MILTEX MEMBRANE TACK KIT

K092855 · Miltex, Inc. · DZL · Dec 29, 2009 · Dental

Device Facts

• Record ID: K092855
• Device Name: MILTEX MEMBRANE TACK KIT
• Applicant: Miltex, Inc.
• Product Code: DZL · Dental
• Decision Date: Dec 29, 2009
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 872.4880
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

Miltex® Membrane Tack Kit is intended to fixate or stabilize guided tissue regeneration membranes to bone at the surgical site.

Device Story

The Miltex® Membrane Tack Kit consists of non-sterile, single-use titanium alloy tacks (3 mm or 5 mm lengths) and reusable stainless steel instruments. The system is used by dental clinicians during surgical procedures to mechanically fixate or stabilize guided tissue regeneration membranes to bone. The kit includes a tack applicator, membrane probe, perforation raspatory, sinus elevator, and various storage/cleaning accessories. By securing the membrane, the device facilitates tissue regeneration at the surgical site.

Clinical Evidence

No clinical data provided; substantial equivalence is based on design, material, and technological characteristics compared to legally marketed predicate devices.

Technological Characteristics

Materials: Titanium alloy tacks, stainless steel instruments. Form factor: 3 mm or 5 mm length tacks. Components: Tack applicator, probe, raspatory, sinus elevator, storage/wash trays. Non-sterile, single-use tacks; reusable instruments.

Indications for Use

Indicated for the fixation or stabilization of guided tissue regeneration membranes to bone at the surgical site in patients requiring dental membrane placement.

Regulatory Classification

Identification

An intraosseous fixation screw or wire is a metal device intended to be inserted into fractured jaw bone segments to prevent their movement.

Predicate Devices

• IMTEC Bone Tac (K973180)
• AutoTacTM System Titanium Tack (K022790)

Submission Summary (Full Text)

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Miltex.
Redefining Excellence

DEC 2 9 2009

K092855

589 Davies Drive
York, PA 17402

phone [phone]
toll-free 800 221-1344-
fax [phone]

**www.miltex.com**

# 510(k) Summary

Submitted by:

Miltex, Inc. 589 Davies Drive York, PA 17402 USA

Contact Person:

Jennifer Bosley, Regulatory Affairs Manager Integra Medical Instrument Group 589 Davies Drive York, PA 17402 USA Phone: [phone] Fax: [phone]

Date Prepared: September 15, 2009

| Device Trade Name: | Miltex® Membrane Tack Kit |
|--------------------------|-------------------------------------------|
| Common/Usual Name: | Dental Membrane Tack |
| Proposed Classification: | Screw, Fixation, Intraosseous |
| | 21 CFR 872.4880 Class II, 76 DZL - Dental |

### Device Description:

The Miltex® Membrane Tack Kit consists of non-sterile, single use titanium alloy tacks available in 3 mm or 5 mm lengths. Membrane Tacks are used in conjunction with the following accessories and reusable stainless steel instruments for implantation: Tack Membrane Probe, Tack Applicator, Perforation Raspatory, Kirsch Sinus 7 Double-ended Spoon and Plugger, Sinus Elevator, Mixing Cup with Plastic Lid, Tack Storage Box for 15 Tacks and Tack Wash Tray with Lid.

#### Indications For Use:

Miltex® Membrane Tack Kit is intended to fixate or stabilize guided tissue regeneration membranes to bone at the surgical site.

#### Predicate Devices:

| 510(k) # | Device | Manufacturer |
|----------|--------------------------------|-----------------------------------|
| K973180 | IMTEC Bone Tac | IMTEC Corporation |
| K022790 | AutoTacTM System Titanium Tack | BioHorizons Implant Systems, Inc. |

#### Substantial Equivalence:

Miltex® Membrane Tack Kit is substantially equivalent to the legally marketed predicate devices with respect to intended use, fundamental technology, design and material.

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#### DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/1/Picture/1 description: The image shows the seal of the U.S. Department of Health & Human Services. The seal is circular and contains the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the top half of the circle. The bottom half of the circle contains a stylized image of a human figure.

#### Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room W-066-0609 Silver Spring, MD 20993-0002

Ms. Jennifer Bosley Regulatory Affairs Manager Miltex. Incorporated Integra Medical Instrument Group 589 Davies Drive York, Pennsylvania 17402

DEC & & 2009

Re: K092855

Trade/Device Name: Miltex® Membrane Tack Kit Regulation Number: 21CFR 872.4880 Regulation Name: Intraosseous Fixation Screw or Wire Regulatory Class: II Product Code: DZL Dated: December 16, 2009 Received: December 17, 2009

Dear Ms. Bosley:

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 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. Bosley

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); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to

http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.html for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Antmon O. an

Anthony D. Watson, B.S., M.S., M.B.A. 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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161

K092855

# Indications For Use

510(k) Number (if known): __

Device Name:

Miltex® Membrane Tack Kit

### Indications for Use:

Miltex® Membrane Tack Kit is intended to fixate or stabilize guided tissue regeneration membranes to bone at the surgical site.

> Prescription Use (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter-Use_ (Part 21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

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

Kag 2855 510(k) Number:

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