SAVE GBR

K222367 · Dentis Co., Ltd. · DZL · Mar 23, 2023 · Dental

Device Facts

• Record ID: K222367
• Device Name: SAVE GBR
• Applicant: Dentis Co., Ltd.
• Product Code: DZL · Dental
• Decision Date: Mar 23, 2023
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 872.4880
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The device is intended for use in stabilizing and fixating bone grafts, bone filling material and/or barrier membranes used for guided bone/tissue regeneration in the oral cavity. Single patient use only.

Device Story

SAVE GBR is a system of titanium alloy (Ti-6Al-4V ELI) screws and tacks used in dental surgery; intended for stabilizing bone grafts and barrier membranes during guided bone/tissue regeneration in the oral cavity. The device is used by dental clinicians in a clinical setting. The screws are implanted via rotation, while tacks are inserted using a mallet. The device provides mechanical fixation of graft materials to support bone regeneration; it remains in the patient for a maximum of 6 months. The system is provided sterile and is for single-patient use. Clinical benefit is derived from the stabilization of regenerative materials, which facilitates bone growth in oral site defects.

Clinical Evidence

No clinical data. Substantial equivalence supported by non-clinical bench testing: mechanical properties (torsion, driving torque, axial pull-out strength) per ISO 19023 and ASTM F543-17; biocompatibility (leveraged from K210080); sterilization/shelf-life validation (ISO 11137, ASTM F1980); and MRI safety assessment via scientific rationale.

Technological Characteristics

Material: Ti-6Al-4V ELI (ASTM F136). Components: GBR screws (Ø1.4mm) and bone tacks (Ø2.5mm). Energy source: None (manual instrumentation). Sterilization: Gamma radiation. Connectivity: None. Software: None.

Indications for Use

Indicated for patients requiring stabilization and fixation of bone grafts, bone filling materials, or barrier membranes for guided bone/tissue regeneration in the oral cavity. No specific age or gender restrictions provided.

Regulatory Classification

Identification

An intraosseous fixation screw or wire is a metal device intended to be inserted into fractured jaw bone segments to prevent their movement.

Predicate Devices

• GBR System by Surgident (K170697)

Reference Devices

• Bone Screw, Bone Tack by Osstem Implant Co., Ltd. (K182881)
• OssBuilder membrane (K172354)

Submission Summary (Full Text)

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Image /page/0/Picture/0 description: The image shows 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.

3/23/23

Dentis Co., Ltd. % April Lee Consultant Withus Group Inc 106 Superior Irvine, California 92620

Re: K222367

Trade/Device Name: SAVE GBR Regulation Number: 21 CFR 872.4880 Regulation Name: Intraosseous Fixation Screw Or Wire Regulatory Class: Class II Product Code: DZL Dated: February 19, 2023 Received: February 21, 2023

Dear April 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. 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.

Sherrill Lathrop Blitzer

for Andrew Steen Assistant Director DHT1B: Division of Dental and ENT 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) K222367

Device Name SAVE GBR

Indications for Use (Describe)

The device is intended for use in stabilizing and fixating bone filling material and/or barrier membranes used for guided bone/tissue regeneration in the oral cavity. Single patient use only.

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

| <input checked="" type="checkbox"/> Prescription Use (Part 21 CFR 801 Subpart D) |
|----------------------------------------------------------------------------------|
| <input type="checkbox"/> Over-The-Counter Use (21 CFR 801 Subpart C) |

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### 510(k) Summary

#### Submitter

Dentis Co., Ltd. Gyu Ri Kim 99, Seongseoseo-ro, Dalseo-gu Daegu, 42718 Korea Email: [e-mail] Tel. [phone] Fax. [phone]

#### Device Information

- . Trade Name: SAVE GBR
- . Common Name: GBR System
- Classification Name: Intraosseous fixation screw or wire .
- . Product Code: DZL
- Panel: Dental
- Regulation Number: 872.4880
- Device Class: Class II
- . Date prepared: 03/23/2023

#### Primary Predicate:

K170697, GBR System by Surgident

#### Reference Device:

K182881, Bone Screw, Bone Tack by Osstem Implant Co., Ltd.

#### Indications for Use:

The device is intended for use in stabilizing and fixating bone grafts, bone filling material and/or barrier membranes used for guided bone/tissue regeneration in the oral cavity. Single patient use only.

#### Device Description:

SAVE GBR is manufactured by Ti-6Al-4V ELI. The SAVE GBR is composed of GBR Screw and Bone Tack and these screws and tacks are used to fix barrier membranes in bone regeneration procedures.

The diameter of the GBR screw is \$1.4 and length is 3.9, 4.38, 5.9, 6.38, 7.9 and 8.38mm. The diameter of the Bone Tack is 2.5 and length is 2.6 and 4.1mm.

These screws and tacks are implanted for a maximum duration of 6 months. The SAVE GBR is provided sterile.

The subject device is compatible with the OssBuilder membrane cleared in K172354.

#### Materials:

- GBR Screw and Bone Tack are manufactured by Ti-6Al-4V ELI according to ASTM F136 .
### Official Correspondent

Withus Group Inc. April Lee 106 Superior, Irvine, CA 92620 USA Email: [e-mail] Phone: [phone] Fax: [phone]

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#### Summaries of Technology Characteristics

The subject device is substantially equivalent to the current cleared devices. They are substantially equivalent in intended use, material and product spec as diameter and length. Comparison demonstrating Substantial Equivalence follows: 1. GBR Screw

| | Subject Device | Primary Predicate | Reference Device |
|---------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Applicant | Dentis Co., Ltd. | Surgident | Osstem Implant Co., Ltd |
| Trade Name | SAVE GBR | GBR System | Bone Screw, Bone Tack |
| 510(k) No. | K222367 | K170697 | K182881 |
| Classification Name | Intraosseous Fixation screw or wire | Intraosseous Fixation screw or wire | Intraosseous Fixation screw or wire |
| Product Code | DZL | JEY, DZL | DZL |
| Class | Class II | Class II | Class II |
| Description | Image: A screw | Image: Screws and plates | Image: Screws |
| Material | Ti-6Al-4V ELI (ASTM F136) | Ti-6Al-4V ELI (ASTM F136) | Ti-6Al-4V ELI (ASTM F136) |
| Screw Diameter (mm) | Ø1.4 | Ø0.85, Ø1.4, Ø1.6 and Ø2.0 | Ø1.4 and Ø1.95 |
| Screw Length (mm) | 3.9, 5.9 and 7.9 | 3.0, 4.0, 5.0, 6.0, 8.0, 10.0 and 12.0 | 4.0, 6.0, 8.0, 10.0, 12.0, 14.0 and 16.0 |
| Single Use | Yes | Yes | Yes |
| Sterile | Gamma Sterilization | End User Sterilization | Gamma Sterilization |
| Shelf Life | 8yearsrs | N/A | 8years |
| Surface Treatment | N/A | Anodizing | N/A |
| Indications For Use | The device is intended for use in<br>stabilizing and fixating bone grafts,<br>bone filling material and/or barrier<br>membranes used for guided<br>bone/tissue regeneration in the oral<br>cavity. Single patient use only. | The device is intended for use in<br>stabilizing and fixating bone grafts,<br>bone filling material and/or barrier<br>membranes used for guided bone/tissue<br>regeneration in the oral cavity. Single<br>patient use only. | Bone Screw is used to stabilize and fixate<br>bone grafts, bone filling material, and/or<br>barrier membranes used for regeneration of<br>bone in the oral cavity. Bone Tack is<br>indicated for use to stabilize and support<br>bone graft and/or fractured bone segments<br>with or without bone plates or titanium<br>mesh in oral and maxillofacial site defects. |
| Substantial Equivalence<br>Comparison | The subject GBR screw is substantially equivalent in dimensions, material, indications, and technological characteristics<br>with the identified primary predicate device(K170697). The difference between the subject and primary predicate is the<br>screw design, anodizing and sterilization. However, the general shapes of both devices are very similar and anodizing does<br>not affect product's fundamental technologies or indications. To support the difference of sterilization, K182881 was added.<br>Therefore, the subject device is substantial equivalent. | | |

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# 2. Bone Tack

| | Subject Device | Primary Predicate | Reference Device |
|------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Applicant | Dentis Co., Ltd. | Surgident | Osstem Implant Co., Ltd |
| Trade Name | SAVE GBR | GBR System | Bone Screw, Bone Tack |
| 510(k) No. | K222367 | K170697 | K182881 |
| Classification Name | Intraosseous Fixation screw or wire | Intraosseous Fixation screw or wire | Intraosseous Fixation screw or wire |
| Product Code | DZL | JEY, DZL | DZL |
| Class | Class II | Class II | Class II |
| Description | Image: Subject Device Description | Image: Primary Predicate Description | Image: Reference Device Description |
| Material | Ti-6Al-4V ELI (ASTM F136) | Ti-6Al-4V ELI (ASTM F136) | Ti-6Al-4V ELI (ASTM F136) |
| Head Diameter | Ø2.5 | Ø2.5 | Ø2.5 |
| Screw Diameter (mm) | Ø0.85 | Ø0.85 | Ø0.7 |
| Length (mm) | 3.5 and 5.0 | 3.5 and 5.0 | 3.0 |
| Surface Treatment | Anodizing (Purple, Blue) | Anodizing (Purple, Blue) | Anodizing (Purple, Blue) |
| Sterile | Gamma Sterilization | End User Sterilization | Gamma Sterilization |
| Indications For Use/<br>Intended Use | The device is intended for use in<br>stabilizing and fixating bone grafts,<br>bone filling material and/or barrier<br>membranes used for guided bone/tissue<br>regeneration in the oral cavity. Single<br>patient use only. | The device is intended for use in<br>stabilizing and fixating bone grafts,<br>bone filling material and/or barrier<br>membranes used for guided<br>bone/tissue regeneration in the oral<br>cavity. Single patient use only. | Bone Screw is used to stabilize and<br>fixate bone grafts, bone filling material,<br>and/or barrier membranes used for<br>regeneration of bone in the oral cavity.<br>Bone Tack is indicated for use to<br>stabilize and support bone graft and/or<br>fractured bone segments with or<br>without bone plates or titanium mesh in<br>oral and maxillofacial site defects. |
| Substantial<br>Equivalence<br>Comparison | The subject bone Tack is substantially equivalent in designs, material, indications and technological characteristics<br>with the identified primary predicate device(K170697). The difference between two products is sterilization. To<br>support this discrepancy, K182881 was added. Therefore, the subject device is substantial equivalent. | | |

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# Non-Clinical Testing

Non-clinical testing data are submitted, referenced, or relied upon to demonstrate substantial equivalence.

### Sterilization and Shelf Life:

The sterilization, shelf-life, and packaging testing was conducted on a worst-case test article representative of the final, finished subject device according to ISO 11137-1, ISO 11137-2 and ASTM F1980-07.

Bacterial Endotoxin Test according to ANSI/AAMI ST72:2011, USP <161>, and USP <85> for subject device was referenced in K192688.

Since endotoxin testing cannot be conducted on every batch in our company, alternative to batch testing was chosen with the sampling plan used for the in-process testing and/or finished product release, as recommended in the FDA guidance, Pyrogen and Endotoxins Testing: Questions and Answers". According to this guidance, we determined that begin with maximum coverage and adjust our sampling plans as they gain confidence in the prevention of endotoxins in their manufacturing processes.

# Biocompatibility Evaluation:

Biocompatibility tests such as cytotoxicity, sensitization testing according to ISO 10993-1 performed on the abutments of K210080 can be leveraged for the subject device because both devices have the same material and manufacturing process. The results of the testing demonstrated the subject device is biocompatible.

# Mechanical Properties:

Mechanical tests such as torsion, driving torque and axial pullout strength for subject device SAVE GBR and predicate device are conducted under the worst-case scenario in accordance with ISO 19023 and ASTM F543-17 Standard Specification that test method for metallic medical bone screw to support the requirement of subject device.

For GBR screw, 3 tests as torque, torsion and pull-out were conducted.

For Bone Tack, 2 tests as torsion and pull-out were conducted. Toque test is not conducted for Bone Tack since the bone tack is inserted by hitting with mallet. Torque test require for only implantation medical device that is implanted by turning, which is not subject to the subject Bone Tack.

# MR Environment Condition:

Non-clinical worst-case MRI review was performed to evaluate the SAVE GBR in the MRI environment using scientific rationale and published literature (e.g., Woods, Terry O., Jana G. Delfino, and Sunder Rajan. "Assessment of Magnetically Induced Displacement Force and Torque on Metal Alloys Used in Medical Devices." Journal of Testing and Evaluation 49.2 (2019): 783-795), based on the entire system including all variations (all compatible implant bodies, dental abutments, and fixation screws) and material composition. Rationale addressed parameters per the FDA guidance "Testing and Labeling Medical Devices for Safety in the Magnetic Resonance (MR) Environment," including magnetically induced displacement force and torque

# Conclusion

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In accordance with the Federal Food, Drug and Cosmetic Act, 21 CFR Part 807, and based on the information provided in this premarket notification, Dentis Co., Ltd. concludes that the SAVE GBR is substantially equivalent to the predicate devices as herein.