MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2017-02-24 for LAVA ULTIMATE CAD/CAM RESTORATIVE FOR CEREC 2914A2-LT manufactured by 3m Espe Dental Products.
[68350102]
Based on the available information, it is not known what role, if any, the lava ultimate restorative material played in this reported outcome. Other factors, such as prior tooth history and dental treatments, may have played a role in the need for root canal treatment.
Patient Sequence No: 1, Text Type: N, H10
[68350103]
On (b)(6) 2017, a dentist reported the case of a (b)(6) male patient who required root canal therapy on tooth #19. This tooth received a lava ultimate crown on (b)(6) 2013, to replace an existing crown. On (b)(6) 2016, the lava ultimate crown debonded and decay was noted beneath the crown; at this time, it was recommended that the patient receive a root canal, which was subsequently performed on (b)(6) 2016.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3005174370-2017-00011 |
| MDR Report Key | 6358299 |
| Report Source | HEALTH PROFESSIONAL |
| Date Received | 2017-02-24 |
| Date of Report | 2017-01-27 |
| Date of Event | 2016-05-02 |
| Date Mfgr Received | 2017-01-27 |
| Date Added to Maude | 2017-02-24 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Reporter Occupation | DENTIST |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | ANGIE DRAPER |
| Manufacturer Street | 2510 CONWAY AVENUE |
| Manufacturer City | ST. PAUL MN 551441000 |
| Manufacturer Country | US |
| Manufacturer Postal | 551441000 |
| Manufacturer Phone | 6517331179 |
| Manufacturer G1 | 3M ESPE DENTAL PRODUCTS-IRVINE |
| Manufacturer Street | 2111 MCGAW AVENUE |
| Manufacturer City | IRVINE CA 92614 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 92614 |
| Single Use | 3 |
| Remedial Action | RC |
| Previous Use Code | 3 |
| Removal Correction Number | Z-2052-2015 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | LAVA ULTIMATE CAD/CAM RESTORATIVE FOR CEREC |
| Generic Name | MATERIAL, TOOTH SHADE RESIN |
| Product Code | EBF |
| Date Received | 2017-02-24 |
| Catalog Number | 2914A2-LT |
| Operator | DENTIST |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | 3M ESPE DENTAL PRODUCTS |
| Manufacturer Address | 2510 CONWAY AVENUE ST. PAUL MN 551441000 US 551441000 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2017-02-24 |