MTA Repair HP

K151047 · Angelus Industria DE Productos Odontologicos · KIF · Aug 31, 2016 · Dental

Device Facts

• Record ID: K151047
• Device Name: MTA Repair HP
• Applicant: Angelus Industria DE Productos Odontologicos
• Product Code: KIF · Dental
• Decision Date: Aug 31, 2016
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 872.3820
• Device Class: Class 2
• Attributes: Therapeutic, Pediatric

Intended Use

Treatment of perforations of root canal and furcation caused iatrogenically or by caries lesions; Via canal treatment of root perforation due to internal resorption; Surgical treatment of root perforation due to internal resorption; Periapical surgery with reverse filling; Pulp capping; Pulpotomy (removal of affected crown portion of the pulp preserving the vitality and function of the remaining radicular portion); Apexogenesis (induction of root development in vital teeth with an inflamed coronal pulp); Apexification (induction of formation of a mineralized barrier at the root tip of young permanent teeth with incomplete root development and a necrotic pulp)

Device Story

MTA Repair HP is an endodontic bioceramic reparative cement; composed of mineral oxides (tricalcium silicate, dicalcium silicate, tricalcium aluminate, calcium oxide) and calcium tungstate (CaWO4) radiopacifier; includes polyvinylpyrrolidone plasticizer in liquid component. Used by dentists/endodontists in clinical settings for root canal/furcation repair, pulp capping, and apexification. Device supplied as powder/liquid capsule system; mixed to form putty-like consistency for manual application into dental cavities. Solidifies in wet environment (setting time ~15 mins). CaWO4 radiopacifier prevents tooth discoloration compared to bismuth oxide-based predicates. Provides physical barrier for root repair; aids in preserving pulp vitality or inducing mineralized barrier formation. Benefits include improved handling/plasticity and aesthetic stability.

Clinical Evidence

Bench testing only. Evaluated per ISO 10993-1, 10993-5 (cytotoxicity), 10993-6 (local effects), 10993-11 (systemic toxicity), ANSI/ADA Specification No. 57, and ISO 6876:2012. Testing confirmed setting time, radiopacity, and solubility are suitable for intended use as a root repair material.

Technological Characteristics

Bioceramic reparative cement; mineral oxides (tricalcium/dicalcium silicate, tricalcium aluminate, calcium oxide); CaWO4 radiopacifier; polyvinylpyrrolidone plasticizer. Supplied as 2-capsule system (powder/liquid). Standards: ISO 6876:2012, ANSI/ADA No. 57, ISO 10993-1. Non-sterile.

Indications for Use

Indicated for patients requiring endodontic repair, including treatment of root/furcation perforations (iatrogenic or caries-related), internal resorption, periapical surgery with reverse filling, pulp capping, pulpotomy, apexogenesis, and apexification.

Regulatory Classification

Identification

A root canal filling resin is a device composed of material, such as methylmethacrylate, intended for use during endodontic therapy to fill the root canal of a tooth.

Predicate Devices

• MTA-Angelus (K112046)

Submission Summary (Full Text)

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Image /page/0/Picture/1 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 three human profiles facing to the right, with the profiles overlapping and merging into a single form.

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

August 31, 2016

Angelus Industria De Productos Odontologicos % Lilian Llull Regulatory Affairs Manager Techlink International PO Box 694125 Miami. Florida 33160

Re: K151047

Trade/Device Name: MTA Repair HP Regulation Number: 21 CFR 872.3820 Regulation Name: Root Canal Filling Resin Regulatory Class: Class II Product Code: KIF Dated: July 5, 2016 Received: July 28, 2016

Dear Lilian Llull:

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.

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

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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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Industry and Consumer Education at its toll-free 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" (21 CFR 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 Industry and Consumer Education at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

# Michael J. Ryan -S

for Tina Kiang, Ph.D. Acting 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

510(k) Number (if known) K151047

Device Name MTA Repair HP

| Indications for Use (Describe) | * Treatment of perforations of root canal and furcation caused iatrogenically or by caries lesions;<br>* Via canal treatment of root perforation due to internal resorption;<br>* Surgical treatment of root perforation due to internal resorption;<br>* Periapical surgery with reverse filling;<br>* Pulp capping;<br>* Pulpotomy (removal of affected crown portion of the pulp preserving the vitality and function of the remaining radicular portion)<br>* Apexogenesis (induction of root development in vital teeth with an inflamed coronal pulp)<br>* Apexification (induction of formation of a mineralized barrier at the root tip of young permanent teeth with incomplete root development and a necrotic pulp) |
|--------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|--------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| Type of Use (Select one or both, as applicable) | |
|-------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------|
| | <input checked="" type="checkbox"/> Prescription Use (Part 21 CFR 801 Subpart D)<br><input type="checkbox"/> Over-The-Counter Use (21 CFR 801 Subpart C) |

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## FOR FDA USE ONLY

Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

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## K151047

#### 510(k) Summary

| Proprietary Name: | MTA Repair HP |
|-----------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------|
| Date of Submission: | August 29, 2016 |
| Submitter: | Angelus Industria de Productos Odontologicos<br>Waldir Landgraf, 101<br>Londrina, Brazil 86031-3200<br>TEL - [phone] |
| Official Contact: | Lilian Llull<br>TechLink International<br>PO Box 694125<br>Miami, FL 33160<br>TEL - (305) 974 - 0088 |
| | |
| Common Name:<br>Trade Name:<br>Classification:<br>Product Code:<br>Classification Panel:<br>Regulation Numbers: | Root Canal Filling Resin<br>MTA REPAIR HP<br>Class II<br>KIF<br>Dental<br>21 CFR 872.3820 |
| Substantial Equivalence: | (K112046) MTA-Angelus |

#### Indications for Use:

- Treatment of perforations of root canal and furcation caused iatrogenically or by caries lesions
- Via canal treatment of root perforation due to internal resorption
- Surgical treatment of root perforation due to internal resorption
- Periapical surgery with reserve filling
- Pulp capping
- Pulpotomy (removal of affected crown portion of the pulp preserving the vitality and function of the remaining radicular portion)
- * Apexogenesis (induction of root development in vital teeth with an inflamed coronal pulp)
- * Apexification (induction of formation of a mineralized barrier at the root tip of young permanent teeth with incomplete root development and a necrotic pulp)

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#### Device Description:

MTA REPAIR HP is an endodontic bioceramic reparative cement with high plasticity, composed of mineral oxides in the form of fine hydrophilic particles. It is indicated for cases of root perforation (canal and furcation), iatrogenic or by caries, root perforation by internal resorption, retrofilling, direct pulp capping, pulpotomy, apexigenesis, and apexification.

The plasticizer Polyviny|pyrrolidone is added in the subject device to improve the plasticity of the mixture powder/liquid, with plasticity being understood as the quality of being easily shaped or molded. Thus, the new formulation of the subject device improves handling and insertion into the dental cavity since the pasted after mixing becomes a molding putty type consistency.

The radiopacifier CaWO4 is also added in the subject device to prevent discoloration of the tooth, since CaWO4 does not reduce when exposed to sunlight, unlike Bi2O3 found in the predicate device. Overall properties noted for the subject device include the following:

- . Setting time: MTA Repair HP solidifies upon being maintained in a wet environment after spatulation. The start setting time is approximately 15 minutes.
- . Radiopacity: Similar to gutta-percha and more radiopaque than dentin and bone.
- . Absence of dental discoloring due to the radiopacifier CaWO4 used.

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## Device Comparison Table

| Element | Proposed Device<br>(K151047) | Predicate Device<br>(K112046) |
|------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Trade Name | MTA REPAIR HP | MTA ANGELUS |
| Device Description | MTA REPAIR HP is an endodontic<br>bioceramic reparative cement with high<br>plasticity, composed of mineral oxides<br>in the form of fine hydrophilic particles.<br>It is indicated for cases of root<br>perforation (canal and furcation),<br>iatrogenic or by caries, root perforation<br>by internal resorption, retrofilling,<br>direct pulp capping, pulpotomy,<br>apexigenesis, and apexification. | MTA Angelus is mineral<br>trioxide aggregate cement<br>used for root repair during<br>endodontic treatment,<br>combining the powder and<br>liquid produces a colloidal gel<br>that solidifies to form a<br>barrier. |
| Common Name | Resin, Root Canal Filling | Resin, Root Canal Filling |
| Classification | Root Canal Filling Resin | Root Canal Filling Resin |
| Class | Class II | Class II |
| Product Code | KIF | KIF |
| Indications for<br>Use | * Treatment of perforations<br>of root canal and furcation<br>caused iatrogenically or<br>by caries lesions;<br><br>* Via canal treatment of root<br>perforation due to internal<br>resorption;<br><br>* Surgical treatment of root<br>perforation due to internal<br>resorption; | * Treatment of perforations<br>of root canal and furcation<br>caused iatrogenically or by<br>caries lesions<br><br>* Via canal treatment of<br>root perforation due to<br>internal resorption<br><br>* Surgical treatment of<br>root perforation due to<br>internal resorption |
| | | |
| | * Periapical surgery with | * Periapical surgery |
| | reverse filling; | with reverse filling |
| | * Pulp capping; | * Pulp capping |
| | * Pulpotomy (removal of | * Pulpotomy (removal of |
| | affected crown portion of the | affected coronal pulp to |
| | pulp preserving the vitality and | preserve vitality of remaining |
| | function of the remaining | pulp tissue) |
| | radicular portion) | |
| | * Apexogenesis (induction of | * Apexogenesis |
| | root development in vital teeth | (indication of root |
| | with an inflamed coronal pulp) | development in vital teeth |
| | | with an inflamed coronal pulp) |
| | * Apexification (induction of | * Apexification (induction |
| | formation of a mineralized | of formation of a |
| | barrier at the root tip of young | mineralized barrier |
| | permanent teeth with | at the root tip of |
| | incomplete root | young permanent |
| | development | teeth with incomplete |
| | and a necrotic pulp) | root development |
| | | and a necrotic pulp) |
| | | |
| Biocompatibility | Biocompatible (Biological | Biocompatible |
| | Evaluation Report) | |
| Design | Powder (capsule) | Powder (bottle) |
| | Liquid (capsule) | Liquid (flask) |
| Shelf Life | 3 years | 3 years |
| | | |
| Standards | ISO 6876:2012 | ISO 6876:2012 |
| | ANS/ADA Nº 57 - 2000 | ISO 10993-1:2009 |
| | ISO 10993-1:2009 | |
| Composition:<br>powder | Tricalcium silicate<br>3CaO.SiO2 Dicalcium<br>silicate 2CaO.SiO2;<br>Tricalcium aluminate<br>3CaO. Al2O3;<br>Calcium Oxide CaO; Calcium<br>Tungstate CaWO4; | Tricalcium silicate<br>3CaO.SiO2; Dicalcium silicate<br>2CaO.SiO2; Tricalcium<br>aluminate<br>3CaO. Al2O3;<br>Calcium Oxide CaO; Bismuth<br>Oxide Bi2O3; |
| Composition:<br>liquid | Distilled water<br>Plasticizer<br>(Polyvinylpyrrolidone) | Distilled water |
| Packaging | 2 capsule system (powder and<br>liquid) | NA |
| Sterile | NA | NA |

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#### Nonclinical Testing:

The subject device features technological characteristics previously cleared in other devices. MTA HP meets the applicable requirements of the following FDA recognized standards:

- ISO 10993-1 Biological evaluation of medical devices-part 1: evaluation and testing.
- ISO 10993.5: 2009 Biological evaluation for medical devices Tests for cytotoxicity: in vitro methods
- ISO 10993-6: 2007 Biological evaluation of medical devices part 6: Tests for local effects after implantation and protocol supplied by the vendor.
- ISO 10993-11: 2006 Biological evaluation of medical devices part 11: Tests for systemic toxicity, described in method TOX-052 Rev. 01.
- . ANSI/ADA Specification no. 57: Endodontic Sealing Material, 2000.
- . ISO 6876:2012 - Dentistry -- Root Canal Sealing Materials

Flow, working time and film thickness ISO 6876 testing is not applicable to root-end filling materials as expected. This is because MTA Repair HP is a root repair material, not a root canal sealer. In this particular situation, ISO 6876:2012 - "Dentistry – Root canal sealing materials" is used as guide to determine properties such as setting time, radiopacity, and solubility. These test results are consistent with the

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intended use of root repair materials, because if the material is too fluid there is no possibility to seal the lateral of a root perforation without experiencing the flowing of the cement and, consequently the loss of the material.

Bench test results allowed us to conclude that MTA Repair HP is well suited for its intended use.

#### Substantial Equivalence:

The subject and the predicate device are substantially equivalent based on identical indications for use, same operating principle and similar material and design. MTA HP and MTA Angelus present the same components except for their radiopacifier. This new radiopacifier agent prevents the discoloration of the tooth, since CaWO4 in the subject device does not reduce when exposed to sunlight, as does Bi2O3 in the predicate device.

MTA HP comes also with a plasticizer in its liquid to improve the plasticity of the material. Physical chemistry and biocompatibility properties of the subject device have not been affected. However, both the substitution of the radiopacifier agent and the addition of the plasticizer into the liquid did not affect the critical properties (setting time, solubility and radiopacity) of MTA REPAIR HP. There is a one minute difference noted in the working time of the subject device, compared to its predicate; however, the time difference does not affect the usability of the subject device.

#### Conclusion:

The subject device and the predicate devices have intended use, have similar technological characteristics, and are made of similar materials. The subject device and predicate device encompass the same range of physical dimensions, including setting time, solubility, biocompatibility and shelf life. The subject and predicate devices are packaged in similar materials and both are provided nonsterile. Any differences in the technological characteristics do not raise new concerns.

Angelus Industria De Productos Odontologicos has demonstrated that, for the purposes of FDA's regulation of medical devices, MTA Repair HP is substantially equivalent in indications and design principles to its predicate device MTA-Angelus.