ALGINATE IMPRESSION MATERIAL III (FAST & REGULAR)

K031439 · Harry J. Bosworth Co. · ELW · Oct 2, 2003 · Dental

Device Facts

• Record ID: K031439
• Device Name: ALGINATE IMPRESSION MATERIAL III (FAST & REGULAR)
• Applicant: Harry J. Bosworth Co.
• Product Code: ELW · Dental
• Decision Date: Oct 2, 2003
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 872.3660
• Device Class: Class 2

Intended Use

Alginate Impression Material III (Fast & Regular Set) with water is used as der tal impression material.

Device Story

Alginate Impression Material III (Fast & Regular) is a dental impression material used by dental professionals to create accurate molds of oral structures. The material is mixed with water to form a paste, which is then placed in an impression tray and inserted into the patient's mouth. Upon setting, it captures the anatomical details of the teeth and surrounding tissues. The resulting impression is used by dentists to fabricate dental restorations, appliances, or diagnostic models. The device is intended for professional clinical use.

Clinical Evidence

Bench testing only.

Technological Characteristics

Alginate-based dental impression material; supplied in powder form for mixing with water; available in Fast and Regular set formulations; Class II medical device (21 CFR 872.3660).

Indications for Use

Indicated for use as a dental impression material for dental procedures.

Regulatory Classification

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.

Special Controls

*Classification.* Class II (Special Controls).

Submission Summary (Full Text)

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Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

OCT - 2 2003

Ms. Mildred M. Goldstein President Harry J. Bosworth Company 7227 North Hamlin Avenue Skokie, Illinois 60076

Re: K031439

Trade/Device Name: Alginate Impression Material III (Fast & Regular) Regulation Number: 872.3660 Regulation Name: Impression Material Regulatory Class: II Product Code: ELW Dated: July 17, 2003 Received: July 21, 2003

Dear Ms. Goldstein:

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 dato 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.

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Page 2 - Ms. Goldstein

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 (OS) 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 vour device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at [phone]. Also, please note the regulation entitled. "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act 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 vours.

Susan Runne

Susan Runner, DDS, MA Interim Director Division of Anesthesiology, General Hospital Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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510(K) Number: 031439

Device Name: Alginate Impression Material III (Fast & Regular)

## INDICATIONS FOR USE:

Alginate Impression Material III (Fast & Regular Set) with water is used as der tal impression material.

Kein Mulley for MSR

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

510(k) Number: K 031439

(PL ::ASE I)O NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use OR (Per 21 CFR 801.109)

Over-the-Counter Use (Optional Format 1/2/96)

**CONFIDENTIAL**