MAUDE Adverse Event Report: KEYSTONE DENTAL, INC. PRIMA; SD 3.5X13 PRIMACONNEX TAPER IMP TC

Model Number	15615K
Medical Device Problem Code	Failure to Osseointegrate (1863)
Health Effect - Clinical Code	Inadequate Osseointegration (2646)
Date of Event	09/03/2024
Type of Reportable Event	Serious Injury
Event or Problem Description
Failed to osseointegrate.
Additional Manufacturer Narrative
Keystone dental inc.Provides labeling with all implants.Failure to osseointegrate and loss of osseointegration (implant mobility) is identified as an adverse reaction and identified in the list of warnings in all endosseous dental implant labeling.The specific cause for a particular complaint is often not readily identified as there are various factors that contribute to the risk of implant failure.These include patient factors such as prior oral infection, poor bone quality or quantity, systemic conditions such as diabetes and uncontrolled hypertension.Technique factors such as overheating of the implant site may cause necrosis of the bone, preventing growth (pelayo et al., 2008; turkyilmaz & al., 2008).Patient habits such as tobacco use (heitz-mayfield & huynh-ba, 2009), alcohol or drug abuse, poor oral hygiene, and bruxism (salvi & braegger, 2009) may also lead to implant failure.In addition, improper surgical technique can lead to implant failure and/or loss of supporting bone (salvi & braegger, 2009).

• Brand Name: PRIMA
• Common Device Name: SD 3.5X13 PRIMACONNEX TAPER IMP TC
• Manufacturer (Section D): KEYSTONE DENTAL, INC.; 13645 alton pkwy ste a; irvine CA 92618
• Manufacturer (Section G): KEYSTONE DENTAL, INC.; 13645 alton pkwy ste a; irvine CA 92618
• Manufacturer Contact: kathleen labrie ; 13645 alton pkwy ste a; irvine, CA 92618 ; 9784308257
• MDR Report Key: 22814206
• Report Number: 3005990499-2025-71650
• Device Sequence Number: 17577335
• Product Code: DZE
• UDI-Device Identifier: D76815615K0
• UDI-Public: +D76815615K0/$$3270720WO022468T
• Combination Product (Y/N): N
• Initial Reporter Country: PL
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2024
• Device Explanted Year: 2024
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Distributor
• Initial Reporter Occupation: Dentist
• Remedial Action: Replace
• Type of Report: Initial
• Report Date (Section B): 08/14/2025

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 Model Number: 15615K
• Device Catalogue Number: 15615K
• Device Lot Number: WO-022468
• 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: 08/13/2025
• Initial Report FDA Received Date: 08/15/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 05/29/2022
• 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 Sex: Male