MICROFILL 13

K022972 · Ab Ardent · EBF · Nov 22, 2002 · Dental

Device Facts

• Record ID: K022972
• Device Name: MICROFILL 13
• Applicant: Ab Ardent
• Product Code: EBF · Dental
• Decision Date: Nov 22, 2002
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 872.3690
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

MICROFILL 13 is to be used as a filling material for restoring function to teeth that have lost portions due to caries: Direct, fixed restorations, placed by the dentist after removal of carious tissue. Anterior restorations, Class III, IV and V Corrections of anomalies such as peg shaped teeth Splinting of mobile anterior teeth. Repair of resin and ceramic veneers. Reconstruction of anterior trauma cases Veneering of discolored anterior teeth. For use only by dental professional such as DDS or DMD. Not for use by general public or OTC.

Device Story

Microfill 13 is a dental restorative material used by dentists (DDS/DMD) in a clinical setting. It is applied directly to teeth following the removal of carious tissue to restore function and aesthetics. The material is indicated for anterior restorations (Class III, IV, V), splinting, veneer repair, and trauma reconstruction. It requires a dry working field for proper application. The device benefits patients by restoring tooth structure and appearance. No automated processing or software is involved.

Clinical Evidence

No clinical data provided; bench testing only.

Technological Characteristics

Tooth shade resin material. Class II device. Intended for direct, fixed dental restorations. No software, electronics, or complex sensing mechanisms.

Indications for Use

Indicated for dental patients requiring restoration of tooth function due to caries, including Class III, IV, and V anterior restorations, correction of peg-shaped teeth, splinting of mobile anterior teeth, repair of resin/ceramic veneers, reconstruction of anterior trauma, and veneering of discolored teeth. Contraindicated if a dry working field cannot be established or if the patient has known allergies to components.

Regulatory Classification

Identification

Tooth shade resin material is a device composed of materials such as bisphenol-A glycidyl methacrylate (Bis-GMA) intended to restore carious lesions or structural defects in teeth.

Submission Summary (Full Text)

{0}------------------------------------------------

#### DEPARTMENT OF HEALTH & HUMAN SERVICES

od and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

AB Ardent C/O Mr. Clyde E. Ingersoll Ardent Product Development 54 Riverview Avenue Tonawanda, New York 14150-5260

Re: K022972

Trade/Device Name: Microfill 13 Regulation Number: 21 CFR 872.3690 Regulation Name: Tooth Shade Resin Material Regulatory Class: II Product Code: EBF Dated: September 5, 2002 Received: September 6, 2002

Dear Mr. Ingersoll:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate 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) that do not require approval of a premarket approval application (PMA). 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 (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

{1}------------------------------------------------

## Page 2 - Mr. Ingersoll

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

This letter will allow you to begin marketing your device as described in your Section 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 regulation (21 CFR Part 801 and additionally 21 CFR Part 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at [phone]. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

Patricia Cucente / fte

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

{2}------------------------------------------------

# AB ARDENT

Generatorgatan 8 S-195 60 Marsta Sweden Phone [phone] +046 8 591 161 83 FAX

> 510 (k MICROFILL 13 ATTACHMENT #4

### INDICATIONS FOR USE

#### Indications:

MICROFILL 13 is to be used as a filling material for restoring function to teeth that have lost portions due to caries:

Direct, fixed restorations, placed by the dentist after removal of carious tissue. Anterior restorations, Class III, IV and V Corrections of anomalies such as peg shaped teeth Splinting of mobile anterior teeth. Repair of resin and ceramic veneers. Reconstruction of anterior trauma cases Veneering of discolored anterior teeth

# Contra indications:

The placement of Microfill 13 is contraindicated

If a dry working field cannot be established or if the stipulated technique cannot be applied.

If the patient is known to be allergic to the components of Microfill 13.

# For use only by dental professional such as DDS or DMD. Not for use by general public or OTC.

Robert Batz, DDS for Dr. Susan Kuemer

(Division Sign-Off) (Division Sign-On)
Division of Anesthesiology General Hospital, Infection Control. Dental Devices

510(k) Number: K022972