MAUDE Adverse Event Report: Implant Direct Sybron Manufact Legacy4 SBM 3.7mmDX10mmL 3.5mmD Plat; Endosseous Dental Implant

Catalog Number	873710
Medical Device Problem Code	Failure to Osseointegrate (1863)
Health Effect - Clinical Codes	Inadequate Osseointegration (2646); Osteopenia/ Osteoporosis (2651); Appropriate Clinical Signs, Symptoms and Conditions Term/Code Not Available (4581)
Date of Event	07/29/2026
Type of Reportable Event	Serious Injury
Event or Problem Description
Failure to osseointegrate.
Additional Manufacturer Narrative
It was repored the customer had delayed healing.

• Brand Name: Legacy4 SBM 3.7mmDX10mmL 3.5mmD Plat
• Common Device Name: Endosseous Dental Implant
• Manufacturer (Section D): Implant Direct Sybron Manufact; 3050 east hillcrest drive; thousand oaks CA 91362
• Manufacturer (Section G): Implant Direct Sybron Manufact; 3050 east hillcrest drive; thousand oaks CA 91362
• Manufacturer Contact: anitha mechery ; 3050 east hillcrest drive; thousand oaks 91362 ; +1(805)778-5975
• MDR Report Key: 50419926
• Report Number: 3001617766-2026-008046
• Device Sequence Number: 21448172
• Product Code: DZE
• UDI-Device Identifier: 10841307102854
• UDI-Public: (01)10841307102854(10)15018278(17)290614
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K192221
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2026
• Device Explanted Year: 2026
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Other Health Care Professional
• Remedial Action: Replace
• Type of Report: Initial
• Report Date (Section B): 08/24/2026

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: 873710
• Device Lot Number: 15018278
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 08/24/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 06/10/2024
• 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: 75 YR
• Patient Sex: Female