BEUDAMED
    FDA Adverse Event Injury Summary report: N

    INTERNAL HEX IMPLANT

    MDR report key: 6048942 · Received October 21, 2016

    Report

    Report Number
    1287163-2016-50677
    Event Type
    Injury
    Date Received
    October 21, 2016
    Date of Event
    August 30, 2016
    Report Date
    September 28, 2016
    Manufacturer
    ACE SURGICAL SUPPLY COMPANY
    Product Code
    DZE
    UDI-DI
    00614950004638
    PMA / PMN Number
    K102981
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    LE
    Reporter Occupation
    DENTIST

    Narratives

    Additional Manufacturer Narrative · 1

    THE REPORTED EVENT HAS BEEN DETERMINED TO BE A POST-PLACEMENT/PRE-LOAD IMPLANT FAILURE. THIS IMPLANT LOSS SUGGESTS THAT THE SOURCE OF THE PROBLEM WAS LIKELY TO STEM FROM PROCEDURAL ERRORS AND/OR THE LACK OF OSSEOINTEGRATION. ADDITIONALLY, OTHER FACTORS THAT MAY HAVE CONTRIBUTED TO THE IMPLANT FAILURE INCLUDES BONE CONDITION, PATIENT ORAL HYGIENE, OR PATIENT BEHAVIOR. PROPER INTENDED USE OF THE IMPLANT IS DESCRIBED IN ITS INSTRUCTIONS FOR USE.

    Description of Event or Problem · 1

    MOBILITY, FISTULA AND PAIN WAS REPORTED. BONE QUALITY AT THE TIME OF IMPLANT FAILURE TYPE III. TIME OF LOSS IN RELATION TO THE IMPLANTATION WAS UP TO 1 YR PROSTHETIC RESTORATION. PRIMARY STABILITY AND OSSEOINTEGRATION WAS ACHIEVED. IT WAS REPORTED BIOMECH OVERLOAD. PATIENT IS A SMOKER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    699689 INTERNAL HEX IMPLANT DENTAL IMPLANT DZE ACE SURGICAL SUPPLY COMPANY 203710 14010026 00614950004638

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention