K Number
K973370
Device Name
AQUAPLAST PALATAL STENT
Date Cleared
1997-12-02

(85 days)

Product Code
Regulation Number
872.3275
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
Dressing for use after intraoral palatal surgery.
Device Description
PS Thermoplastic (Aquaplast) Palatal Stent
More Information

Not Found

None

No
The summary describes a physical palatal stent made of thermoplastic material and does not mention any software, algorithms, or AI/ML related terms.

Yes
The device is a dressing for use after intraoral palatal surgery, which implies it is used for healing and support, thus contributing to therapy.

No
Explanation: The device is described as a "Dressing for use after intraoral palatal surgery" and a "PS Thermoplastic (Aquaplast) Palatal Stent," indicating it's a therapeutic or supportive device, not one used for diagnosis.

No

The device description explicitly states "PS Thermoplastic (Aquaplast) Palatal Stent," which is a physical, hardware-based device.

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

Here's why:

  • Intended Use: The intended use is "Dressing for use after intraoral palatal surgery." This describes a device used directly on or in the body for a therapeutic purpose (dressing a surgical site).
  • Device Description: The device is a "PS Thermoplastic (Aquaplast) Palatal Stent." This is a physical device designed to be placed in the mouth.
  • Lack of IVD Characteristics: IVDs are devices used to examine specimens derived from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening. The provided information does not mention any interaction with bodily specimens for diagnostic purposes.

Therefore, this device falls under the category of a medical device used for treatment or support, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

Dressing for use after intraoral palatal surgery.

Product codes

EMA

Device Description

Not Found

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

intraoral palatal

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)

Not Found

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

Not Found

Predicate Device(s)

Not Found

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 872.3275 Dental cement.

(a)
Zinc oxide-eugenol —(1)Identification. Zinc oxide-eugenol is a device composed of zinc oxide-eugenol intended to serve as a temporary tooth filling or as a base cement to affix a temporary tooth filling, to affix dental devices such as crowns or bridges, or to be applied to a tooth to protect the tooth pulp.(2)
Classification. Class I (general controls). The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 872.9.(b)
Dental cement other than zinc oxide-eugenol —(1)Identification. Dental cement other than zinc oxide-eugenol is a device composed of various materials other than zinc oxide-eugenol intended to serve as a temporary tooth filling or as a base cement to affix a temporary tooth filling, to affix dental devices such as crowns or bridges, or to be applied to a tooth to protect the tooth pulp.(2)
Classification. Class II.

0

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/0/Picture/2 description: The image is a black and white logo for the U.S. Department of Health & Human Services. The logo is circular in shape, with the words "DEPARTMENT OF HEALTH & HUM N SERVICES - USA" arranged around the top half of the circle. In the center of the logo is a stylized image of a caduceus, a symbol of medicine, with a staff entwined by two snakes.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

DEC - 2 1997

Mr. John R. Kirk ·President WFR/Aquaplast Corporation 30 Lawlins Park Wyckoff, New Jersey 07481-1443

K973370 Re : Aquaplast Palatal Stent Trade Name: Requlatory Class: II Product Code: EMA Auqust 25, 1997 Dated: Received: September 8, 1997

Dear Mr. Kirk:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to 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). You may, therefore, market the device, subject to the general controls provisions of the Act. 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.

If your device is classified (see above) into either class II (Special Controls) or class III (Premarket Approval), it may be subject to such additional controls. Existing major requlations affecting your device can be found in the Code of Federal Requlations, Title 21, Parts 800 to 895. A substantially equivalent determination assumes compliance with the current Good Manufacturing Practice requirement, as set forth in the Quality System Requlation (QS) for Medical Devices: General regulation (21 CFR Part 820) and that, through periodic (OS) inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP requlation may result in regulatory In addition, FDA may publish further announcements action. concerning your device in the Federal Reqister. Please note: this response to your premarket notification submission does

1

Page 2 - Mr. Kirk

not affect any obligation you might have under sections 531 not arrect any obtigation for devices under the Electronic Chrough 542 of the Act 101 acvices or other Federal laws or requlations.

This letter will allow you to begin marketing your device as Info icecci wirer 510(k) premarket notification. The FDA described in your sia equivalence of your device to a legally rinding of babbeanelar squared in a classification for your marketed production of mits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4618. Additionally, for questions on Compriance at (301) 331 1010. Indiarodevice, please contact the Office of Compliance at (301) 594-4639. Also, please note ens or on on on itled, "Misbranding by reference to
the regulation entitled, "Misbranding by reference to information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance obeathed from cho mumber (800) 638-2041 or (301) 443-6597 or at its internet address "http://www.fda.gov/cdrh/dsmamain.html".

Sincerely yours,

U. Walcott

Timot ny A. Director Division of Dental, Infection Control and General Hospital Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

Page 1_of 1

510(k) Number (if known):__K973370

Device Name: PS Thermoplastic (Aquaplast) Palatal Stent

Indications For Use:

Dressing for use after intraoral palatal surgery.

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)
Susan Bunres
(Division Sign-Om

Division of D and Gen 510(k) Number

Prescription Use (Per 21 CFR 801.109)

ાવ્યું

Over-The-Counter Use__________________________________________________________________________________________________________________________________________________________

(Optional Format 1-2-96)