MAUDE Adverse Event Report: ZEST ANCHORS, LLC ABUTMENT, IMPLANT, DENTAL, ENDOSSEOUS

Model Number	30702-04
Medical Device Problem Code	Failure to Osseointegrate (1863)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Serious Injury
Event or Problem Description
"this customer was removing the locator screw / locator abutment on the patient - finally the screw in the locator got stuck.68012429- rtx 4.8x4mm to the implant it was cold welded to the implant."" implant failed.".
Event or Problem Description
"this customer was removing the locator screw / locator abutment on the patient - finally the screw in the locator got stuck 68012429- rtx 4.8x4mm to the implant it was cold welded to the implant."" implant failed.".

• Brand Name: ABUTMENT, IMPLANT, DENTAL, ENDOSSEOUS
• Common Device Name: ABUTMENT, IMPLANT, DENTAL, ENDOSSEOUS
• Manufacturer (Section D): ZEST ANCHORS, LLC; 2875 loker ave east; carlsbad
• Manufacturer (Section G): ZEST ANCHORS, LLC; 2875 loker ave east; carlsbad
• Manufacturer Contact: amie toor ; 2875 loker ave e; carlsbad
• MDR Report Key: 23556879
• Report Number: 2023950-2025-00206
• Device Sequence Number: 21352630
• Product Code: NHA
• UDI-Device Identifier: 00840481110825
• UDI-Public: 00840481110825
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K120198
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Distributor
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 01/27/2026

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 Model Number: 30702-04
• Device Catalogue Number: N/A
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/24/2025
• Supplement Date Received by Manufacturer: 10/24/2025
• Initial Report FDA Received Date: 11/14/2025
• Supplement Report FDA Received Date: 01/27/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• 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: Other
• Patient Sex: Unknown