ETIII SA Fixture System (O3.2mm)

K153332 · Hiossen, Inc. · DZE · Oct 27, 2016 · Dental

Device Facts

• Record ID: K153332
• Device Name: ETIII SA Fixture System (O3.2mm)
• Applicant: Hiossen, Inc.
• Product Code: DZE · Dental
• Decision Date: Oct 27, 2016
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 872.3640
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The ETIII SA Fixture System (03.2mm) is indicated for use in mandibular and maxillary lateral and central incisor, in support of single or multiple-unit restorations including; cemented retained, screw retained, or overdenture restorations, and final or temporary abutment support for fixed bridgework. It is intended for delayed loading.

Device Story

ETIII SA Fixture System (Ø3.2mm) is an endosseous dental implant system; surgically placed in mandibular or maxillary bone to support prosthetic restorations. Device consists of titanium alloy (Ti-6Al-4V) fixture, mount, and pure titanium cover screw. Features internal hex, bone-level design, straight body, and 3-sided self-tapping cutting edge. Surface treated via sandblasting and acid etching (SA). Supplied sterile via radiation. Used by dental professionals in clinical settings. Provides stable foundation for artificial teeth; restores chewing function in partially edentulous patients.

Clinical Evidence

No clinical data. Substantial equivalence supported by bench testing, including static and dynamic fatigue testing, rotation angle/gap accuracy, and biocompatibility testing (ISO 10993 series: subchronic toxicity, genotoxicity, cytotoxicity, sensitization, irritation, systemic toxicity, and pyrogenicity).

Technological Characteristics

Materials: Fixture/Mount (Ti-6Al-4V, ASTM F136), Cover Screw (Pure Titanium, ASTM F67). Surface: Sandblasted and Acid-etched (SA). Design: Internal hex, bone-level, straight body, 3-sided self-tapping cutting edge. Dimensions: 3.2mm diameter; 8.7-15.2mm lengths. Sterilization: Radiation.

Indications for Use

Indicated for patients requiring dental implants in mandibular and maxillary lateral and central incisor regions to support single or multiple-unit restorations (cemented, screw-retained, or overdenture) and fixed bridgework. Intended for delayed loading.

Regulatory Classification

Identification

An endosseous dental implant is a prescription device made of a material such as titanium or titanium alloy that is intended to be surgically placed in the bone of the upper or lower jaw arches to provide support for prosthetic devices, such as artificial teeth, in order to restore a patient's chewing function.

Special Controls

*Classification.* (1) Class II (special controls). The device is classified as class II if it is a root-form endosseous dental implant. The root-form endosseous dental implant is characterized by four geometrically distinct types: Basket, screw, solid cylinder, and hollow cylinder. The guidance document entitled “Class II Special Controls Guidance Document: Root-Form Endosseous Dental Implants and Endosseous Dental Implant Abutments” will serve as the special control. (See § 872.1(e) for the availability of this guidance document.)(2) *Classification.* Class II (special controls). The device is classified as class II if it is a blade-form endosseous dental implant. The special controls for this device are:(i) The design characteristics of the device must ensure that the geometry and material composition are consistent with the intended use; (ii) Mechanical performance (fatigue) testing under simulated physiological conditions to demonstrate maximum load (endurance limit) when the device is subjected to compressive and shear loads; (iii) Corrosion testing under simulated physiological conditions to demonstrate corrosion potential of each metal or alloy, couple potential for an assembled dissimilar metal implant system, and corrosion rate for an assembled dissimilar metal implant system; (iv) The device must be demonstrated to be biocompatible; (v) Sterility testing must demonstrate the sterility of the device; (vi) Performance testing to evaluate the compatibility of the device in a magnetic resonance (MR) environment; (vii) Labeling must include a clear description of the technological features, how the device should be used in patients, detailed surgical protocol and restoration procedures, relevant precautions and warnings based on the clinical use of the device, and qualifications and training requirements for device users including technicians and clinicians; (viii) Patient labeling must contain a description of how the device works, how the device is placed, how the patient needs to care for the implant, possible adverse events and how to report any complications; and (ix) Documented clinical experience must demonstrate safe and effective use and capture any adverse events observed during clinical use.

Predicate Devices

• HIOSSEN IMPLANT SYSTEM (K140934)
• MS SA IMPLANT SYSTEM (K122171)
• NobelActive 3.0 (K102436)

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 and Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is a stylized image of three human profiles facing to the right, with flowing lines representing hair or clothing.

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

October 27, 2016

HiOSSEN Inc. David Kim Manager 85 Ben Fairless Dr. Fairless Hills, Pennsylvania 19030

Re: K153332

Trade/Device Name: ETIII SA Fixture System (Ø 3.2mm) Regulation Number: 21 CFR 872.3640 Regulation Name: Endosseous Dental Implant Regulatory Class: Class II Product Code: DZE, NHA Dated: September 27, 2016 Received: September 28, 2016

Dear David Kim:

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

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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 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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SECTION 007

Image /page/2/Picture/1 description: The image shows the logo and contact information for Hiossen Inc. The logo features the company name in a stylized font, with the "H" in red and the rest of the name in gray. Below the logo is the company name, address (85 Ben Fairless Dr. Fairless Hills, PA 19030), phone number (1-888-678-0001), fax number (1-267-759-7004), and website address (www.hiossen.com).

# Indications for Use Statement

510(k) Number K ______________________________________________________________________________________________________________________________________________________________

Device Name : The ETIII Fixture System (Ø3.2mm)

Indication for use :

The ETIII SA Fixture System (03.2mm) is indicated for use in mandibular and maxillary lateral and central incisor, in support of single or multiple-unit restorations including; cemented retained, screw retained, or overdenture restorations, and final or temporary abutment support for fixed bridgework. It is intended for delayed loading.

Prescription Use X (Per 21CFR801 Subpart D) OR Over-The-Counter Use (Per 21CFR807 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

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Section 008

Image /page/3/Picture/1 description: The image shows the logo for Hiossen. The logo is in two colors, red and gray. The letters "HI" are in red, and the rest of the letters are in gray.

Hiossen Inc. 85 Ben Fairless Dr. Fairless Hills, PA 19030 Tel : [phone] / Fax : [phone] www.hiossen.com

## 510(k) Summary

This summary of 510(k) substantial equivalence information is being submitted in accordance with requirements of 21 CFR Part 807.92.

Date : Sept. 27, 2016

1. Company and Correspondent making the submission:

| - Submitter's Name : | HiOSSEN Inc. |
|----------------------|------------------------------------------------|
| - Address : | 85 Ben Fairless Dr.<br>Fairless Hills PA 19030 |
| - Telephone No. | 888 678 0001 |
| - Contact : | Mr. David Kim |

#### 2. Device :

| Trade or (Proprietary) Name : | ETIII SA Fixture System (Ø3.2) |
|-------------------------------|--------------------------------|
| Common or usual name : | Endosseous Dental Implant |
| Regulation Number: | 21 CFR 872.3640 |
| Regulation Name: | Endosseous Dental Implant |
| Regulatory Class: | Class II |
| Product Code: | DZE, NHA |

#### 3. Predicate Device:

Primary Predicate: HIOSSEN IMPLANT SYSTEM (HIOSSEN Inc., K140934) Referenced Predicate #1: MS SA IMPLANT SYSTEM (HIOSSEN Inc., K122171) Referenced Predicate #2: NobelActive 3.0 ( NobelBiocare, K102436 )

#### 4. Description :

- 1) The ETIII SA Fixture System (Ø3.2) is similar to other commercially available products based on the intended use, the technology used, the claims, the material composition employed and performance characteristics.
- 2) The ETIII SA Fixture System (Ø3.2mm) is made of titanium alloy (Ti 6Al 4V) for Fixtures and Simple Mount and pure titanium for Cover Screw. The ETIII SA Fixture System (Ø3.2mm) is indicated for use in mandibular and maxillary lateral and central incisor, in support of single or multiple-unit restorations including; cemented retained, screw retained, or overdenture restorations, and final or temporary abutment support for fixed bridgework. It is intended for delayed loading.

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Image /page/4/Picture/0 description: The image shows the logo for HIOSSEN. The letters "HI" are in red, and the rest of the letters are in gray. There is a red swoosh above the "HI".

### Section 008

Hiossen Inc. 85 Ben Fairless Dr. Fairless Hills, PA 19030 Tel : [phone] / Fax : [phone] www.hiossen.com

#### 3) Fixture

| Device | Intended to be surgically placed in the bone of the upper or lower jaw arches. | | |
|-------------|--------------------------------------------------------------------------------|-----------------------------|------------|
| Description | Fixture is supplied sterile. | | |
| Material | Alloyed Titanium (ASTM F136) | | |
| Surface | SA surface treatment (Sand blasted and Acid etched ) | | |
| | Diameter (mm) | Length (mm) | Connection |
| Dimension | 3.2 | 8.7, 10.2, 11.7, 13.2, 15.2 | Mini |

#### 4) Component

| Mount Set | |
|---------------|----------------------------------------------------------------------------------|
| Description | To be used for easy implanting of the Fixture |
| Material | Alloyed Titanium (ASTM F136) |
| Diameter (mm) | 4.8 |
| Length (mm) | 16 |
| Connection | Mini |
| Cover Screw | |
| Description | To be used to protect the exposed platform of the implant during healing period. |
| Material | Pure Titanium (ASTM F 67) |
| Diameter (mm) | 3.1 |
| Length (mm) | 4.75 |
| Connection | Mini |

#### Substantial Equivalence

| | Proposed device | Primary<br>predicate device | Reference<br>predicate device | Reference<br>predicate device |
|------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| | ETIII SA Fixture<br>System (Ø3.2mm) | Hiossen Implant<br>System | MS SA Implant<br>System | NobelActive 3.0 |
| Design | Image: ETIII SA Fixture System (Ø3.2mm) | Image: Hiossen Implant System | Image: MS SA Implant System | Image: NobelActive 3.0 |
| 510(K) No. | N/A | K140934 | K122171 | K102436 |
| www.hiossen.com | | | | |
| Indication<br>for use | The ETIII SA Fixture<br>System (Ø3.2mm) is<br>indicated for use in<br>mandibular and<br>maxillary lateral and<br>central incisor, in<br>support of single or<br>multiple-unit<br>restorations including;<br>cemented retained,<br>screw retained, or<br>overdenture<br>restorations, and final<br>or temporary<br>abutment support for<br>fixed bridgework. It is<br>intended for delayed<br>loading. | The HIOSSEN Implant<br>System is indicated for<br>use in partially or fully<br>edentulous mandibles<br>and maxillae, in support<br>of single or multiple-unit<br>restorations including;<br>cemented retained, screw<br>retained, or overdenture<br>restorations, and final or<br>temporary abutment<br>support for fixed<br>bridgework. It is intended<br>for delayed loading.<br>ETIII SA Ultra-Wide<br>Fixture is intended to be<br>used in the molar region. | The MS SA Implant<br>(Narrow Ridge) is<br>intended to use in the<br>treatment of missing<br>mandibular central and<br>lateral incisors to support<br>prosthetic device, such as<br>artificial teeth, in order to<br>restore chewing function<br>in partially edentulous<br>patients. The MS SA<br>Implant (Narrow Ridge)<br>is intended for single use<br>only. It is intended for<br>delayed loading. | The NobelActive<br>3.0mm implant is<br>indicated for use in the<br>treatment of missing<br>maxillary lateral incisors<br>or the mandibular<br>central and lateral<br>incisors to support<br>prosthetic devices, such<br>as artificial teeth,in<br>order to restore chewing<br>function in partially<br>edentulous patients. The<br>NobelActive 3.0<br>implants may be put into<br>immediate function<br>provided that stability<br>requirements detailed in<br>the manual are satisfied. |
| Surgery type | One or two stage<br>Surgery | One and two stage<br>Surgery | One stage<br>Surgery | One and two stage<br>Surgery |
| Structure | - Internal Hex<br>- Bone Level Implant<br>- Straight body shape<br>- 3 sided cutting edge<br>with self-tapping | - Internal Hex<br>- Bone Level Implant<br>- Tapered body shape<br>- 3 sided cutting edge<br>with self-tapping | - One Body Implant<br>- Straight body shape<br>- Threaded body<br>design<br>- 2 sided cutting edge | -Internal Hex<br>- Bone Level Implant |
| Body<br>Diameter | 3.2 mm | 3.5, 3.75, 3.77, 4.2, 4.25,<br>4.45, 4.6, 4.63, 4.65, 4.9,<br>5.0, 5.1, 5.05, 5.08, 5.92,<br>5.95, 6.8 mm | 2.5, 2.9 mm | 3.0 mm |
| Length | 8.7, 10.2, 11.7, 13.2,<br>15.2 mm | 6.2, 7.2, 8.2, 8.7, 9.7,<br>10.2, 11.2, 11.7, 12.7,<br>13.2, 15.2, 18.2 mm | 8.5, 10, 11.5, 13 mm | 10, 11.5, 13, 15 mm |
| Material of<br>Fixture | Titanium Alloy<br>Ti-6Al-4V<br>(ASTM F136) | Pure Titanium Grade 4<br>(ASTM F67) | Titanium Alloy<br>Ti-6Al-4V<br>(ASTM F136) | Pure Titanium Grade 4<br>(ASTM F67) |
| Surface | SA(Sandblasting<br>& Acid etching) | SA(Sandblasting<br>& Acid etching) | SA(Sandblasting<br>& Acid etching) | TiUnite |
| Steriliza-tion | Radiation Sterile | Radiation Sterile | Radiation Sterile | Radiation Sterile |
| Shelf life | 8years | 8years | 8 years | n/a |

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Image /page/5/Picture/0 description: The image shows the logo for HIOSSEN. The logo is in two colors, red and gray. The letters "HI" are in red, and the rest of the word "OSSEN" is in gray. There is a red swoosh above the "HI".

Hiossen Inc.

85 Ben Fairless Dr. Fairless Hills, PA 19030 Tel : [phone] / Fax : [phone] www.hiossen.com

# Section 008

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Image /page/6/Picture/0 description: The image shows the logo for Hiossen. The letters "HI" are in red, with a red swoosh above the "H". The rest of the word, "OSSEN", is in gray. The logo is simple and modern.

Hiossen Inc. 85 Ben Fairless Dr. Fairless Hills, PA 19030 Tel : [phone] / Fax : [phone] www.hiossen.com

| Differences | The indications for use:<br>The indication for use statement for the proposed device is not identical to the predicate device(K140934);<br>however, the difference does not alter the general intended use of dental implant. Both the subject and<br>predicate devices have the same intended use for the replacement of missing teeth. And the indication for<br>use of proposed device is very similar with predicate device, K102436.<br>Material:<br>The proposed device is made with alloyed titanium (Ti-6Al 4V) and the predicate device, K140934 is made<br>with pure titanium (Ti CP4). The difference in material is insignificant chemical composition. And another<br>predicate device, K122171 is made with alloyed titanium(Ti-6Al-4V) |
|----------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Similarities<br>And<br>S.E | Proposed device, ETIII SA Fixture System (Ø3.2mm) is same with predicate devices in intended<br>use (K140934 / K102436), material (K122171 ), and surface treatment (K140934 ). |

- 5. Indication for use :
The ETII SA Fixture System (Ø3.2mm) is indicated for use in mandibular and maxillary lateral and central incisor, in support of single or multiple-unit restorations including; cemented retained, screw retained, or overdenture restorations, and final or temporary abutment support for fixed bridgework. It is intended for delayed loading.

- 6. Summary of nonclinical testing
Hiossen predicate K140934 was relied upon for sterility, shelf-life and biocompatibility. Additionally LAL testing per USP <85> was conducted for the subject device.

Non-clinical testing data submitted to demonstrate substantial equivalence includes adaptation accuracy for rotation angle and gap, static and dynamic fatigue test according to "Guidance for industry and FDA staff Class Special Controls Guidance Document Root-form Endosseous Dental Implants and Endosseous Dental Abutment" All tests were conducted in accordance with relative standards without any discrepancies.

| Test Items | Standard |
|-----------------------------------------------------|----------------------------|
| Subchronic Toxicity test ( ISO 90 Days, Bone ) | ISO 10993-11 , ISO 10993-6 |
| Bacterial reverse mutation test (Genotoxicity test) | ISO 10993-3, ISO 10993-12 |
| Chromosome aberration test (Genotoxicity test) | ISO 10993-3, ISO 10993-12 |
| Cytotoxicity test | ISO 10993-5, ISO 10993-12 |
| Sterility test | USP 36 <71> |
| Skin sensitization test (GPMT) | ISO 10993-10 |

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Image /page/7/Picture/0 description: The image shows the word "HIOSSEN" in a stylized font. The "HI" is in red, and the rest of the word is in gray. There is a red swoosh above the "I" in "HI".

Hiossen Inc. 85 Ben Fairless Dr. Fairless Hills, PA 19030 Tel : [phone] / Fax : [phone] www.hiossen.com

| Oral Mucosa Irritation test | ISO 10993-10 |
|------------------------------|----------------------------|
| Acute Systemic Toxicity test | ISO 10993-11 |
| Pyrogen test | ISO 10993-11, USP 36 <151> |

7. Summary of clinical testing No clinical studies are submitted.

#### 8. Conclusions

In accordance with the Federal Food, Drug and Cosmetic Act, 21 CFR Part 807, and based on the information provided in this premarket notification, HIOSSEN Inc. concludes that the The ETIII SA Fixture System (Ø3.2) is substantially equivalent to the predicate devices as described herein.