GC FujiCEM 2 (Improved)

K182854 · GC America, Inc. · EMA · Jul 11, 2019 · Dental

Device Facts

• Record ID: K182854
• Device Name: GC FujiCEM 2 (Improved)
• Applicant: GC America, Inc.
• Product Code: EMA · Dental
• Decision Date: Jul 11, 2019
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 872.3275
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

Cementation of metal-based inlays, onlays, crowns and bridges Cementation of resin inlays, onlays, crowns and bridges Cementation of all ceramic inlays Cementation of high strength (e.g. zirconia based, lithium disilicate) ceramic onlays, crowns and bridges Cementation of metal, ceramic and fiber posts

Device Story

Resin-modified glass ionomer luting cement; supplied in dual-barrel syringe with automix tips. Composed of two pastes (A and B); Paste A contains fluoro-alumino-silicate glass; Paste B contains polyacrylic acid and water. Setting mechanism involves acid-base reaction (forming hydrogel via aluminum/strontium ion crosslinking) and methacrylate polymerization (chemical cure). Optional light-cure (tack cure) feature facilitates excess cement removal. Used by dental professionals in clinical settings for permanent cementation of various dental restorations. Provides radiopacity and fluoride release. Benefits include improved handling via automix delivery and easier cleanup compared to hand-mixed predecessors.

Clinical Evidence

No clinical data. Bench testing only. Biocompatibility assessed per ISO 10993-1 (cytotoxicity, sensitivity, irritation). Physical performance testing conducted per ISO 9917-2:2017, confirming flexural strength >25 MPa and radiopacity exceeding aluminum equivalent.

Technological Characteristics

Resin-modified glass ionomer cement. Dual-paste system (Paste A/B). Setting: acid-base reaction (fluoro-alumino-silicate glass + polyacrylic acid) and methacrylate polymerization (chemical + optional light-cure). Form factor: dual-barrel syringe with static mixing tip. Radiopaque. Non-sterile.

Indications for Use

Indicated for cementation of metal-based, resin, and all-ceramic inlays, onlays, crowns, and bridges, including high-strength ceramics (zirconia, lithium disilicate), and metal, ceramic, or fiber posts.

Regulatory Classification

Identification

Zinc oxide-eugenol is a device composed of zinc oxide-eugenol intended to serve as a temporary tooth filling or as a base cement to affix a temporary tooth filling, to affix dental devices such as crowns or bridges, or to be applied to a tooth to protect the tooth pulp. Dental cement other than zinc oxide-eugenol is a device composed of various materials other than zinc oxide-eugenol intended to serve as a temporary tooth filling or as a base cement to affix a temporary tooth filling, to affix dental devices such as crowns or bridges, or to be applied to a tooth to protect the tooth pulp.

Predicate Devices

• GC FujiCEM (K001730)

Reference Devices

• GC Fuji Direct (K172382)
• GC G-CEM Automix (K073283)

Submission Summary (Full Text)

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

Image /page/0/Picture/0 description: The image contains two logos. The logo on the left is the Department of Health & Human Services logo. The logo on the right is the FDA logo, which is a blue square with the letters "FDA" in white, followed by the words "U.S. FOOD & DRUG ADMINISTRATION" in blue.

July 11, 2019

GC America Inc. Mark Heiss Director, Regulatory Affairs 3737 W. 127th Street Alsip, Illinois 60803

Re: K182854

Trade/Device Name: GC FujiCEM 2 (Improved) Regulation Number: 21 CFR 872.3275 Regulation Name: Dental Cement Regulatory Class: Class II Product Code: EMA Dated: April 12, 2019 Received: April 16, 2019

Dear Mark Heiss:

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.

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

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.

for

Srinivas Nandkumar, Ph.D. Acting Assistant Director DHT1B: Division of Dental Devices OHT1: Office of Ophthalmic, Anesthesia, Respiratory, ENT and Dental Devices Office of Product Evaluation and Ouality Center for Devices and Radiological Health

Enclosure

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

# Indications for Use

510(k) Number (if known)

K182854

Device Name GC FujiCEM 2 (Improved)

### Indications for Use (Describe)

- -Cementation of metal-based inlays, onlays, crowns and bridges
- -Cementation of resin inlays, onlays, crowns and bridges
- Cementation of all ceramic inlays -
- -Cementation of high strength (e.g. zirconia based, lithium disilicate) ceramic onlays, crowns and bridges
- Cementation of metal, ceramic and fiber posts -

Type of Use: (Select one or both, as applicable)X | Prescription Use (Part 21 CFR 801 Subpart D)

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

## CONTINUE ON A SEPARATE PAGE IF NEEDED.

This section applies only to requirements of the Paperwork Reduction Act of 1995.

## *DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.*

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

> Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff @fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

{3}------------------------------------------------

Image /page/3/Picture/0 description: The image shows the letters 'GC' in a stylized, sans-serif font. The letters are a teal color, and there are single quotation marks before and after the letters. The letters are slightly italicized, giving them a dynamic appearance. The background is plain white.

C AMER 3737 W 127th STRE ALSIP, ILLINOIS 60803 TEL [phone] FAX [phone] www.gcamerica.com

K182854

| 1. Submitter Information:<br>GC America Inc.<br>3737 W. 127th Street<br>Alsip, IL 60803 | |
|-----------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------|
| Contact Person:<br>e-mail:<br>Phone:<br>Alternate Contact:<br>e-mail:<br>Phone:<br>Fax: | Mark Heiss, D.D.S.<br>[e-mail]<br>[phone]<br>Lori Rietman<br>[e-mail]<br>[phone]<br>[phone] |
| Date Prepared: | July 8, 2019 |
| 2. Device Name: | |
| Proprietary Name:<br>Classification Name:<br>Device Classification:<br>Product Code: | GC FujiCEM 2 (Improved)<br>Dental Cement<br>Class II, 872.3275<br>EMA |

- 3. Predicate Devices:

| Product | Applicant | 510(k) No. | Code No | Predicate | Decision Date |
|------------------|-----------------|------------|---------|-----------|---------------|
| GC FujiCEM | GC America Inc. | K001730 | EMA | Primary | 07/17/2000 |
| GC Fuji Direct | GC America Inc. | K172382 | EMA | Reference | 04/02/2018 |
| GC G-CEM Automix | GC America Inc. | K073283 | EMA | Reference | 02/20/2008 |

#### 4. Description of Device:

GC FujiCEM 2 (Improved) is a resin modified glass ionomer luting cement. The device is composed of the two pastes, Paste A and Paste B, packaged in an automix dual barrel syringe.

GC FujiCEM 2 (Improved) Package:

- Single Pack Automix ●
- Syringe (9.2 g / 5 mL) QTY: 1
- GC Mixing Tip QTY: 15
- Triple Pack Handmix ●
- Syringe (9.2 g / 5 mL) QTY: 3
- Mixing Pad- QTY: 1
- Triple Pack Automix .
- Syringe (9.2 g / 5 mL) QTY: 3
- GC Mixing Tip QTY: 45

Shades available:

Yellow, Brown

Shelf Life and Storage Conditions:

- Shelf Life 2 years "
- -Recommended for optimal performance, store in a cool and dark place. 4-25℃ (39-77°F)

1

{4}------------------------------------------------

#### ર. Indications for Use Statement:

- Cementation of metal-based inlays, onlays, crowns and bridges ●
- Cementation of resin inlays, onlays, crowns and bridges
- Cementation of all ceramic inlays ●
- Cementation of high strength (e.g. zirconia based, lithium disilicate) ceramic onlays, crowns and bridges
- Cementation of metal, ceramic and fiber posts .

#### 6. Non-Clinical Performance Testing:

Biocompatibility: A biocompatibility assessment was completed according to ISO 10993-1:2009, Biological evaluation of medical devices - Part 1: Evaluation and testing within a risk management process.

### Cytotoxicity (L929 MEM Elution Test)

Based on the criteria of the protocol of ISO 10993-5

### Sensitivity (Kligman Maximization Test)

Based on the criteria of the protocol of ISO 10993-10

### Irritation (Intracutaneous Injection Test)

Based on the criteria of the protocol of ISO 10993-10

GC FujiCEM 2 (Improved) is a resin modified glass ionomer luting cement and does come in contact with body tissues (tooth - enamel, dentin) for more than 24 hours.

In conclusion, biocompatibility of GC FujiCEM 2 (Improved) is acceptable device from the biological evaluation result.

Performance Bench Tests: It is confirmed that the device conforms to the required specifications of ISO 9917-2: 2017 (Dentistry - Water-based cements -Part2: Resin-modified cements) and company standard is suitable for its intended use. Performance testing includes:

| Property | Requirements |
|-------------------|------------------------------------------------------------------|
| Appearance | No visible sign of extraneous matter<br>Free of any gelation |
| Working time | The indenter shall make a complete circular indentation. |
| Setting time | The indenter shall fail to make a complete circular indentation. |
| Flexural strength | More than 25 MPa |
| Radiopacity | More than equivalent thickness of aluminum |

#### 7. Clinical Performance Testing

No clinical testing has been performed on this device.

- 8. Substantial equivalence:
The applicant device complies with all the requirements of ISO 9917-2: 2017 (Dentistry - Water-based cements -Part2: Resin-modified cements).

The curing mechanism of the applicate device and predicate device are substantially equivalent in principle. Therefore, the applicant device and predicate device are the same in function, and similar in composition and intended use. This supports that the compatibility of the applicant device is substantially equivalent to the predicate devices.

- 2

{5}------------------------------------------------

| GC FujiCEM 2 (Improved) | GC FujiCEM |
|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Fluoro-alumino-silicate glass contained in Paste A and<br>Polyacrylic acid contained in Paste B react in the<br>presence of water contained from the paste B.<br>Aluminum ion, Strontium ion and Fluoride ion are<br>released from Fluoro-alumino-silicate glass due to this<br>reaction. Of these ions, Aluminum ion and Strontium<br>ion crosslink the polyacrylic acid and form hydrogel.<br>Fluoride ion doesn't react, it remains inside hydrogel as<br>ion.<br>Methacrylates contained in Paste A polymerize by<br>polymerization initiator contained in Paste B. In<br>addition, they also polymerize by light irradiation<br>thanks to photo polymerization initiator contained in<br>Paste A. | Fluoro-alumino-silicate glass contained in Paste A and<br>Polyacrylic acid contained in Paste B react in the<br>presence of water contained from the paste B.<br>Aluminum ion, Strontium ion and Fluoride ion are<br>released from Fluoro-alumino-silicate glass due to this<br>reaction. Of these ions, Aluminum ion and Strontium ion<br>crosslink the polyacrylic acid and form hydrogel.<br>Fluoride ion doesn't react, it remains inside hydrogel as<br>ion.<br>Methacrylates contained in Paste A polymerize by<br>polymerization initiator contained in Paste B. |
| This material set by the above two reactions. The set<br>material contains fluoride ion inside as free ion. These<br>ions can be gradually release from the setting material<br>in very small amounts with time. | This material set by the above two reactions. The set<br>material contains fluoride ion inside as free ion. These<br>ions can be gradually release from the setting material in<br>very small amounts with time. |

### Differences

The following differences may be noted between GC FujiCEM 2 (Improved) and the predicate device.

- The differences are for clarification of Indications for Use. -
- The applicant device is hardened through chemical cure and partially hardened through light cure (tack curing). This function is used for removing excess cement. On the primary device is hardened through just chemical cure.
- -The applicant device is automixed using a static mixing tip, while primary device is hand mixed.
- -The applicant device is a resin modified glass ionomer cement for luting while the predicate device, GC Fuji Direct, is resin modified glass ionomer cement for filling.
- The applicant device is resin modified glass ionomer cement while the predicate device, GC G-CEM -Automix, is self-adhesive resin cement for luting.

Below is a comparison table between the applicant device, primary device and reference devices, showing the similarities between devices.

{6}------------------------------------------------

| | Applicant Device | Primary Device | Reference Device | Reference Device |
|-----------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Trade name | GC FujiCEM 2 (Improved) | GC FujiCEM | GC Fuji Direct | GC G-CEM Automix |
| | K182854 | K001730 | K172382 | K073283 |
| Manufacturer | GC Corporation | GC Corporation | GC Corporation | GC Corporation |
| Product | Resin modified glass ionomer | Resin modified glass ionomer | Resin-modified glass ionomer | Self-adhesive resin cement |
| category | cement | cement | cement | |
| Paste/Paste ratio | Paste A / Paste B = 1.0 / 1.0 (w/w) | Paste A / Paste B = 2.0 / 1.0 (w/w) | Paste A / Paste B = 1.6 / 1.0 w/w) | Paste A / Paste B = 1.3 / 1.0 (w/w) |
| Indications for Use | 1. Cementation of metal-based<br>inlays, onlays, crowns and<br>bridges<br>2. Cementation of resin inlays,<br>onlays, crowns and bridges<br>3. Cementation of all ceramic<br>inlays<br>4. Cementation of high strength<br>(e.g. zirconia based, lithium<br>disilicate) ceramic onlays,<br>crowns and bridges<br>5. Cementation of metal, ceramic<br>and fiber posts | 1. Cementation of metal-based<br>inlays, onlays, crowns and<br>bridges<br>2. Cementation of resin inlays,<br>onlays, crowns and bridges<br>3. Cementation of all ceramic inlays<br>4. Cementation of high strength<br>(zirconia based) all ceramic<br>crowns and bridges<br>5. Cementation of metal, ceramic<br>and fiber posts | 1. Class III and V restorations<br>2. Restoration of primary teeth<br>3. Core Build-up<br>4. Cases where radiopacity is<br>required<br>5. Base material for Class 1 and<br>Class II cavities using a sandwich<br>laminate technique | GC GAM-100 is intended to be<br>used for cementing all types of<br>ceramic, resin, and metal-based<br>inlays, onlays, crown and<br>bridges, and post. |
| Product<br>description | The device consists of 2 pastes<br>filled in a dual barrel syringe.<br>Paste A and B are automixed<br>with an automix tip and directly<br>applied to restorations or the<br>prepared cavity. | The device consists of 2 pastes<br>filled in a Paste Pak Cartridge.<br>Paste A and B are dispensed with<br>Paste Pak Dispenser and hand<br>mixed. The mixed cement is<br>applied to restorations or the<br>prepared cavity. | The device consists of 2 pastes<br>filled in cartridges. Paste A and B<br>are automixed with an automix<br>tip and directly applied to the<br>prepared cavity. | The device consists of 2 pastes<br>filled in a one body syringe.<br>Paste A and B are automixed<br>with an automix tip and directly<br>applied to restorations or the<br>prepared cavity. |
| Instruction for use | 1. Tooth preparation<br>2. Restoration preparation<br>3. Dispensing<br>4. Cementation<br>5. Cleaning up excess cement<br>6. Finishing restoration and check<br>occlusion. | 1. Tooth preparation<br>2. Restoration preparation<br>3. Dispensing<br>4. mixing pastes<br>5. Cementation<br>6. Cleaning up excess cement<br>7. Finishing restoration and check<br>occlusion. | 1. Tooth preparation<br>2. Mix of 2 pastes<br>3. Application to cavity<br>4. Finishing | 1. Tooth preparation<br>2. Restoration preparation<br>3. Dispensing<br>4. Cementation<br>5. Cleaning up excess cement<br>6. Finishing restoration and<br>check occlusion. |
| Light curing<br>specification | Optionally, tack cure using light for<br>removing excess cement. | | Light cure using a light curing<br>unit.<br>10 sec. (High Power LED Light)<br>(>1200mW/cm2)<br>20 sec. (Halogen/LED) (700<br>mW/cm2) | light cure all surfaces/margins for<br>20 seconds each (Halogen/LED<br>700mW/cm2). |
| Technological<br>Characteristics<br>and Mode of<br>action | The device is set by acid-base<br>reaction and polymerization after<br>mixing 2 pastes.<br>Acid-base reaction occurs Fluoro-<br>alumino-silicate glass in Paste A<br>and Polyacrylic acid in Paste B.<br>Polymerization of methacrylate<br>monomers is through chemical<br>cure.<br>It is also partially hardened through<br>light cure (tack cure). This is used<br>for removing excess cement. | The device is set by acid-base<br>reaction and polymerization after<br>mixing 2 pastes.<br>Acid-base reaction occurs<br>Fluoro-alumino-silicate glass in<br>Paste A and Polyacrylic acid in<br>Paste B.<br>Polymerization of methacrylate<br>monomers is through chemical<br>cure. | The device is set by acid-base<br>reaction and polymerization after<br>mixing 2 pastes.<br>Acid-base reaction occurs<br>Fluoroalumino-silicate glass in<br>Paste A and Polyacrylic acid in<br>Paste B.<br>Polymerization of methacrylate<br>monomers is through dual cure | The device is set by<br>polymerization after mixing 2<br>pastes.<br>Polymerization of methacrylate<br>monomers is through dual cure. |
| Sizes | Single Pack Automix<br>Syringe (9.2 g / 5 mL) QTY: 1<br>GC Mixing Tip – QTY: 15<br>Triple Pack Handmix<br>Syringe (9.2 g / 5 mL) QTY: 3<br>Mixing Pad- QTY: 1<br>Triple Pack Automix<br>Syringe (9.2 g / 5 mL) QTY: 3<br>GC Mixing Tip – QTY: 45 | 1 . GC FujiCEM Refill (Automix<br>compatible)<br>Paste Pak Cartridge (13.3g / 7.2mL)<br>(2) with mixing pad (No.22)<br>2. GC FujiCEM Automix<br>Paste Pak Cartridge (13.3g / 7.2mL)<br>(2), GC FujiCEM Mixing Tip (44)<br>3. Paste Pak Dispenser (1) | 1 x Paste Pak Cartridge SL (14.9g /<br>7.2mL)<br>20 x GC Fuji Mixing Tip SL with<br>intraoral tip<br>1 x Paste Pak Dispenser II | 1. G-CEM Automix syringe 4.8 g<br>(2.7 mL) (2), G-CEM Automix Tip<br>Regular (20)<br>2. G-CEM Automix Tip Regular (20)<br>3. G-CEM Automix Tip for endo<br>including extension tip (10) |
| Shades | Yellow, Brown | Yellow | A1, A2, A3 based on Vita® shades | A2 (Vita® shade), AO3 (opaque),<br>BO1 (opaque) and Translucent |
| Sterility | This device does not require<br>sterilization. | This device does not require<br>sterilization. | This device does not require<br>sterilization. | This device does not require<br>sterilization |

{7}------------------------------------------------

#### 9. Conclusion

Based on similarities in intended use, mode of action, chemical composition, and performance testing, GC FujiCEM 2 (Improved) is substantially equivalent to the predicate device.