MAUDE Adverse Event Report: NORIS MEDICAL LTD ONYX IMPLANT; ONYX DENTAL IMPLANT

Model Number	NM-G3708
Medical Device Problem Code	Loosening of Implant Not Related to Bone-Ingrowth (4002)
Health Effect - Clinical Code	Failure of Implant (1924)
Date of Event	01/09/2025
Type of Reportable Event	Serious Injury
Event or Problem Description
The clinician reports the implant was inserted (b)(6) 2024.On (b)(6) 2025, loosening of implant not related to bone ingrowth was verified on tooth #29.According to the information, the patient is smoker.Observed during the event: mobility.The device was forwarded to the manufacturer.No patient operative or post-operative complications reported.

• Brand Name: ONYX IMPLANT
• Common Device Name: ONYX DENTAL IMPLANT
• Manufacturer (Section D): NORIS MEDICAL LTD; hataasia 8; nesher, 36888 08; IS 3688808
• MDR Report Key: 21729374
• Report Number: 3012141159-2025-00177
• Device Sequence Number: 20991416
• Product Code: DZE
• UDI-Device Identifier: 07290108813074
• UDI-Public: 07290108813074
• Combination Product (Y/N): N
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2024
• Device Explanted Year: 2025
• Serviced by Third Party (Y/N): N
• Reporter Type: Importer
• Initial Reporter Occupation: Dentist
• Type of Report: Initial
• Report Date (Section B): 03/31/2025
• Report Date (Section F): 03/31/2025

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Expiration Date: 07/26/2025
• Device Model Number: NM-G3708
• Device Catalogue Number: NM-G3708
• Device Lot Number: 9000274
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: Yes
• Distributor Facility Aware Date: 03/25/2025
• Device Age: 54 MO
• Event Location: Outpatient Treatment Facility
• Date Report to Manufacturer: 03/31/2025
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 03/31/2025
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Age: 50 YR
• Patient Sex: Male
• Patient Weight: 160 KG
• Patient Ethnicity: Non Hispanic
• Patient Race: Black Or African American
• Date Report Sent to FDA: 03/31/2025