PROVITEMP, DENTOTEMP, TOTALCEM, DENTOCEM

K121804 · Itena Clinical · EMA · Apr 19, 2013 · Dental

Device Facts

• Record ID: K121804
• Device Name: PROVITEMP, DENTOTEMP, TOTALCEM, DENTOCEM
• Applicant: Itena Clinical
• Product Code: EMA · Dental
• Decision Date: Apr 19, 2013
• Decision: SESE
• Submission Type: Abbreviated
• Regulation: 21 CFR 872.3275
• Device Class: Class 2

Intended Use

TotalCem: The device is intended for the cementation of posts, crowns, bridges, inlays and onlays. DentoCem: The device is intended for permanent cementation of: crowns and bridges, inlays, onlays, posts and cores, ceramic crowns, Maryland bridges and veneers; implant prosthesis; orthodontic attachments; amalgam restorations; veneering of alloys; and composite restorations.

Device Story

TotalCem and DentoCem are permanent, radio-opaque, dual-cured (auto/photopolymerizable) resin cements used in dental procedures. TotalCem is a self-etch, self-adhesive resin cement; DentoCem is a multi-purpose adhesive resin cement. Both are supplied in an automix delivery system for application by dental professionals. The cements function by bonding restorative materials (crowns, bridges, inlays, onlays, posts, cores, veneers, implant prostheses, orthodontic attachments, amalgam, and composite restorations) to tooth structure or other substrates. The dual-curing mechanism allows for both light-activation and chemical self-curing, ensuring polymerization in clinical settings where light access may be limited. These devices provide mechanical retention and sealing for dental restorations, benefiting patients by securing prosthetic or restorative components to the tooth.

Clinical Evidence

Bench testing only. Conformity demonstrated with ISO 4049 (Dentistry - Polymer-based filling, restorative and luting materials) and FDA guidance 'Dental Cements - Premarket Notification'. No clinical data provided.

Technological Characteristics

Resin-based dental cements. Matrix: UDMA and BIS-GMA. Fillers: Barium glass, Fumed Silica, TiO2. Curing: Dual-cure (auto/photopolymerizable). Delivery: Automix. Radiopacity: Yes. Standards: ISO 4049.

Indications for Use

Indicated for permanent cementation of dental restorations including crowns, bridges, inlays, onlays, posts, cores, ceramic crowns, Maryland bridges, veneers, implant prostheses, orthodontic attachments, amalgam restorations, and composite restorations.

Regulatory Classification

Identification

Zinc oxide-eugenol is a device composed of zinc oxide-eugenol intended to serve as a temporary tooth filling or as a base cement to affix a temporary tooth filling, to affix dental devices such as crowns or bridges, or to be applied to a tooth to protect the tooth pulp. Dental cement other than zinc oxide-eugenol is a device composed of various materials other than zinc oxide-eugenol intended to serve as a temporary tooth filling or as a base cement to affix a temporary tooth filling, to affix dental devices such as crowns or bridges, or to be applied to a tooth to protect the tooth pulp.

Predicate Devices

• MultiLink (K032470)
• RelyX Luting Plus Cement (K022476)
• PremaCem (K012316)

Submission Summary (Full Text)

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KIZI 804

# Abbreviated 510(k) Summary

Fax:

[phone]

Email: [e-mail]

APR 1 9 2013

| 1. | Name/Address of Submitter: | Itena Clinical |
|----|----------------------------|--------------------------------------|
| | | 83 avenue Foch |
| | | 75116 Paris |
| | | FRANCE |
| 2. | Contact Person: | Louis-Paul Marin |
| | | Co-President, BCF Certification inc. |
| | | Phone: [phone] |

3. Date Summary Prepared: April 25 , 2012

- 4. Devices Names: TotalCem, DentoCem
- ડ. Device Classification: II
- 6. Common name: Dental Cement
- 7. Classification Product Code: EMA
- 8. Predicate Devices:

| TotalCem | MultiLink | |
|----------|--------------------------|----------|
| | K032470 | |
| DentoCem | RelyX Luting Plus Cement | PremaCem |
| | K022476 | K012316 |

#### 0. Devices Description:

TotalCem: TotalCem is a permanent, radio-opaque dual cured (auto/photopolymerizable) self-etch and self-adhesive resin cement. The technological characteristics for this subject device are as follows:

| Technological<br>Characteristics | Subject Device | MultiLink<br>K032470 |
|----------------------------------|----------------------------------------|-------------------------------------------------------------------|
| Matrix | UDMA and BIS-GMA | UDMA and BIS-GMA |
| Fillers | Barium glass and Fumed<br>Silica, TiO2 | Barium glass, ytterbium<br>trifluoride and spheroid<br>mixedoxide |
| Delivery | Automix | Automix |

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| Curing Method | Dual Cure | Dual Cure |
|--------------------|-----------|-----------|
| Radiopacity (% Al) | Yes | Yes |

- DentoCem: DentoCem is a chemical-curing, multi-purpose, dual-cured (auto/photopolymerizable), radio opaque permanent adhesive resin cement comprised of two easy-to-mix components. The technological characteristics for this subject device are as follows:

| · Technological Characteristics | Subject Device | PremaCem<br>K012316 |
|---------------------------------|---------------------------------------|-------------------------|
| Matrix | UDMA and BIS-GMA | UDMA and Bis-GMA |
| Fillers | Barium glass and Fumed Silica<br>TiO2 | Barium glass and Silica |
| Delivery | Automix | Automix |
| Curing Method | Dual Cure | Dual Cure |
| Radiopacity (% Al) | Yes | Yes |

#### 10. Statement of Intended Use:

# Device Name: TotalCem

The device is intended for the cementation of posts, crowns, bridges, inlays and onlays.

### Device Name: DentoCem

The device is intended for permanent cementation of:

- crowns and bridges, inlays, onlays, posts and cores, ceramic crowns, Maryland . bridges and veneers;
- . implant prosthesis:
- orthodontic attachments: �
- amalgam restorations:
- veneering of alloys: and ●
- composite restorations. .

11. Brief Description of Clinical and Non-clinical Testing: This submission is an Abbreviated 510(k) as described in FDA's guidance document entitled "The New 510(k) Paradigm - Alternate Approaches to Demonstrating Substantial Equivalence in Premarket Notifications". In support of this, Itena Clinical has provided information to demonstrate conformity with FDA's guidance document entitled Dental Cements - Premarket Notification, August 1998 and ISO 4049 - Dentistry - Polymer-based filling, restorative and luting materials.

Conclusion Drawn: Based on their indications for use, technological characteristics and comparison to predicate devices, the subject devices have been shown to be safe and effective for

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their intended use. Further, combined with biocompatibility testing and based on a comparison of intended use and indications for use, physical properties and composition, Itena Clinical concludes that the subject devices are substantially equivalent to their respective predicates (respectively, Ivoclar Vivadent MultiLink (K032470) and 3M ESPE's predicate device, RelyXim Luting Plus Cement (K02247) and DMG, USA Permacem (K012316).

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Image /page/3/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 image of an eagle or other bird-like figure, with its wings spread and head turned to the side.

## DEPARTMENT OF HEALTH & HUMAN SERVICES

#### Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

April 19, 2013

Itena Clinical C/O Mr. Louis-Paul Marin Co-President BCF Certification, Incorporated 500 Boul Cartier West Laval, Canada H7V 5B7

Re: K121804

Trade/Device Name: TotalCem, DentoCem Regulation Number: 21 CFR 872.3275 Regulation Name: Dental Cement Regulatory Class: II Product Code: EMA Dated: March 27, 2013 Received: April 3, 2013

Dear Mr. Marin:

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.

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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 devicerelated 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 contact the Division of Small Manufacturers, International and Consumer Assistance at its tollfree number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. 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 O.
Ulmer-S

for

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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# K121804 Indication for Use

## Device Name: TotalCem

Indication for Use: It is intended for the cementation of posts, crowns, bridges, inlays and onlays.

# Device Name: DentoCem

Indication for Use: It is intended for permanent cementation of:

- crowns and bridges, inlays, onlays, posts and cores, ceramic crowns, � Maryland bridges and veneers;
- implant prosthesis; ●
- orthodontic attachments; ●
- . amalgam restorations;
- . veneering of alloys; and
- composite restorations.

# Concurrence of CDRH Office of Device Evaluation

l - l

OR

Prescription Use _X_ 801.109)

| Over-the-counter Use | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ |
|----------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|----------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Mary S. Runner - S | |
|-----------------------|--|
| Susan Runner, DDS, MA | |
| 2013.04.17 | |
| 10:36:45 -04'00' | |

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

510(k) Number: