MAUDE Adverse Event Report: DENTSPLY LLC AUTOMATRIX SHAFT; INSTRUMENTS, DENTAL HAND

Catalog Number	62422603
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Event or Problem Description
In this event it is reported that a automatrix shaft broke during use.All the broken parts were retrieved from the patient's mouth.No injury.
Additional Manufacturer Narrative
While no serious injury resulted in this event, if this malfunction recurred, it could cause or contribute to a serious injury or require medical or surgical intervention to preclude such.This event, therefore, is reportable per 21 cfr part 803.Investigation results dhr 4-2-2026: dhr for item# 62422603 lot# 10850430 has been pulled, reviewed, and attached to this case.Dhr review did not indicate any issues during the execution of the packaging work order for automatrix accessories extra shaft assembly with all inspections completed and deemed acceptable by the operator(s) and quality.Item# 24703, lot# 10673000 is the production work order for the flexshaft in which the customer has complained against (date code 0725).Dhr for item# 24703 lot# 10673000 has also been pulled, reviewed, and attached to this case.Dhr review did not indicate any issues during the assembly work order for the flexible shaft assembly, with all inspections performed and deemed acceptable by the operator(s) and quality as per 0290-wi-7.5-42-04 & 0290-ip-7.5-42-06.Per the wi, weld testing for the 1st 10 subassemblies of every order and every 25th subassembly is conducted and documented.Assemblies are then to bake at 180*f for 30 minutes minimum and documented.Functional test for set screw crimping conducted on the 1st assembly and every 50th assembly in the order and documented.12 in-ounce torque test is performed on 100% of the flexshafts and documented.Torque to fail test is performed every 125th flexshaft assembly and the final assembly in the order for minimum requirement of 1.25 inch-pounds and documented.(b)(4).Retain 4-2-2026: retain for item# 24703 lot# 10673000 has been pulled, inspected per 0290-wi-7.5-42-04 (with exception to destructive testing).The flexshafts were tested by using standard testing protocol.The tests included a functional test, which is to use an automate iii tool and the retain flexshaft to tighten a matrix band (n=5) around a tooth model, and a visual inspection for abnormalities.Retain meets all criteria for form/fit/function of the intended use for the device.(b)(4).

• Brand Name: AUTOMATRIX SHAFT
• Common Device Name: INSTRUMENTS, DENTAL HAND
• Manufacturer (Section D): DENTSPLY LLC; 38 west clarke avenue; milford DE 19963
• Manufacturer (Section G): DENTSPLY LLC; 38 west clarke avenue; milford DE 19963
• Manufacturer Contact: dan eagar ; 221 west philadelphia st.; york, PA 17401 ; 7178457511
• MDR Report Key: 24857665
• Report Number: 2515379-2026-00025
• Device Sequence Number: 13103255
• Product Code: DZN
• UDI-Device Identifier: D0026630161
• UDI-Public: D0026630161
• Combination Product (Y/N): N
• Initial Reporter Country: AU
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 04/13/2026

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Catalogue Number: 62422603
• Device Lot Number: 10850430
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 04/01/2026
• Distributor Facility Aware Date: 03/30/2026
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 03/30/2026
• Initial Report FDA Received Date: 04/13/2026
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Usage of Device: A
• Patient Sequence Number: 1
• Patient Sex: Unknown