MAUDE Adverse Event Report: ADIN DENTAL IMPLANT SYSTEMS LTD TOUAREG CLOSEFIT¿ WP DENTAL IMPLANT 5D 11.5L

Model Number	ISPX1149
Medical Device Problem Code	Osseointegration Problem (3003)
Health Effect - Clinical Codes	Failure of Implant (1924); Inadequate Osseointegration (2646)
Date of Event	01/04/2025
Type of Reportable Event	Serious Injury
Event or Problem Description
Dental implant failure.
Additional Manufacturer Narrative
The doctor reported that the implant was removed due to implant mobility.No further patient complications were reported.Manufacturer's trend analysis show that implant failure is a low-rate adverse event, commonly associated with endosseous dental implants in clinical use.

• Brand Name: TOUAREG CLOSEFIT¿ WP DENTAL IMPLANT 5D 11.5L
• Common Device Name: TOUAREG CLOSEFIT¿ WP DENTAL IMPLANT 5D 11.5L
• Manufacturer (Section D): ADIN DENTAL IMPLANT SYSTEMS LTD; industrial zone alon tavor; pob 1128; afula, 18111 01; IS 1811101
• Manufacturer (Section G): ADIN DENTAL IMPLANT SYSTEMS LTD.; industrial zone alon tavor; pob 1128; afula, 18111 01; IS 1811101
• Manufacturer Contact: ilana lutvak ; industrial zone alon tavor; pob 1128; afula, ; IS
• MDR Report Key: 22283120
• Report Number: 3007518363-2025-00979
• Device Sequence Number: 12985023
• Product Code: DZE
• UDI-Device Identifier: 07290105152282
• UDI-Public: 07290105152282
• Combination Product (Y/N): N
• PMA/510(K) Number: K112585
• 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: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Dentist
• Remedial Action: Replace
• Type of Report: Initial
• Report Date (Section B): 06/18/2025

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
• Operator of Device: Health Professional
• Device Expiration Date: 06/01/2025
• Device Model Number: ISPX1149
• Device Catalogue Number: ISPX1149
• Device Lot Number: 7550903
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/22/2025
• Initial Report FDA Received Date: 06/18/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 06/01/2020
• 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: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 37 YR
• Patient Sex: Female