dental AbutmentEndosseous Dental AbutmentEndosseous Dental Abutment
Product CodeNHAJEY, NHANHA
ClassClass IIClass IIClass II
DescriptionImage: Subject DeviceImage: Primary DeviceImage: Reference Device
MaterialTi-6Al-4V ELI (ASTM F136)Ti-6Al-4V ELI (ASTM F136)Ti-6Al-4V ELI (ASTM F136)
DiameterØ4.5Ø3.1~5.0Ø3.2~5.1

6

Length (mm)7.2 and 8.2mm4.45~9.57.0~15
SterileGamma SterilizationGamma SterilizationGamma Sterilization
Shelf Life8 years8 years8 years
Indications For Use/
Intended UseSAVE GBR is a metal device
intended for use with a dental
implant to stabilize and
support of bone graft in
dento-alveolar bony defect
sites.OssBuilder System is a metal
device intended for use with a
dental implant to stabilize and
support of bone graft in dento-
alveolar bony defect sites.SMART Builder System is a
metal device intended for use
with a dental implant to
stabilize and support of bone
graft in dento-alveolar bony
defect sites.
FeatureThe Spacer is external type of
anchorThe OB Anchor is internal type
of anchorThe SB Anchor is external
type of anchor
Principles of operationUsed with non-resorbable
membrane for bone
regenerationUsed with non-resorbable
membrane for bone
regenerationUsed with non-resorbable
membrane (K120951) for
bone regeneration
Substantial
Equivalence
ComparisonThe subject spacer is substantially equivalent in general design, dimensions, material,
indications, sterilization, shelf life, compatible membrane, and technological characteristics
with the primary predicate (K172354). The difference between the subject and primary
predicate is design, especially head screw shape. To support this discrepancy, K140600 was
added, which has the similar shape of the device. Therefore, the subject device is substantial
equivalent.

Non-Clinical Testing

Non-clinical testing data are submitted, referenced, or relied upon to demonstrate substantial equivalence.

Sterilization and Shelf Life:

The sterilization and shelf life test were performed on predicate healing abutment, K171027 and can be leveraged for subject device since both devices have the same material, sterilization method, packaging method, and manufacturing process as the subject device according to ISO11137-1, ISO11137-2 and ISO11737-3.

Bacterial Endotoxin Test according to ANSI/AAMI ST72:2011, USP , and USP for subject device was referenced in K210080.

Since endotoxin testing cannot be conducted on every batch in our company, alternative to batch testing was chosen with the sampling plan used for the in-process testing and/or finished product release, as recommended in the FDA guidance, Pyrogen and Endotoxins Testing: Questions and Answers".

Reverse Engineering

The pores of the Osstem non-resorbable membranes (K172354) which attach to the abutment were measured and compared to the diameters of the subject device in order to demonstrate compatibility.

Biocompatibility Evaluation:

Biocompatibility tests according to ISO 10993-1 performed on the abutments of K210080 can be leveraged for the subject device because both devices have same material and manufacturing process.

7

MR Environment Condition:

Non-clinical worst-case MRI review was performed to evaluate the GBR System in the MRI environment using scientific rationale and published literature (e.g., Woods, Terry O., Jana G. Delfino, and Sunder Rajan. " Assessment of Magnetically Induced Displacement Force and Torque on Metal Alloys Used in Medical Devices." Journal of Testing and Evaluation 49.2 (2019): 783-795), based on the entire system including all variations (all compatible implant bodies, dental abutments, and fixation screws) and material composition. Rationale addressed parameters per the FDA guidance "Testing and Labeling Medical Devices for Safety in the Magnetic Resonance (MR) Environment," including magnetically induced displacement force and torque

Conclusion

In accordance with the Federal Food, Drug and Cosmetic Act, 21 CFR Part 807, and based on the information provided in this premarket notification, Dentis Co., Ltd. concludes that the SAVE GBR is substantially equivalent to the predicate devices as herein.