MAUDE Adverse Event Report: MIS Implants Technologies Ltd. C1 XD coni. con. implant D5 L10mm , WP; Implant, Endosseous, Root-Form

Catalog Number	C1-D10500
Medical Device Problem Code	Failure to Osseointegrate (1863)
Health Effect - Clinical Code	Failure of Implant (1924)
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that a patient experienced loss of a dental implant.The implant did not progress to the restorative rehabilitation stage, as it was lost 23 days after placement.Guided surgery was completed without complications.Primary stability was achieved with an insertion torque of 40 ncm, and a healing abutment was placed.
Additional Manufacturer Narrative
Since this event resulted in a serious injury, it 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.

• Brand Name: C1 XD coni. con. implant D5 L10mm , WP
• Common Device Name: Implant, Endosseous, Root-Form
• Manufacturer (Section D): MIS Implants Technologies Ltd.; p.o. box 7; bar lev industrial park 20156 00; IS 2015600
• Manufacturer (Section G): MIS Implants Technologies Ltd.; p.o. box 7; bar lev industrial park 20156 00; IS 2015600
• Manufacturer Contact: dan eagar ; 221 west philadelphia st.; york, PA 17401 ; +1(717)845-7511
• MDR Report Key: 50035972
• Report Number: 3004203816-2026-18514
• Device Sequence Number: 9908171
• Product Code: DZE
• UDI-Device Identifier: 07290113996120
• UDI-Public: 07290113996120
• Combination Product (Y/N): N
• Initial Reporter Country: EC
• PMA/510(K) Number: K112162
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional
• Initial Reporter Occupation: Dentist
• Type of Report: Initial
• Report Date (Section B): 07/27/2026

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
• Operator of Device: Health Professional
• Device Catalogue Number: C1-D10500
• Device Lot Number: W25015151
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Initial Date Received by Manufacturer: 07/06/2026
• Initial Report FDA Received Date: 07/27/2026
• 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: 55 YR
• Patient Sex: Male