MAUDE Adverse Event Report: DENTSPLY IMPLANTS MANUFACTURING GMBH PRIMETAPER EV Ø3.0 X 11MM; IMPLANT, ENDOSSEOUS, ROOT-FORM

Catalog Number	68011087
Medical Device Problem Code	Failure to Osseointegrate (1863)
Health Effect - Clinical Code	Failure of Implant (1924)
Date of Event	02/05/2026
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Therefore, because a serious injury resulted, this event is reportable per 21 cfr part 803.The device was not evaluated because the issue is a known inherent risk of the device.We will continue to track and monitor the trend.
Event or Problem Description
Customer reported implant loss.(b)(6).Failure to integrate.Pt returned for 3 weeks follow-up reported implant felt loose.He explained he wears a retainer at night that orthodontist said must be worn to prevent relapse of palatal expansion.Pt.Reported that first few nichts after implant, retainer wouldn't fully seat.Pt then "forced" it in after a few nights and felt that it was putting a lot of pressure on the implant temp crown.

• Brand Name: PRIMETAPER EV Ø3.0 X 11MM
• Common Device Name: IMPLANT, ENDOSSEOUS, ROOT-FORM
• Manufacturer (Section D): DENTSPLY IMPLANTS MANUFACTURING GMBH; rodenbacher chaussee 4; hanau hessen 63457 ; GM 63457
• Manufacturer (Section G): DENTSPLY IMPLANTS MANUFACTURING GMBH; rodenbacher chaussee 4; hanau hessen 63457 ; GM 63457
• Manufacturer Contact: dan eagar ; 221 west philadelphia st.; york, PA 17401 ; 7178457511
• MDR Report Key: 24601424
• Report Number: 3013111692-2026-08257
• Device Sequence Number: 20974509
• Product Code: DZE
• UDI-Device Identifier: 07392532270086
• UDI-Public: 07392532270086
• Combination Product (Y/N): N
• Initial Reporter State: ND
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2025
• Device Explanted Year: 2026
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Dentist
• Type of Report: Initial
• Report Date (Section B): 03/14/2026

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
• Operator of Device: Health Professional
• Device Catalogue Number: 68011087
• Device Lot Number: 530149
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 03/04/2026
• Is the Reporter a Health Professional?: Yes
• Distributor Facility Aware Date: 03/04/2026
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 03/04/2026
• Initial Report FDA Received Date: 03/14/2026
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• 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
• Concomitant Medical Products and Therapy/Usage Dates: DS TEMP CROWN ABUTMENT
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Unknown