K Number
K232498
Date Cleared
2023-08-18

(1 days)

Product Code
Regulation Number
872.3765
Panel
Dental
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

UltraSeal XT plus bioprotection by Nobio sealant - UltraSeal XT plus sealant for prophylactic sealing of pits and fissures and can be used where the use of a flowable composite is indicated. The bioprotection by Nobio reduces demineralization, which is part of the caries formation process.

UltraSeal XT hydro bioprotection by Nobio sealant - Use UltraSeal XT hydro sealant for prophylactic sealing of pits and fissures. The addition of the bioprotection by Nobio reduces demineralization, which is part of the caries formation process.

Device Description

UltraSeal XT plus bioprotection by Nobio sealant and flowable composite – UltraSeal XT plus sealant is a 58% filled, light-cured, radiopaque, methacrylate-based, thixotropic resin sealant. It is used with PrimaDry drying and priming agent to aid in avoiding moisture contamination which can cause microleakage and poor retention. It is a Type 1 Class 2 Group 1 polymer-based dental restorative flowable resin which is suitable for occlusal surfaces. It can be used where the use of a flowable is indicated. It is compatible with adhesives and bonding agents. UltraSeal XT plus sealant has a radiopacity value of 1.44 mm of aluminum. Aluminum has a radiopacity equivalent to that of dentin. Thus, 1 mm of material (having a radiopacity equivalent to 1 mm of aluminum) has a radiopacity equivalent to that of dentin-and 2 mm of aluminum is equivalent to enamel. The addition of the bioprotection by Nobio reduces demineralization, which is part of the caries formation process.

UltraSeal XT hydro bioprotection by Nobio sealant – UltraSeal XT hydro sealant is a Class 2, 53% filled, light-cured, radiopaque, methacrylate-based, thixotropic resin sealant. It is partly hydrophobic and hydrophilic before it is cured, hydrophobic once cured, and has a selfadhesive quality. UltraSeal XT hydro sealant chemistry provides the option of a visual verification for marginal retention-with the use of a black light upon placement and at recall visits. The UV light is not included in the UltraSeal XT hydro sealant kit. The addition of the bioprotection by Nobio reduces demineralization, which is part of the caries formation process.

Some of the silica-based filler particles (max 1.2% wt/wt of the total formulation) contained in all the UltraSeal XT plus Bioprotection by Nobio and UltraSeal XT hydro Bioprotection by Nobio are decorated with quaternary ammonium functional groups that are covalently bound to the filler particles' silica core via a silane linker (herein referred to as "QASi"). Following light induced polymerization, QASi particles (produced by Nobio) remain permanently entrapped within the sealant and destroy microorganisms by contact. As the cell membrane of microorganisms is negatively charged and the QASi particles have strong positive charges, microorganisms are electrostatically attracted to the positively charged cured material's surface resulting in disruption of their cell membrane and immediate microbial lysis.

Both subject devices have a depth of cure ≥ 1.5mm, are curable at wavelengths of 385-515nm and will remain uncured after light exposure while in their primary container. UltraSeal XT plus Bioprotection by Nobio is also indicated for use as a flowable composite. It has a flexural strength of ≥ 80 MPa, Water Sortpion ≤ 40 µ g/mm3, Water Solubility ≤ 7.5 µ g/mm3, Radio-Opacity, ≥ 1mm of Al, Surface Hardness ≥ 20 HK and Ambient light sensistivity resulting in the product being physically homogeneous after 60 seconds.

AI/ML Overview

The provided text focuses on the substantial equivalence determination for dental sealants and does not contain information about a medical device involving AI or machine learning. Therefore, I cannot extract acceptance criteria and study details related to AI/ML device performance from this document.

The document discusses physical and chemical properties of dental sealants and their biocompatibility, which are typically evaluated through bench testing and ISO standards, not through clinical studies with human readers or AI algorithms. As such, information regarding sample sizes for test sets, data provenance, expert adjudication, MRMC studies, standalone performance, training sets, or ground truth establishment in the context of AI/ML is absent.

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

August 18, 2023

Ultradent Product, Inc. % Dave Yungvirt CEO Third Party Review Group, LLC 25 Independence Blvd Warren, New Jersey 07059

Re: K232498

Trade/Device Name: UltraSeal XT plus - Bioprotection by Nobio, UltraSeal XT hydro - Bioprotection by Nobio Regulation Number: 21 CFR 872.3765 Regulation Name: Pit and fissure sealant and conditioner Regulatory Class: Class II Product Code: EBC, EBF Dated: August 14, 2023 Received: August 17, 2023

Dear Dave Yungvirt:

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 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.

Michael E. Adjodha -S

Michael E. Adjodha, M.ChE. Assistant Director DHT1B: Division of Dental and ENT Devices OHT1: Office of Ophthalmic, Anesthesia, Respiratory, ENT and Dental Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K232498

Device Name UltraSeal XT plus Bioprotection by Nobio UltraSeal XT hydro Bioprotection by Nobio

Indications for Use (Describe)

UltraSeal XT plus bioprotection by Nobio sealant - UltraSeal XT plus sealant for prophylactic sealing of pits and fissures and can be used where the use of a flowable composite is indicated. The bioprotection by Nobio reduces demineralization, which is part of the caries formation process.

UltraSeal XT hydro bioprotection by Nobio sealant - Use UltraSeal XT hydro sealant for prophylactic sealing of pits and fissures. The addition of the bioprotection by Nobio reduces demineralization, which is part of the caries formation process.

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)
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------

|X Prescription Use (Part 21 CFR 801 Subpart D)

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

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K232498

510(k) Summary

This summary of the 510(k) substantial equivalence information is being submitted in accordance with the requirements of 21 CFR 807.92 UltraSeal XT plus Bioprotection by Nobio and UltraSeal XT plus Bioprotection by Nobio.

I. Applicant's Name and Address

Ultradent Product, Inc. 505 West Ultradent Drive (10200 South) South Jordan, UT 84095

Contact Person:Ruth Gardner
Title:Regulatory Affairs Specialist II
Telephone:801-553-4431
Fax:801-553-4609
Date Summary Prepared:July 31, 2023

II. Name of the Device

Device:Pit and fissure sealant and conditioner
Trade/Device Name:UltraSeal XT plus Bioprotection by NobioUltraSeal XT hydro Bioprotection by Nobio
Common Name:Sealant, pit and fissure, and conditionerMaterial, Tooth Shade, Resin
Review Panel:Dental
Regulation Number:21 CFR 872.3765
Device Class:Class II
Classification Product Code:EBC, EBF

III. Device Description

UltraSeal XT plus bioprotection by Nobio sealant and flowable composite – UltraSeal XT plus sealant is a 58% filled, light-cured, radiopaque, methacrylate-based, thixotropic resin sealant. It is used with PrimaDry drying and priming agent to aid in avoiding moisture contamination which can cause microleakage and poor retention. It is a Type 1 Class 2 Group 1 polymer-based dental restorative flowable resin which is suitable for occlusal surfaces. It can be used where

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the use of a flowable is indicated. It is compatible with adhesives and bonding agents. UltraSeal XT plus sealant has a radiopacity value of 1.44 mm of aluminum. Aluminum has a radiopacity equivalent to that of dentin. Thus, 1 mm of material (having a radiopacity equivalent to 1 mm of aluminum) has a radiopacity equivalent to that of dentin-and 2 mm of aluminum is equivalent to enamel. The addition of the bioprotection by Nobio reduces demineralization, which is part of the caries formation process.

The dimensions of filler particles are as follows:

ComponentParticle size(μm)
Aluminum Oxide≤ 0.05
Glass1.5 ± 0.25

The percentage by volume of filler particles is 33% (total fillers, 19.2 mL/total volume, 57.90 mL* 100)

UltraSeal XT plussealant shadeVITA 3D-MASTER®*Shade Guide
A2 OpaqueA2

*Not a registered trademark of Ultradent Products, Inc.

UltraSeal XT hydro bioprotection by Nobio sealant – UltraSeal XT hydro sealant is a Class 2, 53% filled, light-cured, radiopaque, methacrylate-based, thixotropic resin sealant. It is partly hydrophobic and hydrophilic before it is cured, hydrophobic once cured, and has a selfadhesive quality. UltraSeal XT hydro sealant chemistry provides the option of a visual verification for marginal retention-with the use of a black light upon placement and at recall visits. The UV light is not included in the UltraSeal XT hydro sealant kit. The addition of the bioprotection by Nobio reduces demineralization, which is part of the caries formation process.

Some of the silica-based filler particles (max 1.2% wt/wt of the total formulation) contained in all the UltraSeal XT plus Bioprotection by Nobio and UltraSeal XT hydro Bioprotection by Nobio are decorated with quaternary ammonium functional groups that are covalently bound to the filler particles' silica core via a silane linker (herein referred to as "QASi"). Following light induced polymerization, QASi particles (produced by Nobio) remain permanently entrapped within the

sealant and destroy microorganisms by contact. As the cell membrane of microorganisms is negatively charged and the QASi particles have strong positive charges, microorganisms are electrostatically attracted to the positively charged cured material's surface resulting in disruption of their cell membrane and immediate microbial lysis.

Both subject devices have a depth of cure ≥ 1.5mm, are curable at wavelengths of 385-515nm and will remain uncured after light exposure while in their primary container. UltraSeal XT plus Bioprotection by Nobio is also indicated for use as a flowable composite. It has a flexural

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strength of ≥ 80 MPa, Water Sortpion ≤ 40 µ g/mm3, Water Solubility ≤ 7.5 µ g/mm3, Radio-Opacity, ≥ 1mm of Al, Surface Hardness ≥ 20 HK and Ambient light sensistivity resulting in the product being physically homogeneous after 60 seconds.

IV. Statement of Intended Use

UltraSeal XT plus bioprotection by Nobio sealant – UltraSeal XT plus sealant for prophylactic sealing of pits and fissures and can be used where the use of a flowable composite is indicated. The addition of the bioprotection by Nobio reduces demineralization, which is part of the caries formation process.

UltraSeal XT hydro bioprotection by Nobio sealant – Use UltraSeal XT hydro sealant for prophylactic sealing of pits and fissures. The addition of the bioprotection by Nobio reduces demineralization, which is part of the caries formation process.

V. Predicate Device

Predicate Identified:UltraSeal XT plus K993846
UltraSeal XT hydro K112517
Infinix Universal Composite, Infinix Flowable Composite,
Infinix Bulk Fill Flow Composite K201010

VII. Comparison of Technological Characteristics

Predicate technological comparison:

The technology, delivery, and intended use of UltraSeal XT plus bioprotection by Nobio and UltraSeal XT hydro bioprotection by nobio are substantially equivalent to the identified predicate as outlined in Table 5-1:

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Table 5-1

UltraSeal XT plus Bioprotection by Nobio:

DescriptiveInformation/characteristicDevice:UltraSeal XT plus bioprotection byNobioPredicate: UltraSeal XT plus (K993846)Identified Characteristic Differences andRationale for Differences
Product CodeEBCEBFEBCSame
Indications forUseUltraSeal XT plus sealant for prophylacticsealing of pits and fissures and can beused where the use of a flowablecomposite is indicated. The addition of thebioprotection by Nobio reducesdemineralization, which is part of thecaries formation process.UltraSeal XT plus sealant for prophylacticsealing of pits and fissures and can be usedwhere the use of a flowable composite isindicated.Similar - Subject device introduces the NobioQASi particles.
RecognizedStandardsISO 6874ISO 4049ISO 13485ISO 14971ISO 10993 SeriesISO 7405IEC 62366-1ISO 6874ISO 4049ISO 13485ISO 14971ISO 10993 SeriesISO 7405IEC 62366-1Similar
Intended UserLicensed Dentist or Dental ProfessionalLicensed Dentist or Dental ProfessionalSame
Characteristics• Prophylactic sealing of pits and Fissures• Flowable, light cured material.• Nobio QASi Antimicrobial technology• Prophylactic sealing of pits and Fissures• Flowable, light cured material.Similar - Subject device introduces the NobioQASi particles.
Composition• Methacrylates• Anti-Bacterial (QASi particles)• Photo-initiators• Methacrylates• Photo-initiator• Glass fillersSimilar - Subject device introduces the NobioQASi particles.
• Source of fluoride• Glass filler• Colorant• ColorantSource of fluoride
Delivery Systemor DeploymentMethodsSyringe with tipSyringe with tipSame
PhysicalProperties• Pit & Fissure Sealant, Flowable Composite• Pit & Fissure Sealant, Flowable CompositeSame
• Depth of cure $≥ 1.5mm$• Depth of cure $≥ 1.5 mm$Same
• Curable at wavelengths of 385-515 nm• Cures with wavelengths of 385 – 515 nmSimilar
• Curing Intensity $≥ 800 mW/cm2$• Curing Intensity $≥ 800 mW/cm2$Similar
• Curing time 10 seconds• Curing time 10 secondsSame
• ISO 4049:2019• ISO 4049:2019Similar
• ISO 4049:2019 - Flexural Strength• ISO 4049:2019 - Flexural strengthSimilar
• Filler Particle Size: Aluminum Oxide $≤ 0.05μm$• Filler Particle Size: Aluminum Oxide $≤ 0.05μm$Similar, filler differences contribute tohandling and usability differences in products
• Glass $1.5 ± 0.25μm$• Glass $1.5 ± 0.25μm$
• QASi antibacterial Nano Fillers
• Water sorption - ISO 4049:2019• Water sorption - ISO 4049:2019Similar
• Water solubility - ISO 4049:2019• Water solubility – ISO 4049:2019Similar
• Radio-Opacity - ISO 4049:2019• Radio-opacity - ISO 4049:2019Similar
• Surface Hardness $≥ 20 HK$• Surface hardness $≥ 20 HK$Similar – Reference device value is unknown
• Fluoride releasing• Fluoride releasingThe subject device and predicate device are both fluoride releasing. The reference device does not include fluoride
• Nobio QASi particles• N/ASimilar – the subject device includes the Nobio QASi particles
• Shade: A2 Opaque shade (off-white to light yellow)• Shades: Opaque White, Clear, A1, A2Similar
• Hydrophobic• HydrophobicSimilar
Biocompatibilityand SafetyTested per ISO 7405, ISO 10993-1• Physical/Chemical Information• Cytotoxicity• Sensitization• Irritation• Acute System Toxicity• Subacute Systemic Toxicity• Genotoxicity• Implantation EffectsTested per ISO 7405, ISO 10993-1• Cytotoxicity• Sensitization• MutagenicityUltraSeal XT plus Bioprotection by Nobio, predicate and reference device is shown to be biocompatible.

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UltraSeal XT hydro Bioprotection by Nobio:

DescriptiveInformation/characteristicUltraSeal XT hydro bioprotection byNobioPredicate: UltraSeal XT hydro (K112517)Identified Characteristic Differences andRationale for Differences
Product CodeEBCEBCSame
Indications forUseUse UltraSeal XT hydro sealant forprophylactic sealing of pits and fissures.The addition of the bioprotection byNobio reduces demineralization, which ispart of the caries formation process.Use UltraSeal XT hydro sealant for prophylacticsealing of pits and fissures.Similar - Subject device introduces the NobioQASi particles.
RecognizedStandardsISO 6874ISO 13485ISO 14971ISO 10993 SeriesISO 7405IEC 62366-1ISO 6874ISO 13485ISO 14971ISO 10993ISO 7405IEC 62366-1Similar
Intended UserLicensed Dentist or Dental ProfessionalLicensed Dentist or Dental ProfessionalSame.
Characteristics• Prophylactic sealing of pits and Fissures• Nobio QASi Antimicrobial technology• Prophylactic sealing of pits and FissuresSimilar - Subject device introduces the NobioQASi particles.
Composition• Methacrylates• Anti-Bacterial (QASi particles)• Lowering pH• Photo-initiator• Source of fluoride• Colorant• Glass filler• Methacrylates• Photo-initiator• Glass fillers• Colorant• Source of fluorideSimilar - Subject device introduces the NobioQASi particles.
Delivery Systemor DeploymentMethodsSyringe with tipSyringe with tipSame
PhysicalProperties• Pit & Fissure Sealant• Pit & Fissure SealantSame
• Depth of cure ≥ 1.5mm• Depth of Cure ≥ 1.5 mmSame
• Curable at wavelengths of 385-515 nm• Curable at wavelengths of 385-515 nmSimilar
• Curing Time 10 seconds• Curing Time 10 secondsSame
• Nobio QASi particles• N/ASimilar - the subject device includes the NobioQASi particles
• Fluoresces• FluorescesThe subject and predicate device have afluorescing feature. The reference device doesnot.
• Curing Intensity ≥ 800 mW/cm2• Curing Intensity ≥ 800 mW/cm2Similar
• Shade: A2 Opaque shade (off-white tolight yellow)• Shades: Opaque White, and NaturalShadesSimilar
• Hydrophilic• HydrophilicSimilar
Biocompatibilityand SafetyTested per ISO 7405, ISO 10993-1• Physical/Chemical Information• Cytotoxicity• Sensitization• Irritation• Acute System Toxicity• Subacute Systemic Toxicity• Genotoxicity• Implantation EffectsTested per ISO 7405, ISO 10993-1•Irritation•Cytotoxicity•Sensitization•MutagenicityUltraSeal XT plus Bioprotection by Nobio,predicate and reference device is shown to bebiocompatible.

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VIII Non-Clinical Performance Testing:

Non-clinical and biological testing was completed to assess the performance and biocompatibility of the UltraSeal XT plus Bioprotection by Nobio and UltraSeal XT hydro Bioprotection by Nobio and to support substantial equivalence. The data provided in this 510(k) submission shows that the sealant is biocompatible based on the biocompatibility assessment conducted as per ISO 10993 and ISO 7405 and performs as intended based on the bench testing per ISO 4049 and ISO 6874. The list of these tests is provided in Table 5-1.

Biocompatibility:
Chemical Characterization
MEM Elution Assay
Guinea Pig Maximization Sensitization
Oral Mucosal Irritation Test
Bench Testing:
UltraSeal XT plus Bioprotection by Nobio
Depth of Cure
Curable at Wavelengths 385-515 nm
Flexural Strength
Ambient Light Sensitivity
Water Sorption
Water Solubility
Radio-opacity
Knoop Hardness
Opaque Delivery System
Medium Viscosity Liquid
Fluoride Release
Hydrophobic Components
Shade and Color
Inclusion of Nobio QASi Particles
UltraSeal XT hydro Bioprotection by Nobio
Depth of Cure
Curable at Wavelengths 385-515 nm
Opaque Delivery System
Fluoride Release
Fluorescing Agent
Shade and Color
Hydrophilic Components
Inclusion of Nobio QASi Particles

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Conclusion:

The predicate and subject devices have identical indications for use with a slight variation highlighting the inclusion of the Nobio QASi particles that reduces demineralization. Reference device, Infinix Flowable composite (K201010), intended for use as a flowable composite and/or pit and fissure sealant, incorporates the same Nobio QASi particles that reduces demineralization. Like the predicate devices, the subject devices utilized ISO 6874 and ISO 4049 to evaluate performance aspects of the devices. Safety is further proven by testing conducted to ISO 10993-1 and ISO 7405 supporting the biological safety of the devices. Lastly, device efficacy is met with clinical acceptance as being an effective pit and fissure sealant and as a flowable restorative (UltraSeal XT plus Bioprotection by Nobio only) through simulated use testing with representative users. As such, the differences in indications for use between the predicate and subject devices does not impact safety or effectiveness of the devices.

Based on this, the similar intended use and testing information presented above for the predicate products, UltraSeal XT plus and UltraSeal XT hydro, and the subject products, UltraSeal XT plus Bioprotection by Nobio and UltraSeal XT hydro Bioprotection by Nobio, are substantially equivalent.

§ 872.3765 Pit and fissure sealant and conditioner.

(a)
Identification. A pit and fissure sealant and conditioner is a device composed of resin, such as polymethylmethacrylate, intended for use primarily in young children to seal pit and fissure depressions (faults in the enamel) in the biting surfaces of teeth to prevent cavities.(b)
Classification. Class II.