K Number
K984505
Device Name
MIRACLE MIX POWDER/LIQUID
Manufacturer
Date Cleared
1999-02-04

(48 days)

Product Code
Regulation Number
872.3275
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Miracle Mix is a powder and liquid self cure silver alloy glass ionomer cement intended for core build ups, restoration of primary teeth, as a base or a liner, for Class I, limited class II, temporary fillings and in cases where radiopacity is required.
Device Description
Miracle Mix is a powder and liquid self cure silver alloy glass ionomer cement.
More Information

Not Found

Not Found

No
The summary describes a dental cement and does not mention any AI or ML capabilities.

No.
The "Intended Use / Indications for Use" states that Miracle Mix is a dental cement for restorations and fillings, which are not considered therapeutic interventions under typical medical device classifications.

No
The device is a cement used for dental restoration and core build-ups, which are treatment procedures, not diagnostic ones.

No

The device description clearly states it is a "powder and liquid self cure silver alloy glass ionomer cement," which are physical materials, not software.

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

Here's why:

  • Intended Use: The intended use describes a material used for dental restorations and procedures within the mouth (core build ups, fillings, bases, liners). This is a therapeutic or restorative use, not a diagnostic one.
  • Device Description: The description confirms it's a dental cement.
  • Lack of IVD Characteristics: There is no mention of analyzing samples from the human body (blood, urine, tissue, etc.) to provide diagnostic information about a disease or condition.

IVDs are used to perform tests on biological samples to diagnose, monitor, or screen for diseases or conditions. This device is a material used to repair or restore teeth.

N/A

Intended Use / Indications for Use

Miracle Mix is a powder and liquid self cure silver alloy glass ionomer cement intended for core build ups, restoration of primary teeth, as a base or a liner, for Class I, limited class II, temporary fillings and in cases where radiopacity is required.

Product codes

EMA

Device Description

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Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

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

Not Found

Key Metrics

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

Image /page/0/Picture/1 description: The image shows the logo for the Department of Health & Human Services - USA. The logo is a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is a stylized image of three human profiles facing right, stacked on top of each other, with flowing lines beneath them.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

FEB 4 1999

Ms. Terry L. Joritz Director-Regulatory Affairs & Quality Control Official Correspondent GC AMERICA INCORPORATED 3737 West 127th Street Alsip, Illinois 60803

K984505 Re : Miracle Mix Powder/Liquid Trade Name: Requlatory Class: II Product Code: EMA December 16, 1998 Dated: Received: December 18, 1998

Dear Ms. Joritz:

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 The general controls provisions of the Act 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 regulations 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 Good Manufacturing Practice for Medical Devices: General (GMP) regulation (21 CFR Part 820) and that, through periodic GMP inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP requlation may result in requlatory action. In addition, FDA may publish further announcements concerning your device in the Federal Register. Please note: this response to your premarket notification submission does not affect any obligation you might have under sections 531 through 542 of

1

Page 2 - Ms. Joritz

the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or regulations.

This letter will allow you to begin marketing your device as described in your 510(k) premarket notification. The FDA & bling of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits 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) 594-4692. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to
premarket notification" (21 CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its internet address "http://www.fda.gov/cdrh/dsmamain.html".

Sincerely yours,

Timothy A. Ulatowski

Direčtbr Division of Dental, Infection Control, and General Hospital Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

K984505

-9-

INDICATIONS FOR USE

Miracle Mix Powder/Liquid Modification Device Name: _

Indications for Use: Miracle Mix is a powder and liquid self cure silver alloy glass ionomer cement intended for core build ups, restoration of primary teeth, as a base or a liner, for Class I, limited class II, temporary fillings and in cases where radiopacity is required.

(Division Sign-Off) Division of Beach Infection Control, and General Fros Mai Dr. Mar

510(k) Number _