TEMPLATE AND COUNTER-FIT

K081017 · Clinician'S Choice Dental Products, Inc. · ELW · Aug 4, 2008 · Dental

Device Facts

• Record ID: K081017
• Device Name: TEMPLATE AND COUNTER-FIT
• Applicant: Clinician'S Choice Dental Products, Inc.
• Product Code: ELW · Dental
• Decision Date: Aug 4, 2008
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 872.3660
• Device Class: Class 2

Indications for Use

Device intended to be placed intraorally or on a preformed impression tray and used to reproduce the structure of a patient's teeth and gums.

Device Story

Template and CounterFit are polydimethylsiloxane-based impression materials. Used by dental professionals to capture accurate anatomical impressions of teeth and gums. Material is placed intraorally or within a preformed impression tray; sets to form a negative mold of the oral structures. Output is a physical impression used by dentists to fabricate dental restorations or models. Facilitates clinical decision-making and treatment planning for restorative dentistry.

Clinical Evidence

Bench testing only.

Technological Characteristics

Polydimethylsiloxane-based impression material. Formulated as a viscous paste for intraoral application or tray loading. Class II medical device under 21 CFR 872.3660 (Impression Material).

Indications for Use

Indicated for use in dental patients requiring reproduction of the structure of teeth and gums via intraoral placement or preformed impression trays.

Regulatory Classification

Identification

Impression material is a device composed of materials such as alginate or polysulfide intended to be placed on a preformed impression tray and used to reproduce the structure of a patient's teeth and gums. The device is intended to provide models for study and for production of restorative prosthetic devices, such as gold inlays and dentures.

Special Controls

*Classification.* Class II (Special Controls).

Submission Summary (Full Text)

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Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Ms. Jeanette Smith Operations Manager Clinician's Choice Dental Products, Incorporated 1980 Hyde Park Road London, Ontario N6H 5L9 CANADA

AUG - 4 2008

Re: K081017

Trade/Device Names: Template and CounterFit Regulation Number: 21 CFR 872.3660 Regulation Name: Impression Material Regulatory Class: II Product Code: ELW Dated: July 18, 2008 Received: July 22, 2008

Dear Ms. Smith:

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.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such 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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## Page 2 - Ms. Smith

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); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

This letter will allow you to begin marketing your device as described in your Section 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), please contact the Center for Devices and Radiological Health's (CDRH's) Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding postmarket surveillance, please contact CDRH's Office of Surveillance and Biometric's (OSB's) Division of Postmarket Surveillance at 240-276-3474. For questions regarding the reporting of device adverse events (Medical Device Reporting (MDR)), please contact the Division of Surveillance Systems at 240-276-3464. You mav obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely vours.

Thhmuele Ferdinnd fox//

Chiu Lin, Ph.D. Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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CLINICIAN'S CHOICE TM Dental Products, Inc. 510(K) Submission: Multiple-Polydimethylsiloxanes Impression Material

## Indications for Use

| 510(k) Number (if known): | K081017 |
|---------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------|
| Device Name: | Template and CounterFit |
| Indications for Use: | Device intended to be placed intraorally or on a preformed<br>impression tray and used to reproduce the structure of a<br>patient's teeth and gums. |

Prescription Use X (21 CFR Part 801 Subpart D) AND/OR

Over-the-Counter Use (21 CFR Part 807 Subpart C)

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

Intray

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510(k) Number: K081017

Section 2-3

1084 Federal Road . Brookfield, CT 06804