Dual Top Screw System

K161335 · Jeil Medical Corporation · OAT · Feb 23, 2017 · Dental

Device Facts

• Record ID: K161335
• Device Name: Dual Top Screw System
• Applicant: Jeil Medical Corporation
• Product Code: OAT · Dental
• Decision Date: Feb 23, 2017
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 872.3640
• Device Class: Class 2
• Attributes: Therapeutic

Indications for Use

The Dual Top Screw System is intended for use as a temporary anchor for orthodontic treatment for use in patients aged 12 and older.

Device Story

Dual Top Screw System consists of titanium alloy screws in various configurations, head designs, lengths, and diameters. Used as temporary orthodontic anchors to provide fixed points for attaching appliances like brackets, wires, and elastic bands. Operated by dental professionals in clinical settings. Screws are implanted into the jaw to facilitate tooth movement; removed after treatment completion. Benefits include stable anchorage for complex orthodontic cases. Provided non-sterilized or gamma-sterilized.

Clinical Evidence

No clinical studies were performed. Substantial equivalence was demonstrated through non-clinical bench testing, including axial pullout, torsional property, and driving torque tests per ASTM 543, and biocompatibility testing per ISO 10933-5.

Technological Characteristics

Material: Titanium Alloy (Ti-6AL-4V) per ASTM F136. Design: Endosseous screw with dual head for orthodontic appliance attachment. Dimensions: Thread diameter 1.3-2.5mm, length 5-16mm. Sterilization: Non-sterile (steam) or gamma-sterilized. No software or electronic components.

Indications for Use

Indicated for use as a temporary orthodontic anchor in patients aged 12 and older.

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

• The C-Type, CT Type and Special Type (K063495)

Reference Devices

• PSM LOMAS / BENEFIT Screws (K110392)

Submission Summary (Full Text)

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

February 23, 2017

Jeil Medical Corporation Seungyoung Lee RA Specialist 702 · 703 · 704 · 705 · 706 · 805 · 807 · 812-ho, 55, Digital-ro34-gil, Guro-gu, Seoul, 08378 KOREA

Re: K161335

Trade/Device Name: Dual Top Screw System Regulation Number: 21 CFR 872.3640 Regulation Name: Endosseous Dental Implant Regulatory Class: Class II Product Code: OAT Dated: January 24, 2017 Received: January 25, 2017

Dear Seungyoung Lee:

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) K161355

Device Name Dual Top Screw System

Indications for Use (Describe)

The Dual Top Screw System is intended for use as a temporary anchor treatment for use in patients aged 12 and older.

Type of Use (Select one or both, as applicable)

X Prescription Use (Part 21 CFR 801 Subpart D)

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

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Image /page/3/Picture/0 description: The image shows the logo for JEIL MEDICAL CORPORATION, followed by the address: 702-703-704-705-706-804-805-807-812-ho, 55, Digital-ro34-gil, Guro-gu, 08378, Korea. The phone number is Tel: [phone] and the fax number is Fax: [phone]. The logo includes a graphic of three stylized figures in green, gray, and orange.

# 510(k) Summary

[As required by 21 CRF 807.92]

# 1. Date Prepared [21 CRF 807.92(a)(1)]

#### 21 February 2017

#### Submitter's Information [21 CFR 807.92(a)(1)] 2.

- Name of Sponsor: Jeil Medical Corporation . -Address: 702·703·704·705·706·804·805·807·812-ho,55 Digital-ro34-gil, Guro-gu, Seoul, 08378, Korea . Contact Name: Seungyong Lee / RA Specialist
- -Telephone No. : [phone]
- Fax No. : -[phone]
- Email Address : [e-mail]
- Registration Number: 3004049923 ●
- Name of Manufacturer: . Same as Sponsor
- Address: Same as Sponsor

#### Trade Name, Common Name, Classification [21 CFR 807.92(a)(2)] 3.

- . Trade Name: Dual Top Screw System . Common Name: Implant, Endosseous, Orthodontic . Classification Name: Endosseous Dental Implant Classification Panel: Dental . Classification Regulation: . 21 CFR 872.3640 . Product Code: OAT . Device Class: II
Dual Top Screw System

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### 4. Identification of Predicate Device(s) [21 CFR 807.92(a)(3)]

The identified predicate devices within this submission are shown as follow;

| • Primary Predicate: | K063495 |
|----------------------|--------------------------------------|
| • Applicant: | Biomaterials Korea, Incorporated |
| • Common Name: | Implant, Endosseous, Orthodontic |
| • Device Name: | The C-Type, CT Type and Special Type |

- Common Name: Implant, Endosseous, Orthodontic ●
- Device Name: PSM LOMAS / BENEFIT Screws ●

#### Orthodontic Anchor Screw

There are no significant differences between the Model Dual Top Screw System and the predicate devices that would adversely affect the use of the product. It is substantially equivalent to these devices in design, function, materials, and operational principles as internal fixation components.

#### 5. Description of the Device [21 CFR 807.92(a)(4)]

The Dual Top Screw System is a temporary fixation and screws in various configurations, shapes and sizes as follow;

| | The Dual Top Screw System | | | | | | | | |
|-----------------------------------------|----------------------------------|------------------------------------|----------------------|----------------------------------|----------------------|---------------------------------|--------------------------|----------------------------------|----------------------|
| Head Design | JA<br>Series | JB<br>Series | G1<br>Series | G2<br>Series | JD<br>Series | JO<br>Series | JS<br>Series | JF<br>Series | JK<br>Series |
| The type of<br>orthodontic<br>appliance | Elastic<br>Band,<br>Arch<br>wire | Elastic<br>Band,<br>NiTi<br>Spring | Arch<br>wire | Elastic<br>Band,<br>Arch<br>wire | Arch<br>wire | Arch<br>wire,<br>NiTi<br>Spring | Elastic<br>Band | Elastic<br>Band,<br>Arch<br>wire | Elastic<br>Band |
| Length | 5,6,7,8,10<br>,12 mm | 5,6,7,8,10<br>,12 mm | 5,6,7,8,10<br>,12 mm | 5,6,7,8,10<br>,12 mm | 5,6,7,8,10<br>,12 mm | 5,6,7,8,10<br>,12 mm | 10,11,12,<br>14,16<br>mm | 5,6,7,8,10<br>,12 mm | 5,6,7,8,10<br>,12 mm |
| diameter | $Ø$ 1.3~<br>$Ø$ 2.0 | $Ø$ 1.3~<br>$Ø$ 2.0 | $Ø$ 1.3~<br>$Ø$ 2.0 | $Ø$ 1.3~<br>$Ø$ 2.0 | $Ø$ 1.3~<br>$Ø$ 2.0 | $Ø$ 1.3~<br>$Ø$ 2.0 | $Ø$ 2.0~<br>$Ø$ 2.5 | $Ø$ 1.4~<br>$Ø$ 2.0 | $Ø$ 1.4 |

The Dual Top Screw System is made of Titanium Alloy (Ti-6AL-4V), which meets ASTM F136, Standard Specification for Wrought Titanium-6 Aluminum-4 Vanadium ELI (Extra Low Interstitial) Alloy for Surgical Implant Applications, which are widely used for surgical implants with well-known biocompatibility. The head of the screw is dual head of the Dual Top Anchor System screw is designed to apply various orthodontic tools. There is a hole in the screw head through which a

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Image /page/5/Picture/0 description: The image shows the logo for JEIL MEDICAL CORPORATION. Below the logo is the address: 702-703-704-705-706-804-805-807-812-ho, 55, Digital-ro34-gil, Guro-gu, 08378, Korea. The phone number is [phone] and the fax number is [phone].

wire can be passed to fix the mandible and maxilla in orthodontic treatment. Also, dual head design of screw accommodates the use of the screw with the orthodontic appliances (bracket, wire, and elastic band etc.) The sizes of the Dual Top System are diverse enough to satisfy various clinical cases. The Dual Top System screws are provided either non-sterilized or gamma-sterilized.

# 6. Indications for Use [21 CFR 807.92(a)(5)]

The Dual Top Screw System is intended for use as a temporary anchor for orthodontic treatment for use in patients aged 12 and older.

# 7. Technological Characteristics [21 CFR 807.92(a)(6)]

Dual Top Screw System Endosseous Dental Implant: They share similar head, neck and thread designs as the smaller screws that are currently cleared under the predicate devices.

| | Subject Device | Primary Predicate | Reference Predicate |
|---------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 510K Number | K161335 | K063495 | K110392 |
| Product name | Dual Top Screw System | The C-Type, CT Type and<br>Special Type Orthodontic<br>Anchor Screws | PSM LOMAS / BENEFIT<br>Screws |
| Manufacturer | Jeil Medical Corporation | Biomaterials Korea<br>Incorporated | PSM MEDICAL<br>SOLUTIONS |
| Indications for Use | The Dual Top Screw<br>System is intended for use<br>as a temporary anchor for<br>orthodontic treatment for<br>use in patients aged 12 and<br>older. | Intended for use as a<br>temporary anchor for<br>orthodontic treatment. | The PSM LOMAS /<br>BENEFIT<br>Screws are intended to<br>provide a fixed anchorage<br>point for attachment of<br>orthodontic appliances to<br>facilitate the orthodontic<br>movement of teeth<br>in adolescents greater than<br>12<br>years of age and adults. The<br>devices are used<br>temporarily and are<br>removed after orthodontic<br>treatment has been<br>completed. Screws are<br>intended for single use<br>only. |
| Design | Screw<br>- Thread Diameter; Ø 1.3~<br>Ø 2.5<br>- Thread Depth: 0.15 ~<br>0.55mm | Screw<br>- Thread Diameter; Ø 1.2~<br>Ø 2.0<br>- Thread Depth: Ø 1.2:<br>0.14mm | Screw<br>- Thread Diameter; Ø 1.5~<br>Ø 2.3<br>- Length; 7~15mm |
| | - Length; 5~16mm | - Length; 5~12mm | |
| Materials | Titanium Alloy (ASTM<br>F136) | Titanium Alloy (ASTM<br>F136) | Titanium Alloy (ASTM<br>F136) |
| Surface Treatment | No surface treatment | Anodized | Anodized |

Dual Top Screw System

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Image /page/6/Picture/0 description: The image shows the logo and contact information for JEIL MEDICAL CORPORATION. The logo features the company name in a stylized font, with a graphic element to the left. Below the logo is the company's address: 702-703-704-705-706-804-805-807-812-ho, 55, Digital-ro34-gil, Guro-gu, 08378, Korea. The phone and fax numbers are also listed: Tel: [phone] / Fax: [phone].

| Sterilization | Non-Sterile<br>(Steam sterilized by user)<br>or Gamma- Sterilized | Non-Sterile<br>(Steam sterilization by user) | Gamma- Sterilized |
|---------------|-------------------------------------------------------------------|----------------------------------------------|-------------------|
|---------------|-------------------------------------------------------------------|----------------------------------------------|-------------------|

The results of this testing indicate that the Dual Top Screw System is equivalent to predicate devices.

#### 8. Non-Clinical Testing Summary

Comparative bench tests were conducted to demonstrate substantial equivalence to the primary predicate device (K063495). The following tests were conducted using FDA recognized standard methods:

- Axial Pullout test: ASTM 543
- Torsional Property test: ASTM 543
- Driving Torque test: ASTM 543
- Biocompatibility test:

The subject device is manufactured from Titanium alloy (conforming with ASTM F136) with a history of safe use. Cytotoxicity testing per ISO 10933-5 was performed to mitigate the risks associated with materials used during manufacturing

#### 9. Clinical Testing Summary

No clinical studies were necessary for the demonstration of substantial equivalence.

#### 10. Conclusion [21 CFR 807.92(b)(3)]

The subject device is made of the same materials and has similar dimensions and characteristics as the primary predicate device. The subject device is manufactured from material of the Titanium Alloy that is used generally in this kind of endosseous dental implant system. The subject device, Dual Top Screw System, is substantially equivalent in intended use and technological characteristics to the primary predicate device (K063495).