MAUDE Adverse Event Report: DENTSPLY LLC CAVITRON INTEGRATED SYSTEM BUILT IN ULTRASONIC SCALER G139; SCALER, ULTRASONIC

Catalog Number	G139
Medical Device Problem Code	Overheating of Device (1437)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Since an overheating insert could necessitate medical/surgical intervention to preclude permanent damage to a body structure or permanent impairment of a body function, this malfunction would be likely to cause/contribute to a serious injury should it recur.As such, this event meets the criteria for reportability per 21 cfr part 803.The device is available for evaluation, though has not been returned as of this report.Evaluation results will be submitted as they become available.
Event or Problem Description
While the customer was using a cavitron integrated system built in ultrasonic scaler g139, they allege that the handpiece and the insert tip get extremely hot.No injury was reported from the alleged event.
Additional Manufacturer Narrative
02/24/2025 mu (b)(6).Emh hp; cable, conn/gun cable damaged.No hp neither harness to be evaluated.Damaged hp cable pins causing poor contact with hp creating an intermittent operation.Replaced the hp cable, checked unit for performance, unit works fine, cleaned and final test.Qa/jb.

• Brand Name: CAVITRON INTEGRATED SYSTEM BUILT IN ULTRASONIC SCALER G139
• Common Device Name: SCALER, ULTRASONIC
• Manufacturer (Section D): DENTSPLY LLC; 1301 smile way; york PA 17404
• Manufacturer (Section G): DENTSPLY LLC; 1301 smile way; york PA 17404
• Manufacturer Contact: dan eagar ; 221 w. philadelphia st.; york, PA 17401 ; 7178494593
• MDR Report Key: 21417288
• Report Number: 2424472-2025-00022
• Device Sequence Number: 7586295
• Product Code: ELC
• UDI-Device Identifier: D00388001041
• UDI-Public: D00388001041
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K052334
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Dentist
• Type of Report: Initial,Followup
• Report Date (Section B): 04/07/2025

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Catalogue Number: G139
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 02/10/2025
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 02/19/2025
• Supplement Report FDA Received Date: 04/07/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Sex: Unknown