MAUDE Adverse Event Report: BIOMET 3I CERTAIN LOW PROFILE ABUTMENT 4.1MM(D) X 2MM(H); DENTAL SCREW

Model Number	ILPC442
Medical Device Problem Code	Fracture (1260)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	11/04/2022
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Zimmerbiomet complaint number: (b)(4).Weight: unknown / not provided.Title: unknown/ not provided.First/given name: unknown / not provided.Last name: unknown / not provided.Email address: unknown / not provided.
Event or Problem Description
It was reported that the patient came with the crown in his hand due to the fracture of the through screw of the transepithelial abutment.The doctor reports that the torque used was 15nw.
Additional Manufacturer Narrative
Zimvie complaint number (b)(4).One abutment was returned for investigation.Visual inspection of the as returned product identified worn markings due to usage and a fracture at the threads.Also, an associated product lpctsh has been returned.However, this item is listed as associated item only and did not cause or contribute to the event.No further investigation will be conducted.Pre-existing patient factors, x-ray, tooth location are not relevant to the reported event.The length of the device usage is unknown.Pictures or x-ray images were not provided.Review of appropriate documentation: documents reviewed: biomet 3i restorative products ifu (p-iis086gr) rev f ¿ october 2019 information identified: 'warnings' 'precautions' 'potential adverse events'.Dhr review: dhr review was completed for the subject lot number (2021050107).It was confirmed that all operations and inspections were executed as per applicable procedure.No deviations or non-conformances, which could have caused or contributed to the reported event was noted as part of the dhr.Lot was inspected and passed all acceptance criteria by qa.Complaint history review: complaint history review was performed for the reported lot number (2021050107) for similar event and no other complaint was identified.Post market trend review: jan post market trending was reviewed and there were no actionable events or corrective actions for the reported event or device.Based on the available information, device malfunction did occur and the reported event was confirmed.
Event or Problem Description
No further event information is available at the time of this report.

• Brand Name: CERTAIN LOW PROFILE ABUTMENT 4.1MM(D) X 2MM(H)
• Common Device Name: DENTAL SCREW
• Manufacturer (Section D): BIOMET 3I; 4555 riverside drive; palm beach gardens FL 33410
• Manufacturer (Section G): BIOMET 3I; 4555 riverside drive; palm beach gardens FL 33410
• Manufacturer Contact: susanne taylor ; 4555 riverside drive; palm beach gardens, FL 33410 ; 5617766700
• MDR Report Key: 15930491
• Report Number: 0001038806-2022-01867
• Device Sequence Number: 4347404
• Product Code: DZE
• UDI-Device Identifier: 00844868021216
• UDI-Public: (01)00844868021216(17)260621(10)2021050107
• Combination Product (Y/N): N
• Initial Reporter Country: SP
• PMA/510(K) Number: K092341
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2022
• Device Explanted Year: 2022
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional
• Initial Reporter Occupation: Dentist
• Type of Report: Initial,Followup
• Report Date (Section B): 03/31/2023
• 2 Devices were Involved in the Event: 1 2

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Lay User/Patient
• Device Expiration Date: 06/21/2026
• Device Model Number: ILPC442
• Device Catalogue Number: ILPC442
• Device Lot Number: 2021050107
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 11/14/2022
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 11/14/2022
• Supplement Date Received by Manufacturer: 03/31/2023
• Initial Report FDA Received Date: 12/07/2022
• Supplement Report FDA Received Date: 03/31/2023
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 06/21/2021
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Patient Age: 42 YR
• Patient Sex: Male