MAUDE Adverse Event Report: Institut Straumann AG BLC, ? 5.0mm WB, SLActive 8mm, RXD; Endosseous Dental Implant

Catalog Number	035.9508S
Medical Device Problem Code	Failure to Osseointegrate (1863)
Health Effect - Clinical Code	Unspecified Infection (1930)
Date of Event	04/16/2026
Type of Reportable Event	Serious Injury
Event or Problem Description
The clinician reports the implant was inserted (b)(6) 2026 in ada 3.On (b)(6) 2026, non-osseointegration was verified.The device was forwarded to the manufacturer.At the event the patient experienced: infection and peri-implantitis.No further patient complications were reported.

• Brand Name: BLC, ? 5.0mm WB, SLActive 8mm, RXD
• Common Device Name: Endosseous Dental Implant
• Manufacturer (Section D): Institut Straumann AG; peter merian-weg 12; basel 04002 ; SZ 04002
• MDR Report Key: 50480303
• Report Number: 0001222315-2026-002604
• Device Sequence Number: 18700696
• Product Code: DZE
• UDI-Device Identifier: 07630031780140
• UDI-Public: 07630031780140
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• Summary Report (Y/N): N
• Device Implanted Year: 2026
• Device Explanted Year: 2026
• Serviced by Third Party (Y/N): N
• Reporter Type: Importer
• Initial Reporter Occupation: Dentist
• Type of Report: Initial
• Report Date (Section B): 08/27/2026
• Report Date (Section F): 08/27/2026

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: 035.9508S
• Device Lot Number: WRRY8
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 08/03/2026
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Distributor Facility Aware Date: 08/27/2026
• Device Age: 2 MO
• Event Location: Other
• Date Report to Manufacturer: 08/03/2026
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 08/27/2026
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• 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: 43 YR
• Patient Sex: Male