Clear-Aligners

K191823 · Cdb Corporation · NXC · Dec 20, 2019 · Dental

Device Facts

• Record ID: K191823
• Device Name: Clear-Aligners
• Applicant: Cdb Corporation
• Product Code: NXC · Dental
• Decision Date: Dec 20, 2019
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 872.5470
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The Clear-Aligner system is indicated for the treatment of malocclusion in patients with permanent dentition. The Clear-Aligner system positions teeth by way of continuous gentle force.

Device Story

Clear-Aligner system; orthodontic treatment for malocclusion. Input: dental molds/scans provided by clinician. Process: clinician uses standard dental software to design treatment plan; CDB designs series of clear, thermoformed copolyester plastic trays based on prescription; physician reviews/approves plan; CDB manufactures trays. Output: sequential plastic aligners. Usage: clinic setting; operated by orthodontist/dentist; patient wears trays to apply continuous gentle force to teeth. Benefit: gradual tooth realignment. Monitoring: clinician monitors treatment from first to final aligner delivery; patient removes trays as needed.

Clinical Evidence

Bench testing only. Evaluated fit of aligners against treatment plans and process consistency from digital files to 3D-printed molds and final thermoformed aligners. Biocompatibility testing (cytotoxicity, sensitization, irritation) performed per ISO 10993-1; results confirmed non-cytotoxic, non-sensitizing, and non-irritating. No clinical data provided.

Technological Characteristics

Thermoformed copolyester plastic trays. Principle: sequential application of continuous gentle force to dentition. Connectivity: standard dental software for ordering and treatment planning. Biocompatibility: ISO 10993-1 compliant. Software: moderate concern.

Indications for Use

Indicated for treatment of malocclusion in patients with permanent dentition.

Regulatory Classification

Identification

An orthodontic plastic bracket is a plastic device intended to be bonded to a tooth to apply pressure to a tooth from a flexible orthodontic wire to alter its position.

Predicate Devices

• Clear Correct (K082556)

Reference Devices

• Invisalign (K981095)

Submission Summary (Full Text)

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Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

December 20, 2019

CDB Corporation Leah Lehman Quality & Regulatory Manager 9201 Industrial Blvd Leland, North Carolina 28451

Re: K191823

Trade/Device Name: Clear-Aligners Regulation Number: 21 CFR 872.5470 Regulation Name: Orthodontic Plastic Bracket Regulatory Class: Class II Product Code: NXC Dated: November 18, 2019 Received: November 19, 2019

Dear Leah Lehman:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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

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requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely,

for Srinivas "Nandu" Nandkumar, Ph.D. Director DHT1B: Division of Dental Devices OHT1: Office of Ophthalmic, Anesthesia, Respiratory, ENT and Dental Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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# Indications for Use

510(k) Number (if known) K191823

Device Name Clear-Aligners

Indications for Use (Describe)

The Clear-Aligner system is indicated for the treatment of malocclusion in patients with permanent dentition. The Clear-Aligner system positions teeth by way of continuous gentle force.

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/2 description: The image shows the logo for CDB Ceramic Dental Brackets. The logo consists of a stylized blue triangle on the left and the text "CDB CERAMIC DENTAL BRACKETS" on the right. Below the logo is the text "510(k) Summary" in a large, bold font.

This 510(k) Summary is submitted in accordance with the requirements of 21CFR 807.92.

| Submitter: | CDB Corporation<br>9201 Industrial Blvd, NE<br>Leland, NC 28451 USA<br>Owner/Operator No.: 9002860<br>Establishment Registration No.: 1054415 |
|-----------------------|-----------------------------------------------------------------------------------------------------------------------------------------------|
| Primary Contact: | Leah M Lehman<br>Quality & Regulatory Manager<br>Phone: [phone]<br>[e-mail] |
| Secondary Contact: | Jens Rumsfeld<br>Managing Director<br>Phone: [phone]<br>[e-mail] |
| Date Prepared: | December 19, 2019 |
| 510k Submission: | K191823 |
| Device Name: | Clear-Aligners |
| Common Name: | Sequential Aligner |
| Classification Name: | Orthodontic Plastic Bracket |
| Regulation Number: | 21 CFR 872.5470 |
| Product Code: | NXC |
| Classification Panel: | Dental Products Panel 76 |
| Classification: | Medical Device, Class II |

#### Indications for Use:

The Clear-Aligner system is indicated for the treatment of malocclusion in patients with permanent dentition. The Clear-Aligner system positions teeth by way of continuous gentle force.

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#### Predicate Devices:

Clear Correct, Clear Correct Inc., K082556 (primary predicate) Invisalign, Align Technology, K981095 (reference device)

#### Device Description:

A dental health care professional (e.q. orthodontist or dentist), using a standard personal computer prescribes the Clear-Aligner system based on an assessment of thee patient's teeth, determines a course of treatment with the system, takes molds of the patient's teeth, and completes a prescription form. Utilizing standard dental software used for tooth alignment, CDB then designs a series of plastic trays intended to gradually realign the patient's teeth in accordance with the physician's prescription. The prescribing physician reviews and approves the treatment plan before the molds are produced. Once approved, CDB produces the trays, which are formed of clear, thin, thermoformed, copolyester plastic. The trays sent back to the dental health care professional, who then provides them to the patient, confirming fit and design. Over a period of months, additional trays are provided sequentially to the patient by the dental health professional to gradually move the target teeth to the desired position. The dental care professional monitors treatment from the moment the first aligner is delivered to when the final aligner is delivered. The trays are held in place by pressure and can be removed by the patient at any time. This technology is essentially identical to that used by a number of sequential alignment systems, including the predicates referenced in Table 1.

## Technoloqical Characteristics:

Treatment of tooth malocclusions via a series of plastic appliances that incrementally moves teeth to a desired end-state is the technological principle for both the subject and predicate devices. A comparison between technological characteristics of the Clear-Aligners and that of legally marketed predicate devices has been performed. The results of this comparison demonstrate that the design, technology, materials, and composition of the Clear-Aligners are substantially equivalent to the predicate devices.

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## Mechanism of Action:

The mechanism of action is similar to the predicate devices and supports a determination of substantial equivalence. Orthodontic tooth movement occurs through forces applied by the appliance to the dentition as each tooth follows the programmed displacement based on a dental health professional's prescription.

## Performance Testing:

Bench testing was performed to ensure the accuracy of the final product carried through the entire process from the initial scan through treatment planning and manufacturing of the model to the final thermoformed aligner. Functional characteristics tested and the standard by which they were tested include the following, all pre-established specification and acceptance criteria:

- . Fit of the aligner against the treatment plan as determined by dental health professional
- Process consistency from the treatment plan file to 3D printed mold to final . aligner was measured against internal acceptance criteria derived by considering all sources of variation

The acceptance results observed during the verification and validation testing that has been conducted on these devices has shown that they are capable of performing to their stated intended use and specification requirements.

Further testing was not performed given there is sufficient information available from the scientific literature and from the predicate devices to demonstrate that sequential aligners provide reasonable assurance of substantial equivalence.

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## Biocompatibility Testing:

The biological evaluation for the device was conducted in accordance with the US FDA Docket Number FDA-2013-D-0350, "Use of International Standard ISO 10993-1, Biological evaluation and testing within a risk management process - Guidance for Industry and Food and Drug Administration Staff" as recognized by FDA. The aligner is considered mucosal membrane contacting for a duration of greater than 30 days. The battery of testing included the following tests:

- Cytotoxicity ●
- Sensitization
- Irritation ●

The results of the testing met the requirements of the study protocols and the material is considered non-cytotoxic, non-sensitizing, and is not an intracutaneous irritant. The results of the studies further support the determination of substantial equivalence.

## Software Consideration

There are two areas in the Clear-Aligner process where software is used; they are the ordering process and treatment planning. The software usage in these areas is considered of moderate concern. Software testing has been performed to verify the function of the Clear-Aligners, which supports a substantial equivalence decision.

## Substantial Equivalence Comparison:

The following table compares the Clear-Aligner system to the predicate devices, Clear Correct (primary predicate) and the Align System (reference device), with respect to intended use, technological characteristics, and principles of operation.

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| Feature | Clear-Aligners<br>Submission Device | Clear Correct<br>Primary Predicate | Align System<br>Reference Device |
|----------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 510(k) Number | K191823 | K082556 | K981095 |
| Manufacturer | CDB Corporation | Clear Correct Inc. | Align Technology |
| Regulation Number | 872.5470 | 872.5470 | 872.5470 |
| Device Classification | Aligner, Sequential | Aligner, Sequential | Aligner, Sequential |
| Product Code | NXC | NXC | NXC |
| Device Class | II | II | II |
| Indications for Use | The Clear-Aligner<br>system is indicated<br>for the treatment of<br>malocclusion in<br>patients with<br>permanent dentition.<br>The Clear-Aligner<br>system positions<br>teeth by way of<br>continuous gentle<br>force. | The Clear Correct<br>System is indicated<br>for the treatment of<br>tooth malocclusion in<br>patients with<br>permanent dentition<br>(i.e. all second<br>molars). The Clear<br>Correct System<br>positions teeth by<br>way of continuous<br>gentle force. | The Align System is<br>indicated for the<br>treatment of tooth<br>malocclusion in patients<br>with permanent dentition<br>(i.e. all second molars).<br>The Align System<br>positions teeth by way<br>of continuous gentle<br>force. |
| Mode of Action | Alignment of teeth by<br>sequential use of<br>preformed plastic<br>trays. | Alignment of teeth by<br>sequential use of<br>preformed plastic<br>trays. | Alignment of teeth by<br>sequential use of<br>preformed plastic trays. |
| Material | Thermoformed<br>Copolyester | Thermoformed<br>Polycarbonate | Thermoformed<br>Polycarbonate |
| Material Properties | Demonstrates<br>sufficient tensile<br>strength, elasticity,<br>ductility, chemical<br>resistance, and<br>clarity for use as a<br>clear tray aligner | Demonstrates<br>sufficient tensile<br>strength, elasticity,<br>ductility, chemical<br>resistance, and clarity<br>for use as a clear tray<br>aligner | Demonstrates sufficient<br>tensile strength,<br>elasticity, ductility,<br>chemical resistance,<br>and clarity for use as a<br>clear tray aligner |
| Software Used for<br>Ordering Workflow | Yes | Yes | Yes |
| OTC or Rx | Rx | Rx | Rx |

## Table 1. Predicate Device Information Comparison

## Substantial Equivalence Conclusion:

The conclusion drawn from the data included in this submission demonstrates that the Clear-Aligner system is substantially equivalent to the predicate devices in indications for use, design, technological characteristics, mechanism of action, performance, materials, and biocompatibility.