MAUDE Adverse Event Report: Institut Straumann AG BLC ?3.75mm RB, SLActive? 6mm RXD; Endosseous Dental Implant

Catalog Number	035.9206S
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	08/20/2026
Type of Reportable Event	Serious Injury
Event or Problem Description
The clinician reports that the day the implant was placed in ada 4, failure occurred upon insertion.Details of surgery: primary stability not achieved and ridge augmentation.Patient presented with bone type iii and inadequate bone quality/quantity.The device was forwarded to the manufacturer.There were no reported patient injuries or complications.

• Brand Name: BLC ?3.75mm RB, SLActive? 6mm RXD
• Common Device Name: Endosseous Dental Implant
• Manufacturer (Section D): Institut Straumann AG; peter merian-weg 12; basel 04002 ; SZ 04002
• MDR Report Key: 50918349
• Report Number: 0001222315-2026-002976
• Device Sequence Number: 17491270
• Product Code: DZE
• UDI-Device Identifier: 07630031764270
• UDI-Public: 07630031764270
• Combination Product (Y/N): N
• Initial Reporter State: VA
• 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): 09/28/2026
• Report Date (Section F): 09/28/2026

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: 035.9206S
• Device Lot Number: YCYH9
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 09/02/2026
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Distributor Facility Aware Date: 09/28/2026
• Device Age: 5 MO
• Event Location: Other
• Date Report to Manufacturer: 09/02/2026
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 09/28/2026
• 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: 72 YR
• Patient Sex: Male