BPA-FREE MICROHYBID COMPOSITE

K120237 · Novocol, Inc. · EBF · Dec 11, 2012 · Dental

Device Facts

• Record ID: K120237
• Device Name: BPA-FREE MICROHYBID COMPOSITE
• Applicant: Novocol, Inc.
• Product Code: EBF · Dental
• Decision Date: Dec 11, 2012
• Decision: SESE
• Submission Type: Abbreviated
• Regulation: 21 CFR 872.3690
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

Microhybrid Composite is indicated for direct esthetic restoration in the anterior and posterior regions. This composite can be used in all direct dental restorations, Class I, II, III, IV, and V, and diastema closure.

Device Story

Microhybrid Composite is a dental restorative material used by dentists for direct esthetic restorations. It is applied to the tooth structure to repair or restore Class I through V cavities and close diastemas. The material is placed directly into the prepared tooth cavity by the clinician, where it is shaped and cured to restore form and function. It serves as a permanent restorative material, benefiting patients by repairing tooth decay or structural defects and improving dental aesthetics.

Clinical Evidence

Bench testing only.

Technological Characteristics

Microhybrid composite resin material; indicated for direct dental restorations; classified as a tooth shade resin material (21 CFR 872.3690).

Indications for Use

Indicated for direct esthetic dental restorations in anterior and posterior regions, including Class I, II, III, IV, and V restorations and diastema closure.

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)

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Image /page/0/Picture/0 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is a stylized symbol that resembles an abstract representation of human figures or forms.

### DEPARTMENT OF HEALTH & HUMAN SERVICES

### December 11, 2012

Ms. Cora Bracho-Troconis Regulatory Affairs Analyst Novocol, Incorporated 416 South Taylor Avenue LOUISVILLE CO 80027

Re: K120237

Trade/Device Name: Microhybrid Composite Regulation Number: 21 CFR 872.3690 Regulation Name: Tooth Shade Resin Material Regulatory Class: II Product Code: EBF Dated: November 15, 2012 Received: November 16, 2012

### Dear Ms. Bracho-Troconis:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

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.

#### Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-002

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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.htm 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/Resourcesfor You/Industry/default.htm.

Sincerely yours,

# Kwame Ó. Ulmer

Anthony D. Watson, B.S., M.S., M.B.A. Director Division of Anesthesiology, General Hospital, Respiratory, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

### Enclosure

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### Indications for Use Statement

510K number (if known): K120237

Device Name: Microhybrid Composite

Indications for Use:

Microhybrid Composite is indicated for direct esthetic restoration in the anterior and posterior regions. This composite can be used in all direct dental restorations, Class i, II, III, IV, and V, and diastema closure.

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

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

1

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

2012.12.11
Susan Runner DDS, MA 14:57:21
-05'00'

്വിvision Sign-Off) Jivision of Anesthesiology, General Hospital nfection Control, Dental Devices

K120237 510(k) Number:

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## Indications for Use Statement

510K number (if known): \/ /20237

Device Name: Microhybrid Composite

Indications for Use: ·

Microhybrid Composite is indicated for direct esthetic restoration in the anterior and Micronio regions. This composite can be used in all direct dental restorations, Class I, II, III, IV, and V, and diastema closure.

Prescription Use × (Part 21 CFR 801 Subpart D)

C

AND/OR

Over-The-Counter Use (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)

Susan Runner DDs, MA: 2012.12.10
Susan Runner DDs, MA: 2012.12.10 -05 12:22:08 -05 00'

Ulvision Sign-Off) Jivision of Anesthesiology, General Hospital nfection Control, Dental Devices

510(k) Number;_