ADAPTAIN SOLUBLE IMPLANT MATERIAL

K120220 · Ceremed , Inc. · KHJ · Jun 6, 2012 · Ear, Nose, Throat

Device Facts

• Record ID: K120220
• Device Name: ADAPTAIN SOLUBLE IMPLANT MATERIAL
• Applicant: Ceremed , Inc.
• Product Code: KHJ · Ear, Nose, Throat
• Decision Date: Jun 6, 2012
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 874.3620
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

Adaptain™ Soluble Implant Material is indicated for use as a water-soluble implant material and as a water-soluble space occupying material as an adjunct during the natural healing process.

Device Story

Adaptain™ Soluble Implant Material is a sterile, odorless, opaque, wax-like synthetic polymer; composed of water-soluble alkylene oxide copolymers (AOC PolymerBlend™). Provided in bars and sheets (0.5 to 5 grams). Used as a space-occupying material to support natural healing processes. Applied by clinicians; manipulated by hand or warming to increase stickiness/softness. Device is water-soluble, eliminating need for surgical removal. Sterile by irradiation; single-use only.

Clinical Evidence

No clinical data; substantial equivalence based on non-clinical evaluations including design, materials, and performance comparisons to the predicate.

Technological Characteristics

Material: Water-soluble alkylene oxide copolymers (AOC PolymerBlend™). Form: Sterile bars and sheets. Sterilization: Irradiation. No additives or colorants.

Indications for Use

Indicated for use as a water-soluble implant material and space-occupying material as an adjunct during the natural healing process.

Regulatory Classification

Identification

Ear, nose, and throat synthetic polymer material is a device material that is intended to be implanted for use as a space-occupying substance in the reconstructive surgery of the head and neck. The device is used, for example, in augmentation rhinoplasty and in tissue defect closures in the esophagus. The device is shaped and formed by the suregon to conform to the patient's needs. This generic type of device is made of material such as polyamide mesh or foil and porous polyethylene.

Predicate Devices

• Ceretene™ Soluble Implant Material (K081531)

Submission Summary (Full Text)

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**JUN - 6 2012**

20220

(Revised 06/05/12) 10F2 Ceremed, Inc. Traditional 510(k) - Adaptain™ Soluble Implant Material

## VI - 510 (K) SUMMARY

#### Submitted by:

Chelsea Mitchell Ceremed, Inc. 3643 Lenawee Ave. Los Angeles, California 90016 Tel: [phone] Fax: [phone]

Contact Person:

Date Prepared

Common/Usual Name:

Proprietary Name:

Regulation Number:

Regulation Name:

Regulatory Class:

Product Code:

Predicate Device:

Chelsea Mitchell

May 29, 2012 .

Soluble Synthetic Polymer Implant Material

Adaptain™ Soluble Implant Material

21 CFR 874.3620

Ear, nose and throat synthetic polymer material

II

KHJ

Ceremed, Inc. Ceretene ™ Soluble Implant Material (K081531)

#### Description of the device:

Adaptain™ Soluble Implant Material is an odorless, opaque wax-like material designed to be utilized directly out of the package. It is best used immediately following removal from the package, and can be softened and increased in stickiness by warming and by additional handling and manipulation, if so desired.

Adaptain" Soluble Implant Material is comprised of a sterile mixture of water-soluble alkylene oxide copolymers (AOC PolymerBlend"). Adaptain" "Soluble Implant Material
contains no other additives or colorants. Adaptain"" Soluble Implant Material is formed in bars and sheets of various sizes with weights ranging from 0.5 to 5 grams each.

Adaptain™ Soluble Implant Material is provided sterile by irradiation and must not be resterilized.

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K120220

(Revised 06/05/12)

# Traditional 510(k) – Adaptain" Soluble Implant Material

# Indications for use:

Adaptain™ Soluble Implant Material is indicated for use as a water-soluble implant material and as a water-soluble space occupying material as an adjunct during the natural healing process.

#### Substantial equivalence:

The non-clinical evaluations used to determine substantial equivalence included indications, intended use, design, materials, sterilization, and performance. The comparison demonstrates that the device in this submission is identical in design, materials, indications, performance and sterilization to the predicate Ceretene " Soluble Implant Material (K081531).

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# DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" around the perimeter. Inside the circle is an abstract symbol resembling an eagle or bird in flight, composed of three curved lines representing wings and two curved lines representing legs or talons.

#### Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring, MD 20993-0002

JUN - 6 2012

Ceremed, Inc % Ms. Chelsea Mitchell Vice President, Regulatory Affairs 3643 Lena Wee Avenue Los Angeles, California 90016

Re: K120220

Trade/Device Name: Adaption™ Soluble Implant Material Regulation Number: 21 CFR 874.3620 Regulation Name: Ear, nose and throat synthetic polymer material Regulatory Class: Class II Product Code: KHJ Dated: May 29, 2012 Received: May 31, 2012

Dear Ms. Chelsea Mitchell:

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

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### Page 2 - Ms. Mitchell

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

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR 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.

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/MedicalDevices/Resourcesfor You/Industry/default.htm.

Sincerely yours,

Mark N. Melkerson

Mark N. Melkerson Director Division of Surgical, Orthopedic and Restorative Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure ·

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(Revised 06/05/12) Ceremed, Inc. Traditional 510(k) - Adaptain™ Soluble Implant Material

# V. INDICATIONS FOR USE:

510 (k) Number (if known):

Device Name: Adaptain™ Soluble Implant Material

Indications For Use:

Adaptain™ Soluble Implant Material is indicated for use as a water-soluble implant material and as a water-soluble space occupying material as an adjunct during the natural healing process.

OR

Prescription Use X (Per 21 CFR 801.109)

Over-The-Counter Use (Optional Format 1-2-96)

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

CONCURRANCE OF CDRH, OFFICE OF DEVICE EVALUATION (ODE)

Daire King lu MM
(Division Sign-Off)

Division of Surgical, Orthopedie, and Restorative Devices

**510(k) Number** K120220

Division Sign-Off

510(k) Number