BEUDAMED
    FDA Adverse Event Injury Summary report: N

    IMPLANTIUM

    MDR report key: 1820676 · Received August 26, 2010

    Report

    Report Number
    3005503242-2010-00070
    Event Type
    Injury
    Date Received
    August 26, 2010
    Date of Event
    July 19, 2010
    Report Date
    July 28, 2010
    Manufacturer
    DENTIUM USA
    Product Code
    DZE
    PMA / PMN Number
    K041368
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    DENTIST

    Narratives

    Additional Manufacturer Narrative · 1

    CONCLUSION: BASED ON INSPECTION RESULTS AND THE DHR REVIEW, THE RETURNED PRODUCT HAS BEEN FOUND TO BE WITHIN SPECIFICATION. THEREFORE, THE IMPLANT FAILURE IS MOST LIKELY DUE TO CAUSES OTHER THAN THE PRODUCT SUCH AS SURGICAL MISTAKE, PT BONE CONDITION, PT ORAL HYGIENE, OR PT BEHAVIOR.

    Description of Event or Problem · 1

    PRODUCT WAS RETURNED AS AN IMPLANT FAILURE BECAUSE IT DID NOT INTEGRATE WITH BONE DUE TO INFECTION. BASED ON THE REPORT, THE PT HAD GOOD ORAL HYGIENE AND MODERATE BONE CONDITION. THE FIXTURE WAS PLACED WITH A TRADITIONAL 2 STAGE SURGERY IN TOOTH LOCATION #18. A SINGLE PROSTHETIC WAS ATTACHED. SEPTODONT BONE MATERIAL WAS USED. THE DOCTOR INDICATED THAT THE DEVICE WAS NOT RECEIVED DAMAGED OR DEFECTIVE SUCH THAT IT WOULD NOT PERFORM AS INTENDED. THE PT'S OUTCOME WAS REPORTED AS RECOVERED, NO COMPLICATIONS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 IMPLANTIUM ENDOSSEOUS DENTAL IMPLANT DZE DENTIUM USA FX4310MLC A07Y06H01AR

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Required Intervention