MAUDE Adverse Event Report: JJGC S.A. CM DRIVE IMPL TI 5.0X11.5; ENDOSSEOUS DENTAL IMPLANT

Catalog Number	109.691
Medical Device Problem Codes	Fracture (1260); Loss of Osseointegration (2408)
Health Effect - Clinical Codes	Hemorrhage/Blood Loss/Bleeding (1888); Unspecified Infection (1930); Pain (1994); Fibrosis (3167)
Date of Event	05/29/2025
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
The batch number could not be verified due to incomplete or missing information and / or product from the customer.Our manufacturing q-system assures that production and process controls are in place to ensure that batches confirm to the applicable specifications before theyare distributed.The loss of an endosseous dental implant after successful osseointegration and restoration is a known inherent risk of the procedure.Implants may have to be removed in case one or more of the implant success criteria are not met.Implant success criteria according to buser et al.(1991) are: 1.Absence of persistent subjective complaints such as pain, foreign body sensation and /or dysesthesia 2.Absence of a recurrent peri-implant infection with suppuration 3.Absence of implant mobility 4.Absence of a continuous radiolucency around the implant.The manufacturer's trend analysis confirms that the reported failure rate associated with its dental implants is below the expected failure rate for this treatment as published in the scientific literature.
Event or Problem Description
The clinician reports the implant was inserted (b)(6) 2018 in fdi 46.On (b)(6) 2025, loss of osseointegration was verified.Patient presented with fair oral hygiene.No product was returned to the manufacturer.At the event the patient experienced: peri-implantitis, pain, mobility and bleeding.No further patient complications were reported.
Event or Problem Description
The clinician reports the implant was inserted (b)(6) 2018 in fdi 46.On (b)(6) 2025 fracture of the implant was verified.Patient presented with fair oral hygiene.The device was forwarded to the manufacturer.At the event the patient experienced: peri-implantitis, pain, mobility and bleeding.No further patient complications were reported.
Additional Manufacturer Narrative
The batch number could not be verified due to incomplete or missing information and / or product from the customer.Our manufacturing q-system assures that production and process controls are in place to ensure that batches confirm to the applicable specifications before they are distributed.The fracture of a dental implant is a known long-term complication of endosseous dental implants.The manufacturers trend analysis confirms that the reported implant fracture rate associated with its dental implants is low and remains consistent with the experience as documented in the literature.There are different reasons why implants break and this problem has been illuminated by various authors (e.G.Maeglin 1988, beumer 1989, tetsch 1991, worthington 1992).Beumer and lewis 1989 report the following causes: a) production / design flaws, b) inadequate fitting of the suprastructure, c) occlusal overload, d) bruxism, e) bone resorption around the implants, f) insufficient axle alignment of the implants, g) trauma, h) biomechanical causes, i) design of the suprastructure.Non-fatal serious injury or device malfunction stored due to covid 19 pandemic in accordance with fda guidance "postmarketing adverse event reporting for medical products and dietary supplements during a pandemic" published may 2020.
Event or Problem Description
The clinician reports the implant was inserted (b)(6) 2018 in fdi 46.On (b)(6) 2025, loss of osseointegration was verified.Patient presented with fair oral hygiene.The device was forwarded to the manufacturer.At the event the patient experienced: peri-implantitis, pain, mobility and bleeding.No further patient complications were reported.
Additional Manufacturer Narrative
The batch number could not be verified due to incomplete or missing information and / or product from the customer.Our manufacturing q-system assures that production and process controls are in place to ensure that batches confirm to the applicable specifications before they're distributed.The loss of an endosseous dental implant after successful osseointegration and restoration is a known inherent risk of the procedure.Implants may have to be removed in case one or more of the implant success criteria are not met.Implant success criteria according to buser et al.(1991) are: 1.Absence of persistent subjective complaints such as pain, foreign body sensation and /or dysesthesia 2.Absence of a recurrent peri-implant infection with suppuration 3.Absence of implant mobility 4.Absence of a continuous radiolucency around the implant.The manufacturer's trend analysis confirms that the reported failure rate associated with its dental implants is below the expected failure rate for this treatment as published in the scientific literature.Non-fatal serious injury or device malfunction stored due to covid 19 pandemic in accordance with fda guidance "postmarketing adverse event reporting for medical products and dietary supplements during a pandemic" published may 2020.

• Brand Name: CM DRIVE IMPL TI 5.0X11.5
• Common Device Name: ENDOSSEOUS DENTAL IMPLANT
• Manufacturer (Section D): JJGC S.A.; av. juscelino kubitschek de; oliveira, 3291 cic; curitiba PR 81270 -200; BR 81270-200
• Manufacturer (Section G): JJGC S.A.; av. juscelino kubitschek de; oliveira, 3291 cic; curitiba PR 81270 -200; BR 81270-200
• Manufacturer Contact: jennifer jackson ; 60 minuteman road; andover, MA 01810 ; 9787472509
• MDR Report Key: 22405104
• Report Number: 3008261720-2025-002285
• Device Sequence Number: 8408160
• Product Code: DZE
• UDI-Device Identifier: 07898237569291
• UDI-Public: 07898237569291
• Combination Product (Y/N): N
• Initial Reporter Country: AN
• PMA/510(K) Number: K123022
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2018
• Device Explanted Year: 2025
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional
• Initial Reporter Occupation: Dentist
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 12/29/2025

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 Catalogue Number: 109.691
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Distributor Facility Aware Date: 12/29/2025
• Event Location: Other
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: Not provided
• Supplement Date Received by Manufacturer: Not provided; Not provided
• Initial Report FDA Received Date: 07/04/2025
• Supplement Report FDA Received Date: 08/07/2025; 12/29/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• 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: 54 YR
• Patient Sex: Male