Fluorescence Mode

K171007 · Carl Zeiss Suzhou Co., Ltd. · NBL · May 3, 2018 · Dental

Device Facts

• Record ID: K171007
• Device Name: Fluorescence Mode
• Applicant: Carl Zeiss Suzhou Co., Ltd.
• Product Code: NBL · Dental
• Decision Date: May 3, 2018
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 872.1745
• Device Class: Class 2

Intended Use

The Fluorescence Mode is intended to be used by dentist as an aid in the detection of dental caries

Device Story

Fluorescence Mode is an accessory for the EXTARO 300 surgical microscope; utilizes a 405nm narrow-band LED light source to illuminate tooth surfaces. Principle of operation involves exciting bacteria within carious lesions to fluoresce, which is then visualized through a bandpass filter integrated into the microscope head. Operated by dentists in a clinical setting; provides real-time visualization of the surgical field. The device integrates into the existing microscope workflow, allowing the clinician to view the fluorescence directly through the optics. This aids in the identification of dental caries, potentially improving diagnostic accuracy and clinical decision-making during dental procedures. The system includes a multi-function knob on the microscope head for control.

Clinical Evidence

No clinical trials were conducted. Evidence consists of bench testing, including system verification, usability testing (15 clinicians, 12 sites, >40 cases), and validation against consensus standards (IEC 62471, IEC 60601-1-2, ISO 10936-1). Background light interference testing confirmed performance at ambient light levels up to 40lx.

Technological Characteristics

Accessory to EXTARO 300 surgical microscope. Components: 405nm violet LED source, bandpass filter, multi-function control knob. Operates via fluorescence excitation. Complies with IEC 62471 (photobiological safety), IEC 60601-1-2 (EMC), and ISO 10936-1 (optics). Software follows IEC 62304 (Moderate Level of Concern).

Indications for Use

Indicated for use by dentists as an aid in the detection of dental caries.

Regulatory Classification

Identification

A laser fluorescence caries detection device is a laser, a fluorescence detector housed in a dental handpiece, and a control console that performs device calibration, as well as variable tone emitting and fluorescence measurement functions. The intended use of the device is to aid in the detection of tooth decay by measuring increased laser induced fluorescence.

Special Controls

*Classification.* Class II, subject to the following special controls:(1) Sale, distribution, and use of this device are restricted to prescription use in accordance with § 801.109 of this chapter; (2) Premarket notifications must include clinical studies, or other relevant information, that demonstrates that the device aids in the detection of tooth decay by measuring increased laser induced fluorescence; and (3) The labeling must include detailed use instructions with precautions that urge users to: (i) Read and understand all directions before using the device, (ii) Store probe tips under proper conditions, (iii) Properly sterilize the emitter-detector handpick before each use, and (iv) Properly maintain and handle the instrument in the specified manner and condition.

Predicate Devices

• VistaCam iX "Proof" (K150672)

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, there is a symbol representing the Department of Health & Human Services-USA. To the right, there is a blue square with the letters "FDA" in white. Next to the blue square, the words "U.S. FOOD & DRUG ADMINISTRATION" are written in blue.

Carl Zeiss Suzhou Co., Ltd. % Mandy Ambrecht Staff Regulatory Affairs Specialist Carl Zeiss Meditec, Inc. 5160 Hacienda Drive Dublin, California 94568

Re: K171007

Trade/Device Name: Fluorescence Mode Regulation Number: 21 CFR 872.1745 Regulation Name: Laser Fluorescence Caries Detection Device Regulatory Class: Class II Product Code: NBL Dated: April 4, 2018 Received: April 4, 2018

Dear Ms. Ambrecht:

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 of medical device-related adverse events) (21 CFR 803); good

May 3, 2018

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manufacturing practice requirements as set forth in 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.

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.

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/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). 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 (http://www.fda.gov/DICE) for more information or contact DICE by email ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely,

# Mary S. Runner -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) K171007

Device Name

Fluorescence Mode

Indications for Use (Describe)

The Fluorescence Mode is intended to be used by dentist as an aid in the detection of dental caries

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

> Prescription Use (Part 21 CFR 801 Subpart D)

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

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# 510(k) SUMMARY (per 21 CFR §807.92)

# Fluorescence Mode

### GENERAL INFORMATION

| Applicant: | Carl Zeiss Suzhou Co., Ltd.<br>Modern Industrial Square 3b<br>No. 333 Xing Pu Road Sip<br>Suzhou, Jiangsu 215126 China<br>+ 86-512-8227-1388 (phone)<br>+ 86-512-6287-1366 (fax)<br>Establishment Registration Number: 3008564898 |
|-------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Contact Person: | Mandy Ambrecht<br>Staff Regulatory Affairs Specialist<br>Carl Zeiss Meditec, Inc.<br>5160 Hacienda Drive<br>Dublin, CA 94568<br>[phone] Phone<br>E-mail: [e-mail] |
| Date Prepared: | May 3, 2018 |
| Common Name: | Dental Fluorescence Examination Device |
| Classification Name: | Laser Fluorescence Caries Detection Device |
| Product Code and Class: | NBL — Class II |
| Classification Number: | 21 CFR 872.1745 |
| Trade/Proprietary Name: | Fluorescence Mode |

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### PREDICATE DEVICE

Company: Durr Dental AG

Device: VistaCam iX "Proof" (K150672)

lt is the opinion of Carl Zeiss Suzhou Company, Limited that the dental Fluorescence Mode of the EXTARO 300 surgical microscope is substantially equivalent to the predicate VistaCam iX "Proof" (K150672) for the intended use as an aid in the detection of dental caries .The Fluorescence Mode built-in to the surgical microscope aids in the detection of caries.

# INDICATIONS FOR USE (21 CFR §807.92(a)(5))

The Fluorescence Mode is intended to be used by dentist as an aid in the detection of dental caries

### DEVICE DESCRIPTION SUMMARY (21 CFR §807.92(a)(4))

CZSZ currently manufactures an optional accessory, Fluorescence Mode, to the EXTARO 300 intended to be used by dentist as an aid in the detection of dental caries.

#### Device Overview

The Fluorescence Mode is an accessory to the EXTARO 300 surgical microscope to utilize a kind of LED light that illuminates the tooth surfaces in the blue light region with a narrow band ( around wavelength 405nm).

The Fluorescence Mode is not a standalone device. It is a built-in feature (new components) to existing surgical microscope. These components include (1) an additional violet source in existing LED lamp, (2) a bandpass filter in existing OPMI (Operation Microscope) Head and (3) multi-function knob on existing OPMI Head.

The primary operating functions of EXTARO 300 are:

- to provide a view of the surgical field with variable magnification,
- to illuminate the surgical field, ।
- to provide means to move the microscope to the surgical field, and,
- to hold it in this position while viewing the surgical procedure.

The primary operating functions are realized by the viewing optics in the microscope, the illumination system, and the microscope stand/suspension system.

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#### Description of Software

Software of the EXTARO 300 surgical microscope provides the firmware control following functionalities:

- Light source control l
- -Filter control
- । Video control
- । Communication with iPad
- Wi-Fi module has access control -

CZSC has implemented a software development process according to IEC 62304 for software with a Moderate Level of Concern.

#### Risk Management

Carl Zeiss Suzhou Co., Ltd. has implemented and maintains a risk management assessment process according to ISO 14971. This process which is defined in an internal Standard Operation Procedure was conducted on EXTARO 300.

The device labeling contains instructions for use and any necessary cautions and warnings for use of the device.

Risk management is ensured via a risk analysis, which is used to identify potential hazards and mitigations. These potential hazards are controlled by software means, user instructions, verification of requirements and validation of the clinical workflow to ensure that the product meets its intended uses. To minimize electrical, mechanical and radiation hazards, ZEISS adheres to recognized and established industry practice and relevant international standards.

#### Technological Characteristics and Substantial Equivalence (21 CFR §807.92(a)(6)):

lt is the opinion of CZSZ that the proposed device, the dental Fluorescence Mode of the EXTARO 300 surgical microscope, is substantially equivalent to the predicate VistaCam iX "Proof" (K150672).

The indications for use for the Fluorescence Mode of the EXTARO 300 surgical microscope is similar to the indications for the predicate device VistaCam iX "Proof" (K150672).

Technological and functionalities comparisons demonstrate that the Fluorescence Mode of the EXTARO 300 surgical microscope is functionally equivalent to the primary predicate VistaCam iX "Proof" (K150672) and does not raise new questions regarding safety and effectiveness.

#### Non-Clinical Performance Testing (21 CFR §807.92(b)):

There were several devices identified to already be on the market which were considered similar or equivalent to Fluorescence mode based on EXTARO 300 surgical microscope. Due to non-contact operation of this fluorescence module and surgical microscope with the patient, it has a very low surgical risk profile. The verification and validation test of the Fluorescence Mode based on EXTARO 300 have generated data to provide evidence of substantial equivalence.

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The Fluorescence Mode of the EXTARO 300 surgical microscope is designed and tested to applicable standards for electrical and optical safety with established specifications. Performance testing conducted on the system was consistent to the intended use claim. The verification testing demonstrates that the device performance complies with specifications and requirements. Results of verification and validation demonstrate substantially equivalent safety and effectiveness as the predicate device; tests can be categorized into the following groups:

- Device System Verification
- Verification According to Harmonized/Recognized Standards
- Electromagnetic Compatibility and Electrical Safety .
- . Environmental Simulation
- Usability
- Software Verification and Validation
- Product Validation

# Testing to Consensus Standards (21 CFR §807.92(b)(1))

The Fluorescence Mode of EXTARO 300 surgical microscope has been tested (as needed) to meet the requirements for conformity (where applicable) to multiple industry standards. The R&D evaluation of the relevant testing to consensus standards is documented and listed as below.

| No. | Performance testing | Standard followed | Conclusion |
|----------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 1 | Light Safety Testing | IEC 62471:2006/EN 62471:2008<br>Photobiological safety of lamps<br>and lamp systems<br><br>IEC/TR 62471-2 edition 1.0<br>2009-08 Technical Report<br>Photobiological safety of lamps<br>and lamp systems - Part 2<br>Guidance on manufacturing<br>requirements relating to non-<br>laser optical radiation safety | Testing has demonstrated the<br>fluorescence mode conforms<br>to the requirements of current<br>FDA recognized standard, IEC<br>62471:2006 Photobiological<br>safety of lamps and lamp<br>systems. |
| 2 | Environmental<br>Testing | N/A | The Environmental testing<br>demonstrated that the<br>performance of products were<br>not changed after various<br>environmental testing<br>parameters, including<br>temperature, simulated<br>transportation, moisture, and<br>pressure. |
| 3 | Usability Testing | IEC 62366-1 : 2015 Medical<br>devices -- Part 1: Application of<br>usability engineering to medical<br>devices | Usability testing demonstrated<br>that the device could be used<br>by the intended users without<br>serious use errors or<br>problems, for the intended<br>uses and under the expected<br>use conditions. This testing<br>involved total 15 clinicians and |
| Performance testing | Standard followed | Conclusion | |
| | | 12 sites, who used<br>Fluorescence Mode to aid in<br>the detection of caries in more<br>than 40 cases in clinical<br>practices. | |
| System Verification<br>Testing | ISO 10936-1:2000 Optics and<br>photonics -- Operation<br>microscopes -- Part 1:<br>Requirements and test methods | System verification testing<br>demonstrated that all System<br>Requirement Specifications<br>were met, including those for<br>product stability, ergonomics,<br>dimensions, image quality,<br>image filters, and light<br>sources. | |
| EMC/ES Testing | IEC 60601-1-2:2014 (4th<br>edition) - Medical electrical<br>equipment - Part 1-2: General<br>requirements for basic safety<br>and essential performance -<br>Collateral Standard:<br>Electromagnetic disturbances -<br>Requirements and tests | The device conforms to IEC<br>60601-1-2:2014 (4th edition)<br>and the requirements of<br>current FDA recognized<br>standard, IEC 60601-1-2<br>Edition 4.0 2014-02 Medical<br>electrical equipment - Part 1-<br>2: General requirements for<br>basic safety and essential<br>performance - Collateral<br>Standard: Electromagnetic<br>disturbances - Requirements<br>and tests.<br>Essential performance<br>requirements have been met<br>and documented. | |
| Software Verification<br>and Validation<br>Testing | N/A | Software V&V was performed<br>in accordance with FDA<br>Guidance for the Content of<br>Premarket Submissions for<br>Software Contained in Medical<br>Devices for a device of<br>Moderate Level of Concern. | |
| Background light<br>interference<br>verification. | N/A | Testing demonstrated that<br>expected levels of background<br>light do not impact the<br>performance of the device. A<br>light intensity of 40lx for CCT<br>4000K-6500K light was<br>selected as an acceptable level<br>of background light in the<br>exam room. Testing across the<br>spectrum of 4000k-6500k<br>background light sources has<br>demonstrated that the carious<br>teeth can be differentiated at | |

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No.

4

5

6

7

40lx and below.

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# Substantial Equivalence to Predicates (21 CFR §807.92(b)(1))

Verification testing to the system requirements (SRS) for the Fluorescence Mode and the validation of the intended use is intended to support the claim of substantial equivalence to the following Substantial Equivalence table:

Table 1: Substantial Equivalence Table (abbreviated)

| Device | The Fluorescence Mode<br>(Proposed Device) | VistaCam iX "Proof" (K150672) |
|----------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------|
| Intended Use | The Fluorescence Mode is intended to be used by<br>dentist as an aid in the detection of dental caries | Caries detection aid |
| Indication for<br>Use | The Fluorescence Mode is intended to be used by<br>dentist as an aid in the detection of dental caries. | The VistaCam iX "Proof" is intended to be used as<br>an aid in the detection and diagnosis of dental<br>caries |
| Device<br>Classification<br>Name | Laser Fluorescence Caries Detection | Laser Fluorescence Caries Detection |
| Generic<br>Common Name | Dental Fluorescence Examination Device | Intraoral Camera with Fluorescence Caries<br>Detection Aid |
| Classification<br>Product Code | NBL | NBL |
| Class | II | II |
| Technology | Fluorescence technology to aid in the detection of<br>carious lesions | Fluorescence technology to aid in the detection<br>of carious lesions |
| Mode of<br>Operation | Excites bacteria to fluoresce | Excites bacteria to fluoresce |
| Detection<br>Wavelength | 405 nm | 405 nm (Proof interchangeable head) |
| Differences: | | |
| Device<br>Operating<br>Feature | Dental microscope with built-in feature provides<br>visualization and an uninterrupted workflow | Headpiece with control buttons |
| Software | Software of Surgical Microscope:<br>• Light Source Control<br>• Filter Control<br>• Video Control<br>• Wi-Fi Module: Firmware processes network<br>communication | Using DBSWIN Imaging Software |

The above table shows that these two devices are similar in the technological characteristics, the intended use, and the performances in detecting dental caries. Details of the Substantial Equivalence Discussion and comparison chart are in Section 12.

The differences between the subject device and the predicate device are supported by performance data and do not raise any new questions about safety and effectiveness. The device can therefore be considered substantially equivalent to the predicate device.

# 510(k) Summary (21 CFR §807.92(c))

As described in this 510(k) Summary, all testing deemed necessary was conducted on the Fluorescence Mode of the EXTARO 300 surgical microscope to ensure that the device is substantially equivalent to the predicate in terms of safety and effectiveness for its intended use when used in accordance with its Instructions for Use.