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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: NEODENT - JJGC S.A. TITAMAX IMPLANT WITH MOUNT 3.3X11; ENDOSSEOUS DENTAL IMPLANT
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NEODENT - JJGC S.A. TITAMAX IMPLANT WITH MOUNT 3.3X11; ENDOSSEOUS DENTAL IMPLANT Back to Search Results
Catalog Number 109141
Medical Device Problem Code Loss of Osseointegration (2408)
Health Effect - Clinical Codes Unspecified Infection (1930); Pain (1994); Tissue Damage (2104)
Date of Event 10/05/2015
Type of Reportable Event Serious Injury
Additional Manufacturer Narrative
Exemption number: e2015015.Instradent usa, inc is submitting the report on behalf of neodent - jjgc.
 
Event or Problem Description
Rp.000222 - the dentist reported that 6 years after two dental implants were installed in intraoral regions #19 and #18, it was verified their loss of osseointegration.Patient presented bone type iii.
 
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Brand Name
TITAMAX IMPLANT WITH MOUNT 3.3X11
Common Device Name
ENDOSSEOUS DENTAL IMPLANT
Manufacturer (Section D)
NEODENT - JJGC S.A.
av. juscelino kubitschek de
oliveira, 3291 cic
curitiba PR 81270 -200
BR  81270-200
MDR Report Key7013009
Report Number3008261720-2017-00691
Device Sequence Number13697561
Product Code DZE
UDI-Device Identifier07898237566665
UDI-Public07898237566665
Combination Product (Y/N)N
Initial Reporter CountryBR
PMA/510(K) Number
K101207
Number of Events Summarized1
Summary Report (Y/N)N
Device Implanted Year2009
Device Explanted Year2015
Reporter Type Manufacturer
Report Source distributor,foreign,health pr
Initial Reporter Occupation Dentist
Type of Report Initial
Report Date (Section B) 10/19/2015
Report Date (Section F) 10/19/2015
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 Dentist
Device Catalogue Number109141
Other Device ID Number07898237566665
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer10/19/2015
Was the Report Sent to FDA? No
Distributor Facility Aware Date11/09/2017
Event Location Other
Date Report to Manufacturer10/19/2015
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 10/19/2015
Initial Report FDA Received Date11/09/2017
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)		 No
Patient Sequence Number1
Outcome Attributed to Adverse Event Required Intervention;
Patient Age60 YR
Patient Weight65
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