Wishbone HA

K211551 · Wishbone SA · NPM · Aug 20, 2021 · Dental

Device Facts

• Record ID: K211551
• Device Name: Wishbone HA
• Applicant: Wishbone SA
• Product Code: NPM · Dental
• Decision Date: Aug 20, 2021
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 872.3930
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

Filling of infrabony periodontal defects; Filling of periodontal defects in conjunction with products intended for guided tissue regeneration and guided bone regeneration: Filling of defects after root resection, apicectomy and cystectomy; Filling of extraction sockets to enhance preservation of the alveolar ridge; Augmentation or reconstructive treatment of the alveolar ridge; Elevation of the maxillary sinus floor; Filling of peri-implant defects in conjunction with products intended for guided bone regeneration.

Device Story

Wishbone HA is a xenograft biomaterial composed of deproteinized bovine hydroxyapatite; supplied as cancellous and cortical granules (0.25-1.0 mm) in sterile thermoformed blisters. Used by dentists, periodontists, and oral surgeons in clinical settings to fill, augment, or reconstruct periodontal and bony defects of the jaw. Acts as a conductive bone graft matrix to support bone regeneration. Device is single-use and sterilized via gamma irradiation. Clinical benefit includes structural support for bone healing in dental procedures.

Clinical Evidence

Non-clinical bench testing included chemical analysis, phase composition, morphology, porosity, pH, dissolution, and mechanical evaluation per FDA guidance. In-vivo performance was evaluated in a GLP canine mandibular defect model at 4, 12, and 26 weeks. Results at 26 weeks showed biocompatibility and bone regeneration comparable to the predicate device. Biocompatibility testing followed ISO 10993 standards.

Technological Characteristics

Bovine-derived deproteinized hydroxyapatite (≥97%). Granule size: 0.25-1.0 mm. Sterilization: Gamma irradiation (SAL 10^-6). Packaging: PETG blister with Tyvek seal. Standards: ISO 10993 (biocompatibility), ISO 22442 (animal tissue), ISO 11137 (sterilization), ISO 11607 (packaging), and various ASTM standards for packaging integrity (e.g., ASTM F88, F1929, F1980).

Indications for Use

Indicated for adults requiring bone grafting for periodontal defects, extraction socket preservation, alveolar ridge augmentation/reconstruction, maxillary sinus floor elevation, or peri-implant defect filling.

Regulatory Classification

Identification

Bone grafting material is a material such as hydroxyapatite, tricalcium phosphate, polylactic and polyglycolic acids, or collagen, that is intended to fill, augment, or reconstruct periodontal or bony defects of the oral and maxillofacial region.

Special Controls

*Classification.* (1) Class II (special controls) for bone grafting materials that do not contain a drug that is a therapeutic biologic. The special control is FDA's “Class II Special Controls Guidance Document: Dental Bone Grafting Material Devices.” (See § 872.1(e) for the availability of this guidance document.)(2) Class III (premarket approval) for bone grafting materials that contain a drug that is a therapeutic biologic. Bone grafting materials that contain a drug that is a therapeutic biologic, such as biological response modifiers, require premarket approval. (c) *Date premarket approval application (PMA) or notice of product development protocol (PDP) is required.* Devices described in paragraph (b)(2) of this section shall have an approved PMA or a declared completed PDP in effect before being placed in commercial distribution.

Predicate Devices

• Geistlich Bio-Oss (K122894)

Submission Summary (Full Text)

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August 20, 2021

Wishbone SA Emilie Dory Operations Manager 1, Rue de 1'Expansion Flemalle, Liege 4400 BELGIUM

Re: K211551

Trade/Device Name: Wishbone HA Regulation Number: 21 CFR 872.3930 Regulation Name: Bone Grafting Material Regulatory Class: Class II Product Code: NPM Dated: June 7, 2021 Received: June 8, 2021

Dear Emilie Dory:

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.

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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 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 (QS) 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 medical devices and radiation-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 Andrew Steen Assistant Director DHT1B: Division of Dental Devices OHT1: Office of Ophthalmic, Anesthesia, Respiratory, ENT and Dental Devices Office of Product Evaluation and Ouality Center for Devices and Radiological Health

Enclosure

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# Indications for Use

510(k) Number (if known)

Device Name Wishbone HA

Indications for Use (Describe)

Wishbone HA is intended for the following uses:

· Filling of infrabony periodontal defects;

· Filling of periodontal defects in conjunction with products intended for guided tissue regeneration and guided bone regeneration:

· Filling of defects after root resection, apicectomy and cystectomy;

- · Filling of extraction sockets to enhance preservation of the alveolar ridge;
- · Augmentation or reconstructive treatment of the alveolar ridge;
- · Elevation of the maxillary sinus floor;

· Filling of peri-implant defects in conjunction with products intended for guided bone regeneration.

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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# 510(k) Summary

## 1. SUBMITTER

| Submitter Name: | Wishbone SA |
|---------------------------------------------------|---------------------------------------------------|
| Submitter Address: | 1, Rue de l'Expansion,<br>4400 Flémalle - Belgium |
| Phone Number: | [phone] |
| Contact Person: | Emilie Dory |
| Date Prepared: | 20 August 2021 |
| 2. DEVICE | |
| Device Trade Name: | Wishbone HA |
| Common Name: | Bone graft material |
| Classification Name,<br>Number &<br>Product Code: | Bone grafting material<br>21 CFR 872.3930<br>NPM |
| Class: | II |
| Classification Panel: | Dental |

## 3. PREDICATE DEVICE

K122894, Geistlich Bio-Oss, Geistlich Pharma AG Primary Predicate Device:

## 4. REFERENCE DEVICE

Reference Device: No reference device was used in this submission

## 5. DEVICE DESCRIPTION

Wishbone HA is a xenograft biomaterial composed of deproteinized hydroxyapatite from bovine origin. It is intended to fill, augment, or reconstruct periodontal defects and/or bony defects of the upper or lower jaw.

Wishbone HA is supplied as a mix of cancellous and cortical particles size 0.25 to 1.0 mm) in a single use thermoformed blister, packaged in a secondary thermoformed blister and sterilized by gamma irradiation.

The device is intended to be used in medical procedures, by a qualified physician (academically trained dentists, periodontists and oral surgeons).

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# 6. INDICATIONS FOR USE

Wishbone HA is intended for the following uses:

- Filling of infrabony periodontal defects .
- Filling of periodontal defects in conjunction with products intended for guided tissue . regeneration and guided bone regeneration
- Filling of defects after root resection, apicectomy and cystectomy
- . Filling of extraction sockets to enhance preservation of the alveolar ridge
- . Augmentation or reconstructive treatment of the alveolar ridge
- Elevation of the maxillary sinus floor ●
- Filling of peri-implant defects in conjunction with products intended for quided bone . regeneration.

### 7. COMPARISON OF TECHNOLOGICAL CHARACTERISTICS WITH PREDICATE DEVICE

| | New Device | Primary Predicate Device |
|--------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Device name | Wishbone HA | Geistlich Bio-Oss |
| 510(k) Number | K211551 | K122894 |
| Manufacturer | Wishbone SA | Geistlich Pharma AG |
| Regulation Number | 872.3930 | 872.3930 |
| Device<br>Classification Name | Bone grafting material | Bone grafting material |
| Product Code | NPM | NPM |
| Intended Use/<br>Indications for use | • Filling of infrabony periodontal defects;<br>• Filling of periodontal defects in conjunction with products intended for guided tissue regeneration and guided bone regeneration;<br>• Filling of defects after root resection, apicectomy and cystectomy;<br>• Filling of extraction sockets to enhance preservation of the alveolar ridge;<br>• Augmentation or reconstructive treatment of the alveolar ridge<br>• Elevation of the maxillary sinus floor;<br>• Filling of peri-implant defects in conjunction with products intended for guided bone regeneration. | - Augmentation or reconstructive treatment of the alveolar ridge;<br>- Filling of infrabony periodontal defects;<br>- Filling of defects after root resection, apicoectomy, and cystectomy;<br>- Filling of extraction sockets to enhance preservation of the alveolar ridge;<br>- Elevation of the maxillary sinus floor;<br>- Filling of periodontal defects in conjunction with products intended for Guided Tissue Regeneration (GTR) and Guided Bone Regeneration (GBR); and<br>- Filling of peri-implant defects in conjunction with products intended for Guided Bone Regeneration (GBR). |
| Intended patient<br>population | Adults | Adults |
| Mode of action | Conductive bone graft | Conductive bone graft |
| | | |
| Anatomical sites | Oral, Periodontal | Oral, Periodontal |
| Environment of use | Wishbone HA should only be used<br>by trained dentists, periodontists or<br>oral surgeons. | Geistlich Bio-Oss® should only be<br>used by trained dentists or oral<br>surgeons. |
| Sterilization | Gamma irradiation | Gamma irradiation |
| Reusability | Single use only | Single use only |
| Pyrogenicity | Non-pyrogenic | Non-pyrogenic |
| Packaging | Wishbone HA particles are<br>packaged in a single use<br>thermoformed PETG<br>(Polyethylene Terephthalate<br>Glycol) blister (primary packaging)<br>hermetically sealed with a<br>Tyvek®. This package is placed in<br>a secondary thermoformed. | Double sterile barrier system<br>consisting of a glass vial and an<br>outer blister. |
| Source of materials | Bovine | Bovine |
| Chemical<br>Composition | Calcium: 30 - 40 % (w./w.)<br>Phosphorous: 15 - 20 % (w./w.)<br>Sodium: 0.0 - 1.0 % (w./w.)<br>Magnesium: 0.0 - 1.0 % (w./w.)<br><br>Summed up to 100% by mass: | From the original 510(k):<br>Calcium: 35% - 40% (w./w.)<br>Phosphorous: 13.5% - 18.5%<br>(w./w.)<br><br>Summed up to 100% by mass**: |
| | - Hydroxyapatite $Ca_5(PO_4)_3OH$<br>(CAS® 1306-06-5): ≥97%<br>- $CaCO_3$ (CAS® 471-34-1)<br>- $MgO$ * (CAS® 1309-48-4): ≤2%<br>- $H_2O$ (CAS® 7732-18-5): ≤1%<br>- Organic compounds: 0% | - Hydroxyapatite<br>(Pentacalciumhydroxy-[tri]- phosphate $Ca_5(PO_4)_3(OH)$ )<br>(93.6%),<br>- Calcium carbonate ( $CaO_3$ )<br>(3,4%)<br>- Water (3%)<br>- No organic components (0%) |
| Crystalline phases | Hydroxyapatite > 95% | Hydroxyapatite |
| Dosage form | Mix of cancellous and cortical<br>granules | Cancellous granules or porous<br>block |
| Particle sizes | 0.25 - 1.0 mm | 0.25 - 1.0 mm (small particles)<br>1.0 - 2.0 mm (large particles) |
| Product size (g) | 0.25, 0.5, 1.0, 2.0 | 0.25, 0.5, 2.0, 5.0 (0.25-1.0 mm)<br>0.5, 2.0 (1.0-2.0 mm)<br>For blocks: 1 X 1 X 2 cm (approx.) |

Table 1: Comparison of new device to predicate device

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| Biocompatibility testing | Chemical characterization<br>Toxicological evaluation<br>Cytotoxicity<br>Sensitization<br>Intracutaneous Reactivity/Irritation<br>Acute Systemic Toxicity<br>Material Mediated Pyrogenicity<br>Genotoxicity<br>Implantation | Per ISO 10993-1 for the intended use |
|--------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------|
|--------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------|

* Wishbone HA is composed of only bovine bone without any added components. The magnesium oxide (MgO) is not added to Wishbone HA but rather naturally appears during the sintering process in the form of magnesium oxide crystals.

** Data taken from 510(k) summary of Straumann® Cerabone® (K173594) which uses K122894 Geistlich Bio-Oss as the predicate device.

### Equivalences:

The intended use is the same, and the technological characteristics are essentially the same as those of the predicate, K122894, Geistlich Bio-Oss. Both devices are made of deproteinized hydroxyapatite from bovine origin, intended to be implemented as a bone graft matrix in periodontal or bony defects. Both devices are intended to be used by dental health care professionals (e.g. dentists, periodontists and oral surgeons). Both devices are intended for single patient use and sterilized by gamma irradiation.

#### Differences that are demonstrated to be substantially equivalent:

As indicated in Table 1 above, several differences with respect to technological characteristics were identified between Wishbone HA and the primary predicate, namely the chemical composition, crystalline phases, dosage form, specific surface area and the packaging configuration.

Performance testing was conducted to demonstrate substantial equivalence of Wishbone HA to the predicate device. The test results are summarized below.

#### 8. PERFORMANCE DATA

- Non-Clinical Wishbone HA was the subject of the full range of physical and chemical bench testing characterization tests recommended in the FDA's "Class II Special Controls Guidance Documents: Dental Bone Grafting Devices". These bench tests included chemical analysis, phase composition analysis, protein and organic content analysis, morphology analysis, porosity analysis, pH analysis, dissolution analysis and mechanical evaluation.

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| Non-Clinical<br>animal<br>performance<br>Testing | A pre-clinical GLP study was performed in canine mandibular defect<br>model system in Beagle dogs to evaluate the in-vivo performance of the<br>Wishbone HA. In this study the local effects of implantation of Wishbone<br>HA in the target locations, as well as bone growth, at subchronic time-<br>points (4, 12 and 26 weeks) were evaluated. |
|--------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| | By all parameters assessed at the 26 weeks time-point of the study,<br>biocompatibility and regeneration of defects treated with Wishbone HA<br>showed similar results to defects treated with the predicate device, Bio-<br>Oss®. |
| Biocompatibility | Wishbone HA was the subject of a range of biocompatibility tests in<br>accordance with ISO 10993 series. Test results confirmed that Wishbone<br>HA is biocompatible for the stated intended use. |
| Animal tissue | The methods of sourcing, collection and handling of the bovine-derived<br>bones were assessed to demonstrate compliance with relevant<br>requirements of ISO 22442 series and FDA guidance (2019). Wishbone<br>HA is provided free from organic residues. Protein content is routinely<br>controlled during the production process. The manufacturing process<br>includes several steps intended to inactivate viruses. The results of the |

viral inactivation studies showed that the raw material and device manufacturing processes of the Wishbone HA are capable of achieving at least a 6-log viral reduction of selected model viruses which were tested.

- Sterilization Wishbone HA is provided sterile and is intended for single patient use only. Wishbone HA is sterilized with gamma irradiation to meet a and shelf life minimum sterility assurance level (SAL) of 106. Validation of the sterilization dose was conducted following VDmax method.
Shelf life study supports a shelf life of 36 months for Wishbone HA when stored under the recommended environmental conditions. The shelf life studies confirmed that the packaging maintains the integrity of the device and its sterility throughout the shelf life of the device.

Validation studies for sterilization, packaging and shelf life conform to the following standards:

| Standard<br>reference | Standard title |
|---------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| EN ISO 11607-<br>1:2020 | Packaging for terminally sterilized medical devices -<br>Part 1: Requirements for materials, sterile barrier<br>systems and packaging systems |
| EN ISO 11607-<br>2:2020 | Packaging for terminally sterilized medical devices -<br>Part 2: Validation requirements for forming, sealing<br>and assembly processes |
| EN ISO 11137-<br>1:2015/A2:2019 | Sterilization of health care products - Radiation - Part<br>1: Requirements for development, validation and<br>routine control of a sterilization process for medical<br>devices |
| EN ISO 11137-<br>2:2015 | Sterilization of health care products - Radiation - Part<br>2: Establishing the sterilization dose |
| EN ISO 11137-<br>3:2017 | Sterilization of health care products - Radiation - Part<br>3: Part 3: Guidance on dosimetric aspects of<br>development, validation and routine control |
| EN ISO 11737-<br>1:2018 | Sterilization of medical devices - Microbiological<br>methods - Part 1: Determination of a population of<br>microorganisms on products |
| EN ISO 11737-<br>2:2009 | Sterilization of health care products - Microbiological<br>methods - Part 2: Tests of sterility performed in the<br>definition, validation and maintenance of a sterilization<br>process |
| EN 868-5:2009 | Packaging for terminally sterilized medical devices -<br>Part 5: Sealable pouches and reels of porous<br>materials and plastic film construction - Requirements<br>and test methods |
| ASTM F88F88M-<br>15 | Standard Test Method for Seal Strength of Flexible<br>Barrier Materials |
| ASTM<br>F1886F1886M-16 | Standard Test Method for Determining Integrity of<br>Seals for Flexible Packaging by Visual Inspection |
| ASTM F1929-15 | Standard Test Method for Detecting Seal Leaks in<br>Porous Medical Packaging by Dye Penetration |
| ASTM F1980-16 | Standard Guide for Accelerated Aging of Sterile<br>Barrier Systems for Medical Devices |
| ASTM D642-15 | Standard Test Method for Determining Compressive<br>Resistance of Shipping Containers, Components, and<br>Unit Loads |
| ASTM D6344-04<br>(2017) | Standard Test Method for Concentrated Impacts to<br>Transport Packages |
| ASTM D999-08<br>(2015) | Standard Test Methods for Vibration Testing of<br>Shipping Containers |
| ASTM D4169-16 | Standard Practice for Performance Testing of Shipping<br>Containers and Systems |
| ASTM D4332-14 | Standard Practice for Conditioning Containers.<br>Packages, or Packaging Components for Testing |
| ASTM D4728-17 | Standard Test Method for Random Vibration Testing of<br>Shipping Containers |
| ASTM D5276-98<br>(2017) | Standard Test Method for Drop Test of Loaded Containers by Free Fall |
| EN ISO 11140-<br>1:2014 | Sterilization of health care products - Chemical indicators - Part 1: General requirements |

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# 9. CONCLUSION

The information discussed above and provided in the 510(k) submission demonstrate that the Wishbone HA is substantially equivalent to the predicate.