MAUDE Adverse Event Report: MIS Implants Technologies Ltd. C1 XD coni. con. implant D3.30 L11.50mm , NP; implant, endosseous, root-form

Catalog Number	C1-D11330
Medical Device Problem Code	Failure to Osseointegrate (1863)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	07/27/2026
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that a patient experienced a dental implant loss.No patient injury was reported.
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 D3.30 L11.50mm , NP
• Common Device Name: implant, endosseous, root-form
• Manufacturer (Section D): MIS Implants Technologies Ltd.; fabrikstrasse 31; bensheim ; GM
• Manufacturer (Section G): Dentsply Implants Manufacturing GmbH; fabrikstrasse 31; bensheim ; GM
• Manufacturer Contact: dan eagar ; 221 w. philadelphia st.; suite 60 w; york, PA 17401 ; +1(717)845-7511
• MDR Report Key: 50948595
• Report Number: 3013111692-2026-42939
• Device Sequence Number: 10452070
• Product Code: DZE
• UDI-Device Identifier: 07290113996137
• UDI-Public: 07290113996137
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K053384
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2026
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional,Distributor
• Initial Reporter Occupation: Dentist
• Type of Report: Initial
• Report Date (Section B): 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?: Yes
• Operator of Device: Health Professional
• Device Catalogue Number: C1-D11330
• Device Lot Number: W21027472
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 09/01/2026
• Initial Report FDA Received Date: 09/30/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• 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: Unknown
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other; Required Intervention
• Patient Sex: Unknown