GENIE MAGIC MIX ULTRA HYDROPHILIC IMPRESSION MATERIAL

K043054 · Sultan Chemists, Inc. · ELW · Feb 18, 2005 · Dental

Device Facts

• Record ID: K043054
• Device Name: GENIE MAGIC MIX ULTRA HYDROPHILIC IMPRESSION MATERIAL
• Applicant: Sultan Chemists, Inc.
• Product Code: ELW · Dental
• Decision Date: Feb 18, 2005
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 872.3660
• Device Class: Class 2

Intended Use

Material is intended for use as a dental impression material, compatible with all techniques including dual-phase, monophase and dual impression techniques. The material is dispensed from an automatic mixing machine system and placed into dental impression trays (metal or plastic) and is used to accurately reproduce intra-oral structures (teeth & gums) to provide models for study and/or fabrication of prosthetic devices.

Device Story

Sultan Genie Magic Mix™ Ultra Hydrophilic Impression Material is a dental impression material used by dental professionals to capture accurate replicas of intra-oral structures, including teeth and gums. The material is designed for use with automatic mixing machine systems, which dispense the material into dental impression trays (metal or plastic). Once placed in the patient's mouth, the material sets to create a physical mold. This mold is subsequently used to produce dental models for study or the fabrication of prosthetic devices. The device facilitates clinical decision-making by providing accurate anatomical representations necessary for restorative and diagnostic dental procedures.

Clinical Evidence

No clinical data provided; bench testing only.

Technological Characteristics

Ultra-hydrophilic impression material; compatible with automatic mixing machine systems; suitable for use with metal or plastic dental impression trays; supports dual-phase, monophase, and dual impression techniques.

Indications for Use

Indicated for use as a dental impression material for reproducing intra-oral structures (teeth and gums) to create models for study or prosthetic fabrication. Compatible with dual-phase, monophase, and dual impression techniques. For professional use only.

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

FEB 1 8 2005

Dr. Clark Smith Senior Vice President Sultan Chemists, Incorporated 85 West Forest Avenue Englewood, New Jersey 07631

Re: K043054

Trade/Device Name: Sultan Genie Magic Mix™ Ultra Hydrophilic Impression Material Regulation Number: 872.3660 Regulation Name: Impression Material Regulatory Class: II Product Code: ELW Dated: November 3, 2004 Received: December 8, 2004

Dear Dr. 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 approvisions 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 (1 vir 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); good 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 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 Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may 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 yours.

Sustie Michu Oms

Chiu Lin, Ph.D. I)irector 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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## Statement of Indications For Use

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510(k) Number: Koy 3054

Device Name:

Sultan Genie Magic Mix™ Ultra Hydrophilic Impression Indications For Use: Material is intended for use as a dental impression material, compatible with all techniques including dual-phase, monophase and dual impression techniques. The material is dispensed from an automatic mixing machine system and placed into dental impression trays (metal or plastic) and is used to accurately reproduce intra-oral structures (teeth & gums) to provide models for study and/or fabrication of prosthetic devices.

PLEASE DO NOT WRITE BELOW THIS LINE -- CONTINUE ON ANOTHER PAGE IF NEEDED Concurrence of CDRH, Office of Device Evaluation (ODE)

| Prescription Use | <div style="display:flex; align-items:center;"> <span>✓</span> </div> (Per 21 CFR 801.109) |
|----------------------|--------------------------------------------------------------------------------------------|
| Over-the-Counter Use | |

*Suzy Suaze*
(Division Sign-Off)
Division of Anesthesiology, General Hospital,
Infection Control, Dental Devices

| 510(k) Number: | K043054 |
|----------------|---------|
|----------------|---------|

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