K Number
K993381
Device Name
TONGUE STABILIZER DEVICE
Date Cleared
1999-12-21

(75 days)

Product Code
Regulation Number
872.5570
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
To be used for the treatment of simple snoring in both dentate and edentult patientis. Can be used also for the treatment of snoring in patients with periodontically comprised dentitions and likewise patients presenting with Tempero-mandibular Dysfunction (TMD). Cephalometric and videoendoscopy studies have established that tongue protrusion creates a greater, increase in oropharyIngeal, velopharyngeal and hypopharyngeal cross-sectional areas of the upper airway, hence improving airway patency and function.
Device Description
TONGUE STABILIZING DEVICE
More Information

Not Found

Not Found

No
The summary describes a mechanical device (tongue stabilizing device) and mentions clinical studies, but there is no mention of AI, ML, image processing, or any computational analysis that would suggest the use of AI/ML.

Yes
The device is intended for the "treatment of simple snoring" and "in patients with periodontically comprised dentitions and likewise patients presenting with Tempero-mandibular Dysfunction (TMD)," which indicates a therapeutic purpose.

No

The intended use description focuses on treatment ("treatment of simple snoring") and improving function ("improving airway patency and function"), rather than diagnosing a condition. While it mentions "studies" that "established" certain findings, these are presented as underlying science justifying the device's mechanism of action for treatment, not as a function the device itself performs for diagnosis.

No

The device description explicitly states "TONGUE STABILIZING DEVICE," which implies a physical, hardware component used for tongue stabilization, not solely software.

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

Here's why:

  • Intended Use: The intended use is for the treatment of simple snoring by physically stabilizing the tongue to improve airway patency. This is a therapeutic intervention, not a diagnostic test performed in vitro (outside the body) on biological samples.
  • Device Description: It's described as a "TONGUE STABILIZING DEVICE," which aligns with a physical device used for treatment.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), detecting specific analytes, or providing diagnostic information about a disease or condition based on laboratory testing.

IVD devices are used to examine specimens from the human body to provide information for diagnosis, monitoring, or screening. This device's function is purely mechanical and therapeutic.

N/A

Intended Use / Indications for Use

To be used for the treatment of simple snoring in both dentate and edentult patients. Can be used also for the treatment of snoring in patients with periodontically comprised dentitions and likewise patients presenting with Tempero-mandibular Dysfunction (TMD). Cephalometric and videoendoscopy studies have established that tongue protrusion creates a greater, increase in oropharyngeal, velopharyngeal and hypopharyngeal cross-sectional areas of the upper airway, hence improving airway patency and function.

Product codes

LRK

Device Description

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Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

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Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

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Description of the training set, sample size, data source, and annotation protocol

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Description of the test set, sample size, data source, and annotation protocol

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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): 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.

Not Found

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.

Not Found

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

§ 872.5570 Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea.

(a)
Identification. Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea are devices that are worn during sleep to reduce the incidence of snoring and to treat obstructive sleep apnea. The devices are designed to increase the patency of the airway and to decrease air turbulence and airway obstruction. The classification includes palatal lifting devices, tongue retaining devices, and mandibular repositioning devices.(b)
Classification. Class II (special controls). The special control for these devices is the FDA guidance document entitled “Class II Special Controls Guidance Document: Intraoral Devices for Snoring and/or Obstructive Sleep Apnea; Guidance for Industry and FDA.”

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Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" arranged around the perimeter. Inside the circle is an abstract image of an eagle with three lines representing its wings.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

DEC 21 1999

Ms. Christina M. LaJoie Sleep Apnea/Snoring Project Manager Great Lakes Orthodontics, LTD 199 Fire Tower Drive P.O. Box 5111 Tonawanda, New York 14151-5111

Re : K993381 Tongue Stabilizer Device Trade Name: Requlatory Class: Unclassified Product Code: LRK September 8, 1999 Dated: Received: October 7, 1999

Dear Ms. LaJoie:

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 requlations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 895. A substantially equivalent determination assumes compliance with the Good Manufacturing Practice for Medical Devices: General (GMP) requlation (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 regulation may result in regulatory 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

1

Page 2 - Ms. LaJoie

obligation you might have under sections 531 through 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or requlations,

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 leqally 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

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

Enclosure

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Page __ ਹ

1993381 510(k) Number (if known):

TONGUE STABILIZING DEVICE Devide Name:

Indications For Use:

To be used for the treatment of simple snoring in both dentate and edentult Can be used also for the treatment of snoring in patients with patientis. periodontically comprised dentitions and likewise patients presenting with Tempero-mandibular Dysfunction (TMD). Cephalometric and videoendoscopy studies have established that tongue protrusion creates a greater, increase in oropharyIngeal, velopharyngeal and hypopharyngeal cross-sectional areas of the upper airway, hence improving airway patency and function.

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Presoription Use (Per 21 CFR 801.108

Susan Swanson

OR

Over-The-Counter Use

(Optional Format 1-2-96)

(Division Sign-Off) Dodsion of Dental, Infection Control, and General Hospital Device 510(k) Number

0011:07 / 2007 / 1 200

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