FLC COMPOSITE

K991491 · Harry J. Bosworth Co. · EBF · Jun 21, 1999 · Dental

Device Facts

• Record ID: K991491
• Device Name: FLC COMPOSITE
• Applicant: Harry J. Bosworth Co.
• Product Code: EBF · Dental
• Decision Date: Jun 21, 1999
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 872.3690
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

This fluid composite will flow into difficult areas and therefore indicates its use for Class V and Class III restorations.

Device Story

FLC Composite is a flowable, light-cured dental restorative material. Designed for application in difficult-to-reach areas of the tooth, the material flows into cavity preparations. Used by dental professionals in a clinical setting to restore tooth structure in Class V and Class III cavities. The material is applied by the clinician and cured using a dental light-curing unit. The flowable consistency allows for precise placement, facilitating the restoration of dental defects and potentially improving patient outcomes by restoring tooth function and aesthetics.

Clinical Evidence

bench testing only

Technological Characteristics

Flowable, light-cured composite resin dental restorative material. Designed for delivery into cavity preparations. Class II device (Product Code EBF).

Indications for Use

Indicated for Class V and Class III dental restorations in patients requiring restorative dental procedures.

Regulatory Classification

Identification

Tooth shade resin material is a device composed of materials such as bisphenol-A glycidyl methacrylate (Bis-GMA) intended to restore carious lesions or structural defects in teeth.

Submission Summary (Full Text)

{0}------------------------------------------------

Image /page/0/Picture/1 description: The image shows the seal of the Department of Health & Human Services (HHS). The seal features a stylized caduceus, a symbol often associated with medicine and healthcare, in the center. Encircling the caduceus are the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" in a circular arrangement. The seal is presented in black and white.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUN 2 1 1999

Ms. Mildred M. Goldstein President Harry J. Bosworth Company 7227 North Hamlin Avenue Skokie, Illinois 60076

Re: K991491 Trade Name: FLC Composite Regulatory Class: II Product Code: EBF Dated: April 21, 1999 Received: April 28, 1999

Dear Ms. Goldstein:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to 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). You may, therefore, market the device, subject to the general The general controls controls provisions of the Act. provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (Premarket Approval), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Requlations, Title 21, Parts 800 to 895. A substantially equivalent determination assumes compliance with the Good Manufacturing Practice for Medical Devices: General (GMP) regulation (21 CFR Part 820) and that, through periodic GMP inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP requlation may result in regulatory action. In addition, FDA may publish further announcements concerning your device in the Federal Register.

{1}------------------------------------------------

Page 2 - Ms. Goldstein

this response to your premarket notification Please note: submission does not affect any obligation you might have under sections 531 through 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or regulations.

This letter will allow you to begin marketing your device as described in your 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at [phone]. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number [phone] or [phone] or at its internet address

"http://www.fda.gov/cdrh/dsmamain.html".

Sincerely yours,

Timothy A. Ulatowski

Director Division of Dental, Infection Control, and General Hospital Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

{2}------------------------------------------------

Page __ 1 _of _1

510(k) Number: K ዓ억 | ԿԳ |

Device Name:

## INDICATIONS FOR USE:

## FLOWABLE LIGHT CURE COMPOSITE:

This fluid composite will flow into difficult areas and therefore indicates its use for Class V and Class III restorations.

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

| Company consumeration processional delivery and consideration in the considered to |
|------------------------------------------------------------------------------------|
| Concurrence of CDRH, Office of Device Evaluation (ODE) |

Prescription Usev (Per 21 CFR 801.109)

OR

Over-the-Counter Use

(Optional Format 1-2-96)

Susan Russo

(Division Sign-Off) Division of Dental, Infection Control, and General Hospital D 510(k) Number