POWERTOME PERIOTOME

K063007 · Westport Medical, Inc. · EKX · Oct 17, 2006 · Dental

Device Facts

• Record ID: K063007
• Device Name: POWERTOME PERIOTOME
• Applicant: Westport Medical, Inc.
• Product Code: EKX · Dental
• Decision Date: Oct 17, 2006
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 872.4200
• Device Class: Class 1
• Attributes: Therapeutic, 3rd-Party Reviewed

Intended Use

The intended use of this device is as an aid in the removal of teeth, due to caries(decay), trauma, orthodontic reasons, periodontal bone loss or malformation of the tooth. It is also intended to be used to remove teeth as part of the preparation for dental implants, where minimizing bone loss is critical.

Device Story

Powertome Periotome is a dental handpiece used by dental professionals to assist in tooth extraction and dental implant site preparation. It functions by severing periodontal ligaments and expanding the alveolar bone to minimize bone loss. The device uses a solenoid-driven handpiece to deliver consistent, controlled force to a periotome tip, replacing the traditional manual method of using a periotome and mallet. The professional controls the device via a foot switch, allowing for precise on/off control and power settings. By providing consistent force and professional-controlled operation, the device improves repeatability and safety compared to manual mallet-assisted extraction. It benefits patients by reducing bone loss and potentially decreasing trauma during the extraction process.

Clinical Evidence

No clinical data provided. Substantial equivalence is supported by bench testing comparing force delivery characteristics (mean force, frequency, duration) between the Powertome and manual mallet-assisted periotomes, and anecdotal reports from two dental professionals.

Technological Characteristics

Materials: Wrought stainless steel patient-contact components. Energy source: Electric solenoid. Form factor: Handpiece with interchangeable tips. Connectivity: None. Sterilization: Not specified. Control: Foot-switch operated electronic force delivery. The device replaces manual mallet-driven force with a solenoid-actuated mechanism providing controlled, consistent force per stroke.

Indications for Use

Indicated for expanding the tooth socket to facilitate tooth extraction due to caries, trauma, orthodontic reasons, periodontal bone loss, or tooth malformation, and to prepare the site for placement of endosseous dental implants or abutments.

Regulatory Classification

Identification

A dental handpiece and accessories is an AC-powered, water-powered, air-powered, or belt-driven, hand-held device that may include a foot controller for regulation of speed and direction of rotation or a contra-angle attachment for difficult to reach areas intended to prepare dental cavities for restorations, such as fillings, and for cleaning teeth.

Predicate Devices

• B.T.I. BIOTECHNOLOGY INSTITUTE, S.L. periotome
• Osseous Technologies of America periotome
• Karl Schumacher periotome

Submission Summary (Full Text)

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K063007

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510(k) Summary

Westport Medical, Inc. 6603 Rippling Brook Drive SE Salem, OR 97319 (p)503-510-7560 (f) 866-457-9667

OCT 1 7 2006

Contact information: Ralph Wells 14372 Fishback Rd. Monmouth, OR 97361 (p) 503-623-5880 (f) 503-831-5376

This 510(k) summary was prepared June/July, 2006, and finished 15 July, 2006.

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## Trade Name - PowertomeTM Periotome S100

Common name - periotome

Classification name - probe, periodontic (21CFR872.4565, Product Code ElX) We are claiming substantial equivalence to a device made by B.T.I. BIOTECHNOLOGY INSTITUTE. S.L., Osseous Technologies of America, Karl Schumacher, and others, called a periotome.

Device description: The Powertome periotome is designed as an aid to dental professionals in the extraction of a tooth, or multiple teeth, from their socket. It is designed to minimize alveolar bone loss, thus providing an initial step in the preparation prior to placing dental implants, whose success rate is highly dependent on minimal (or no) bone loss. It functions by severing the periodontal ligaments that attach the cementum of the tooth to the alveolar bone, by use of different sized and shaped tips that provide the leverage and effect desired. These ligaments are one of two methods by which teeth stay in the jaw. The second function is to push the alveolar bone away from the tooth, thus disengaging the mechanical leverage the alveolar bone uses on the imequiarity of the tooth to also help hold the tooth in place. Once the ligaments are cut, and the alveolar bone pushed away, the tooth extracts trivially.

Typical methods of extraction of a tooth are:

- 1. Use of forceps. The forceps grab the tooth, and the professional then twists the tooth in place, tearing the periodontal ligaments, and also expanding the alveolar bone. Once there is sufficient clearance, and the periodontal ligaments are detached, the tooth can be removed. This results in significant bone loss, and can be painful for the patient.
- 2. Use of a manual periotome: The periotome is inserted between the tooth and gum, and pushed between the tooth and bone until it meets resistance. The device can then be pushed toward the root of the tooth by moving the periotome back and forth, tangentially to the tooth surface,
- 3. Use of a manual periotome and mallet: The periotome is inserted between the tooth and gum. and pushed between the tooth and bone until it meets resistance. The device can then be tapped on the end with a mallet, driving it through the periodontal ligaments the root of the tooth. Often the use of the mallet is done with an assistant, who taps the end of the periotome with the mallet equal to the number of times the professional says "tap tap" (in this example, 3 taps with the mallet).
- 4. Our method is the same as #3, above, except that instead of an assistant tapping on the end of the periotome with a mallet, we use a small solenoid in the handpiece, which delivers a small but consistent force on the periotome tip, controlled in duration by the professional by use of a foot switch (for on/off control). The total delivered power for each stroke is controlled, and can be set by the professional.

This product was designed to simulate the action that is provided by the mallet, but to give greater control over the process, both from a safety (totally controlled by the professional) and effectiveness (controlled stroke allows the professional to easily determine when the tooth has been sufficiently loosened in it's socket). The materials used that come in contact with the patient are the same as used in the manual periotomes - wrought stainless steel. The tips employed are of the same general length, width, and depth as those currently used by manual periotomes.

Intended use: The intended use of this device is as an aid in the removal of teeth, due to caries(decay), trauma, orthodontic reasons, periodontal bone loss or malformation of the tooth. It is also intended to be used to remove teeth as part of the preparation for dental implants, where minimizing bone loss is critical.

All types of devices typically used in extractions, including forceps, periotomes, dental elevators, and even chisels, are Class I, exempt from 510(k). The specific indications for use have been taken from advertising done by various dental distribution or manufacturers, and, although not verbatim on our intended use, have very similar wording. Differences do not impact the safety, not the effectiveness of this device when used as labeled.

Technological characteristics: Our device does have different technological characteristics from the predicate device. The power source to cut through the periodontal ligaments and expand the bone are done either by manually forcing the tip through the ligaments, or with an external power source consisting of an assistant and a hammer (mallet), used to supply additional force to out through the periodontal ligaments and expand the socket. To determine the amount of force, and do a comparison with our device, we tested the amount of force delivered by utilization of our device, and with a hammer, and also characterized typical numbers by interviewing professionals:

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| Characteristic | Predicate Device | Powertome periotom |
|----------------------------------|-------------------------|------------------------|
| Maximum amount of force/stroke | 122 lb | 90 lb |
| Minimum amount of force/stroke | 16 lb | 21 lb |
| Standard deviation force/stroke | 27 lb | 15 lb |
| Mean force/stroke | 79 lb | 52 lb |
| Frequency | 200 milliseconds/stroke | 50 milliseconds/stroke |
| Duration of impact | 420 ms | 70 ms |
| Force controlled by professional | No | Yes |
| Max/Min length of power1 stroke | 1/3 - 10" | .01" max., .01" min. |

Clinical data: We have not used clinical data to support our claim of substantial equivalence.

Anecdotal data: Two dental professionals have been using prototype versions of the product. Neither practitioner wishes to return to the manual periotome with mallet, as the Powertome periotome provides significantly increased control over the outcome.

Conclusions:

| Characteristic | Predicate Device | Powertome periotome |
|----------------------------------------------------------------------|--------------------------|------------------------------|
| Success in cutting periodontal<br>ligament | Yes, with verbal control | Yes, with electronic control |
| Success in expanding tooth<br>socket by movement of alveolar<br>bone | Yes, with verbal control | Yes, with electronic control |
| Repeatability | Low | High |
| Safety: Force controlled by<br>professional | No | Yes |

The Powertome periotome is as safe and as effective as the predicate device in performing it's indicated use.

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Image /page/3/Picture/11 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle with its wings spread, and the text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" arranged in a circular pattern around the eagle. The eagle is depicted in black, and the text is also in black.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

## OCT 17 2008

Westport Medical, Incorporated C/O Ms. Michelle S. Lee Responsible Third Party Official Underwriters Laboratories. Incorporated 2600 N.W. Lake Road Camas, Washington 98607-8542

Re: K063007

Trade/Device Name: Powertome Periotome Regulation Number: 872.4200 Regulation Name: Dental Handpiece and Accessories Regulatory Class: I Product Code: EKX Dated: September 29, 2006 Received: October 2, 2006

Dear Ms. Lee:

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.

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Page 2 - Ms. Lee

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 your 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/industry/support/index.html.

Sincerely yours.

Clive
Thio Li-Ann, Ph.D.

Chiu Lin, Ph.D. 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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## Indications for Use Statement

510(k) Number (if known): _ KOODO

## Powertome Periotome Device Name:

Indications for Use: This device is to be used to expand the tooth socket to facilitate tooth easth and least thinkations for Ose. This device is to be acod of expans the malformation of the tooth, and/or to to other the site for placement of endosseous dental implants or abutments.

Prescription Use _ X (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

Susan Ruane

n Offi Ji Anasthasinlogy Ganeral Hos n Control, Dantal Dav

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