K Number
K991221
Device Name
VESTOGUM
Manufacturer
Date Cleared
1999-05-20

(38 days)

Product Code
Regulation Number
872.3660
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
Gingiva Modeling Material for: Combination works when choosing and mounting the attachment, the papilla is fully preserved Telescopic works the shoulder of the crowns to be cut is indicated according to the gingiva contour Anterior tooth area with regard to esthetics and periodontal hygienics, the forming possibilities of the interdental spaces are increased Forming of different tooth lengths according to the natural conditions in the patient's mouth, they can be adapted in anatomically correct way; especially in bridge spans Color rating of the veneer material the material which is in color adapted to the gingiva, serves for more precise color matching Controlled modellation the cervical-incisal crown convexity for the protection of the gingival margin can be controlled
Device Description
VESTOGUM® is classified as a dental impression material (21 C.F.R. § 872.3660) because it is a device intended to be one step in the process to reproduce the structure of a patient's gums. VESTOGUM® serves for making a gingiva model. Because of exposing the preparation border on the master cast, there is an essential lack of information with regard to the impressed soft tissues. The gingiva modeling material on polyether basis, in color adapted to the natural gingiva, is a controlling material in order to avoid a displacement of the marginal periodontium due to overcontuored crowns. VESTOGUM® thus contributes considerably to a periodontally hygienic functional and esthetic prosthesis. VESTOGUM® consists of the same ingredients as IMPREGUM® PENTA, ESPE's proven and well-established polyether based impression material except one pigment. This pigment, however, is contained in ESPE's polyether based impression material PERMADYNE® PENTA H.
More Information

K 954192, K 953027

K 954192, K 953027

No
The device description and intended use describe a physical dental impression material, not a software or system that would typically incorporate AI/ML. There is no mention of AI, ML, or related concepts in the provided text.

No.
The device is a dental impression material used to reproduce the structure of a patient's gums, not for treating or rehabilitating a disease, injury, or to alter the structure or function of the body.

No.
This device is a gingiva modeling material used for making a gingiva model, which is a step in reproducing the structure of a patient's gums for dental prosthesis. It is not used to diagnose a medical condition or disease.

No

The device description clearly states that VESTOGUM® is a "dental impression material" and a "gingiva modeling material on polyether basis." This indicates a physical material, 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 the material's function in creating a model of the gingiva for dental prosthesis fabrication. This is a mechanical process for reproducing anatomical structures, not a diagnostic test performed on a biological sample to determine the state of health or disease.
  • Device Description: The description explicitly classifies the device as a "dental impression material" and explains its role in creating a gingiva model. It highlights its use in the process of making a prosthesis and its contribution to periodontal hygiene and esthetics.
  • Lack of Diagnostic Activity: There is no mention of the device being used to analyze biological samples (like blood, urine, tissue, etc.) or to provide information for the diagnosis, monitoring, or treatment of a disease or condition.
  • Classification: The device is classified under 21 C.F.R. § 872.3660, which is for dental impression materials, not IVDs.

In summary, the device is a tool used in the creation of dental prosthetics by modeling the gingiva. It does not perform any diagnostic function on biological samples.

N/A

Intended Use / Indications for Use

Gingiva Modeling Material for:
Combination works
when choosing and mounting the attachment,
the papilla is fully preserved
Telescopic works
the shoulder of the crowns to be cut is indicated
according to the gingiva contour
Anterior tooth area
with regard to esthetics and periodontal
hygienics, the forming possibilities of the
interdental spaces are increased
Forming of different tooth lengths
according to the natural conditions in the
patient's mouth, they can be adapted in
anatomically correct way; especially in bridge
spans
Color rating of the veneer material
the material which is in color adapted to the
gingiva, serves for more precise color matching
Controlled modellation
the cervical-incisal crown convexity for the
protection of the gingival margin can be
controlled

Product codes

ELW

Device Description

VESTOGUM® is classified as a dental impression material (21 C.F.R. § 872.3660) because it is a device intended to be one step in the process to reproduce the structure of a patient's gums.
VESTOGUM® serves for making a gingiva model. Because of exposing the preparation border on the master cast, there is an essential lack of information with regard to the impressed soft tissues.
The gingiva modeling material on polyether basis, in color adapted to the natural gingiva, is a controlling material in order to avoid a displacement of the marginal periodontium due to overcontuored crowns. VESTOGUM® thus contributes considerably to a periodontally hygienic functional and esthetic prosthesis.
VESTOGUM® consists of the same ingredients as IMPREGUM® PENTA, ESPE's proven and well-established polyether based impression material except one pigment. This pigment, however, is contained in ESPE's polyether based impression material PERMADYNE® PENTA H.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

gums, gingiva

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)

K 954192, K 953027

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 872.3660 Impression material.

(a)
Identification. Impression material is a device composed of materials such as alginate or polysulfide intended to be placed on a preformed impression tray and used to reproduce the structure of a patient's teeth and gums. The device is intended to provide models for study and for production of restorative prosthetic devices, such as gold inlays and dentures.(b)
Classification. Class II (Special Controls).

0

II.

510(K) SUMMARY OF SAFETY AND EFFECTIVENESS

Submitter

Name:ESPE Dental AG
Street:ESPE Platz
ZIP-Code, City:D-82229 Seefeld
Federal State:Bavaria
Country:Germany
Establishment Registration Number:9611385
Contact:Dr. Andreas Petermann, Regulatory Affairs
Phone:011-49-8152-7001395
Fax:011-49-8152-7001869
E-mail:Andreas_Petermann@ESPE.de
Date:April 8, 1999

Name of Device

Proprietary Name:VESTOGUM®
Classification Name:Impression Material
Common Name:Gingiva Modeling Material

Predicate Device

IMPREGUM® PENTA by ESPE……………………….K 954192 PERMADYNE® PENTA H by ESPE ................... K 953027

Description for the Premarket Notification

VESTOGUM® is classified as a dental impression material (21 C.F.R. § 872.3660) because it is a device intended to be one step in the process to reproduce the structure of a patient's gums.

VESTOGUM® serves for making a gingiva model. Because of exposing the preparation border on the master cast, there is an essential lack of information with regard to the impressed soft tissues.

The gingiva modeling material on polyether basis, in color adapted to the natural gingiva, is a controlling material in order to avoid a displacement of the marginal

Image /page/0/Picture/13 description: The image shows the text "510(k) VESTOGUM" in the top left corner, with a registered trademark symbol next to it. Below the text is a logo that includes a tree and the word "ESPE" in bold letters. The logo is black and white and appears to be for a product or company called VESTOGUM.

1

periodontium due to overcontuored crowns. VESTOGUM® thus contributes considerably to a periodontally hygienic functional and esthetic prosthesis.

VESTOGUM® consists of the same ingredients as IMPREGUM® PENTA, ESPE's proven and well-established polyether based impression material except one pigment. This pigment, however, is contained in ESPE's polyether based impression material PERMADYNE® PENTA H. The fact that no new ingredients are contained ensures in our opinion that no new toxicology and biocompatibility studies are necessary.

ESPE has long marketing experience with polyether based impression materials. IMPREGUM® F, which is the hand-mixed version of IMPREGUM® PENTA is marketed in the U.S.A. since 1986, the hand-mixed PERMADYNE® impression materials since 1980. In European countries, VESTOGUM® is successfully marketed for more than 10 years. In our opinion the marketing experience with VESTOGUM®, the substantial equivalence of VESTOGUM® to the predicate devices IMPREGUM® and PERMADYNE® with long marketing history and clinical experience, and the performance data support the safety and effectiveness of VESTOGUM® for the intended use.

Image /page/1/Picture/3 description: The image contains the text "510(k) VESTOGUM" at the top. Below the text is a logo that contains a tree inside of a square. To the right of the logo is the word "ESPE" in large, bold letters.

2

Public Health Service

Image /page/2/Picture/2 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle with three stripes forming its wing and body. The eagle is positioned within a circular border that contains the text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" in all capital letters.

MAY 20 1999

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Dr. Andreas Petermann, Requlatory Affairs ESPE Dental AG ESPE Platz D-82229 Seefeld Bavaria, Germany

K991221 Re : Trade Name: VESTOGUM® II Requlatory Class: Product Code: ELW Dated: April 8, 1999 April 12, 1999 Received:

Dear Dr. Petermann:

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. ರ್ಗ 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 regulatory action. In addition, FDA may publish further announcements concerning your device in the Federal Register.

3

Page 2 - Dr. Petermann

this response to your premarket notification Please note: submission does not affect any obliqation you miqht have under sections 531 through 542 of 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 finding 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 requlation (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

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

Enclosure

4

991221

STATEMENT OF INDICATIONS FOR USE

Device Name:VESTOGUM®
Indications for use:Gingiva Modeling Material for:
Combination works
when choosing and mounting the attachment,
the papilla is fully preserved
Telescopic works
the shoulder of the crowns to be cut is indicated
according to the gingiva contour
Anterior tooth area
with regard to esthetics and periodontal
hygienics, the forming possibilities of the
interdental spaces are increased
Forming of different tooth lengths
according to the natural conditions in the
patient's mouth, they can be adapted in
anatomically correct way; especially in bridge
spans
Color rating of the veneer material
the material which is in color adapted to the
gingiva, serves for more precise color matching
Controlled modellation
the cervical-incisal crown convexity for the
protection of the gingival margin can be
controlled
Prescription use:☒Over-the counter use ☐

(Division Sign-Off) Division of Dental, Infection Control,
and General Hoonitel Devise Division of Dental, Infection Control
and General Hospital, Devices
510(k) Number ____________________________________________________________________________________________