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CeraRoot dental implants are especially designed for the surgical implantation in the maxilla and mandible for the retention of fixed prosthetic devices, such as an artificial tooth, in order to restore patient aesthetics and chewing function. The CeraRoot dental implants can be used for single or multiple unit restorations in splinted or non-splinted applications. CeraRoot implants can be placed in immediate or delayed tooth extractions. CeraRoot implants are not intended for immediate loading. The CeraRoot dental implants are specially indicated in patients with metal allergies and chronic illness due to metal allergies.

CeraRoot is an endosseous zirconia implant that incorporates both the implant and abutment into a one-piece design, and is intended for use in prosthetic dentistry to support single or multiple tooth restorations. The main characteristics of the CeraRoot implant are its extreme hardness, and ability to be fabricated into final net shapes with very tight tolerances via state-of-the-art CNC processing. The implants are single use devices and are delivered in sterile condition having been sterilized using ethylene oxide (EtO). Depending on the particular tooth to be replaced, CeraRoot implants are made available in five different implant shapes: Wide Upper Central Incisor & Cuspid, Upper Central Incisor & Cuspid, Upper Lateral & Lower Incisor, Bicuspid, Molar; four different implant lengths: 8, 10, 12 & 14 mm; and five different implant diameters: 3.5, 4.1, 4.8, 6, & 6.5 mm. The CeraRoot implants have similar indications to the predicate devices produced by Z-Systems and Nobel Biocare, are made of virtually identical materials (i.e., zirconia that is at least 95% by weight Z.O.) and are available in similar lengths and diameters. The primary difference in the CeraRoot implants and the predicate devices lies in their overall shapes, surface finish and threaded areas. The CeraRoot implants are made available in five different unique shapes that have been designed for specific areas of the mouth, and use a color coding method that matches the correct implant shape to the location in the mouth where it is to be placed. The CeraRoot implants are also subjected to an acid etching process called ICE -surface that is used to impart the unique surface finish to the device that helps to enhance the osseointegration process. This compares to the more conventional mechanical processes that are imparted to the surfaces of the predicate devices. Additionally, the CeraRoot 14 Bicuspid implant is designed to be press-fit into place, as only the coronal half of the endosseous implant contains threads. The surgical method by which this implant is placed requires that it be tapped into place, with no rotational aspect to the insertion as compared to all the remaining implant shapes, which are surgically inserted by conventional means (i.e., screwed into place). This design is unique to the CeraRoot 14 Bicuspid implant only, and is not found on any of the other predicate implants.

The provided text does not contain typical "acceptance criteria" as would be defined for the performance of a diagnostic or AI-powered medical device (e.g., sensitivity, specificity thresholds). Instead, the document describes the substantial equivalence criteria for a dental implant, focusing on material, design, and intended use as compared to predicate devices, and reports on non-clinical (bench) and clinical data supporting that equivalence.

Therefore, the response below will describe the criteria and studies based on the information provided for this specific type of device submission.

Acceptance Criteria and Study Details for CeraRoot Implant System

1. Table of Acceptance Criteria and Reported Device Performance

Technological Characteristics - Material: Made of zirconia (at least 95% by weight Z.O.), similar to predicate devices.

Technological Characteristics - Design & Performance:

• Similar lengths and diameters to predicate devices.
• Manufacturing process results in clean, textured, pure zirconia surface (acid etching and post-etching validated for repeatability).
• Mechanical strength to withstand physiological loading (demonstrated via dynamic fatigue testing in wet and dry environments, worst-case scenario).
• Biocompatibility suitable for long-term dental implant devices.
• Clinical safety and effectiveness (osseointegration, long-term success rate). | Intended Use: The device states the identical intended use as explicitly described in the acceptance criteria. It explicitly states indications for metal allergies.

Technological Characteristics - Material: Confirmed as zirconia (at least 95% Z.O.), explicitly stating "made of virtually identical materials (i.e., zirconia that is at least 95% by weight Z.O.)".

Technological Characteristics - Design & Performance:

• Available in similar lengths and diameters (8, 10, 12, 14 mm; 3.5, 4.1, 4.8, 6, 6.5 mm).
• SEM surface analysis and surface topography studies proved clean, textured, pure zirconia surface; acid etching and surface cleaning processes validated for repeatability.
• Fatigue testing performed on CeraRoot Model 14 Bicuspid implant (worst-case) in dry (air) and wet (saline) environments, adhering to ISO 14801.
• Biocompatibility testing performed in accordance with applicable parts of ISO 10993-1 for long-term dental implant devices.
• Clinical study demonstrated a "Five-Year Success Rate of 831 Consecutively Placed Zirconia Dental Implants" and a case report on full-mouth rehabilitation. |

2. Sample Size Used for the Test Set and Data Provenance

• Test Set (Clinical Data):
  • Sample Size: The primary clinical study reported a "Five-Year Success Rate of 831 Consecutively Placed Zirconia Dental Implants."
  • Data Provenance: The study was part of a "European clinical study," indicating European origin. It is explicitly described as a "five-year follow-up study for their implants," suggesting a prospective nature, although "consecutively placed" also implies data collected over time rather than a single point in time retrospectively.

3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications of Those Experts

The document does not specify the number of experts used to establish a "ground truth" in the manner of diagnostic performance evaluations. For a dental implant study focused on success rates, the "ground truth" would generally be established via clinical outcomes (e.g., implant survival, absence of complications, osseointegration assessed radiographically), potentially adjudicated by the treating clinicians or independent assessors.

The authors of the referenced publications are:

• Xavi Oliva, DDS, MSc
• Josep Oliva, DDS, MSc
• Josep D. Oliva, DDM

These individuals, with DDS, DDM, and MSc qualifications, would be considered qualified dental professionals. The text does not detail the specific adjudication method or independent expert review for the clinical outcomes.

4. Adjudication Method for the Test Set

The document does not specify an adjudication method (e.g., 2+1, 3+1) for the clinical outcomes presented in the study summary. Clinical success and failure in implantology are typically ascertained through defined criteria observed by the treating clinicians or documented in patient records and radiographs.

5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study Was Done

No, a Multi-Reader Multi-Case (MRMC) comparative effectiveness study was not done. This type of study is typically performed for diagnostic imaging devices to assess human reader performance with and without AI assistance. This submission is for a dental implant, which is a therapeutic device, not a diagnostic one.

6. If a Standalone (Algorithm Only Without Human-in-the-Loop Performance) Was Done

No, a standalone (algorithm only) performance evaluation was not done. This type of evaluation is relevant for AI/ML-driven diagnostic devices. The CeraRoot Implant System is a physical dental implant.

7. The Type of Ground Truth Used

The ground truth for the clinical study was based on clinical outcomes data, including implant survival/success rate over a five-year period, likely assessed through clinical examination and radiographic images as the document mentions "radiographic images that were part of its European clinical study." The outcomes were published in peer-reviewed dental journals.

8. The Sample Size for the Training Set

The document does not specify a "training set" as it would for an AI/ML device. This submission is not for an AI/ML device, but for a medical device (dental implant). The "training" for such a device effectively involves its design, material selection, and manufacturing process development, validated by extensive non-clinical testing and clinical studies.

9. How the Ground Truth for the Training Set Was Established

As there is no "training set" in the context of an AI/ML device, this question is not applicable. For the CeraRoot Implant System, the "ground truth" of its design and manufacturing would be established through engineering specifications, material science testing, and adherence to quality standards. The bench testing (fatigue, surface analysis, biocompatibility) serves as validation that the device meets its design requirements.

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