ResMed LT-008 Narval CC Oral Appliance User Guide

ResMed LT-008 Narval CC Oral Appliance

For more information about the Narval CC appliance ordering, please refer to the Narval CC Order Guide.

• The Narval CC appliance is designed according to patients’ dental impressions and the technical information provided in the order forms. Thus, it is essential to provide good quality impressions and accurately fill in the order form.
• If the appliance cannot be correctly made using the data provided, your approved Dental Lab will contact you for additional information (new impressions and/or additional details).
• Your order cannot be processed if you only send scans without the associated order form.

How do I order Narval CC?

Prerequisites

1. Contact your ResMed certified Dental Lab
   Before you start with your first Narval CC order with digital impressions, please contact your ResMed certified Dental Lab.

2. Check your equipment
   Please make sure you are equipped with:

   • A TRIOS (any version) intraoral scanner, with the latest version of the software
   • 3shape Communicate account
   • An internet connection.
   • A CEREC Omnicam intraoral scanner, with the CEREC Ortho software version 1.1 or above
   • A Sirona Connect account

Digital Impressions

IMPORTANT
Do not use any of the intraoral scanner software functions to send notes or comments to your ResMed certified Dental Lab about your scans or about your order. ResMed certified Dental Lab will only retrieve the digital imprints and the patient identification from the scan communication platform (3shape Communicate, Sirona Connect). Please note all relevant comments and information on the Narval CC order form.

Connecting to Your ResMed Certified Dental Lab

Via 3shape Communicate
Log in to your 3shape Communicate account to add your Dental Lab as a new laboratory. Please contact your lab to confirm the email address they have registered in 3Shape Communicate.
Once the Dental Lab approves the request for connection, it becomes active and you can send scans.

Via CEREC Ortho Software
From your CEREC Ortho software, log in to your Sirona Connect account. Click on “Add laboratory”. Search for your ResMed certified Dental Lab. You can either add this laboratory account to your list of favorites, or repeat the above search steps every time you want to send us a case.

Scanner Configuration

TRIOS Scanner

Make sure that your scanner is configured as follows: post-processing: “Normal” or “Detailed” (but not “Fast”). You should also choose a contrasting “hole close color” that emphasises the areas that have not been scanned (holes in the data).
The “Bite alignment mode” can be configured “live” or “automatic”, or even “manual”. If needed, alignment can always be manually corrected. For details, please refer to your scanner manufacturer user documentation.

CEREC Omnicam Scanner

There are no specific configuration requirements to scan for Narval CC (the bite alignment is always automatic).

Patient/Order Creation

Proceed as usual, according to the information provided by the scanner manufacturer. Always enter the patient family and first name in the exact same way as you will type them on the corresponding order form.

Scanning

1. Getting Started
   Make sure that your intraoral scanner is calibrated, that the mirror/glass in the tip is clean, and that the tip is preheated to avoid condensation. Otherwise, the digital impression quality may degrade and the Narval CC appliance designed from it may not have an optimal fit.

2. General Scanning Instructions
   Proceed according to the intraoral scanner manufacturer’s recommandations to scan both full arches and the bite. Unless otherwise advised, you should:

   • dry excess saliva as its reflecting effect may degrade the scan quality;
   • avoid direct light into the scanning area;
   • avoid scanning soft tissues (tongue, lips) or foreign bodies (finger, etc.);
   • it is not necessary to scan the palate.

• Start scanning each arch on the occlusal surface of a molar, as it is larger and has more distinctive features.
• When doing the pass on the incisors scan the lingual and labial side alternately a few times as you scan from canine to canine.

Let the software guide you through the protocol for scanning both arches.
Make sure that:

• the scan boundary extends far enough from the gingival margin (see next section).
• the holes and areas insufficiently recorded during the first swipe (highlighted in yellow) are later completely scanned.

For more details, refer to the information provided by the manufacturer/reseller of your equipement.

Specific Scanning Instructions for Narval CC

For each arch, you should scan 1 cm beyond the gingival margins, including distal to the last molars (or a minimum of 5 mm of soft tissue distal to the last molar – as these areas can be difficult to scan).
All teeth must be scanned (including wisdom teeth, if present).

It is necessary to scan at least:
For the upper arch:

• 50% of the last present molars;
• If all molars are missing, 100% of the second premolars AND 15mm of soft tissue extension after distal.

For the lower arch:

• 100% of the second molars AND 5mm of soft tissue extension distal to them;
• If second molars are missing, 100% of first molars AND 15mm of soft tissue extension after distal.

Make sure the gingival margin, undercuts, incisal edges and occlusal surfaces are correctly scanned and well defined (see arrows pointing these key area on the pictures below).
The last molar can, in certain circumstances, be a critical retention point in cases with low retention. It is always useful to scan up to its distal face on every case where the patient’s anatomy and the scanning hardware allow.
If the last molar is impossible to access/scan then:

• you cannot request an appliance with full teeth coverage of the molar;
• in case of technical necessity (to improve retention for instance), ResMed may ask you to provide more complete impressions, possibly traditional ones.

Once an arch is scanned, the software automatically suggests a scan boundary. Before you validate this boundary, please check it preserves the information defined above. If not, please redefine the boundary farther from the gingival margin.

Example of Correct Scans

Scan of the Bite Registration

In order to register the occlusion of your patient with the intraoral scanner, you can choose to scan the bite in 2 possible positions:

• Option 1: in centric/natural occlusion, providing us with additional measurements;
• Option 2: in desired protrusion.

For full arch applications, 3shape recommends registering bites with two scans, one on each side. The software allows to do it with only one scan; if you choose to do so, please make sure that the result is correct and that there is no misalignement.
The two scans are mandatory as the software will not allow you to move forward until the second scan is recorded.

• Option 1: Scan in centric occlusion and measurement
  Please scan both sides, around the molars and premolars. Two bite registration scans are required (one on each side).
  Each scan should include 4 to 6 teeth: 2 to 3 teeth of the upper arch and 2 to 3 of the lower arch. In addition to the scan of the centric occlusion, you will have to provide ResMed measurements of the maximal protrusion and the latero deviation in protrusion.
  These measurements must be completed in the order form (see chapter “Complete the order form”).

• Option 2: Scan in desired protrusion
  The operation is similar to what is described in option 1. Two bite registrations are required, one on each side, around the molars and premolars.
  Whatever the method and the material you use to record the bite registration in protrusion, it is essential that the patient’s jaw remains stable when scanning. The material used for the bite registration will not prevent the scanner from recording correctly the occlusion, as long as it does not cover so much of the teeth that the scanner cannot see enough of them. The scanner software will automatically take away the material from the final 3D scan.
  Scan of the bite registration
  Automatic removal of bite material

Whatever the method you use it is important to verify the scan quality to make sure the jaw has not moved during / between scans, for instance when the tip of the scanner is introduced in the mouth.

Scan Verification

For your first three patients, you can benefit from a live diagnosis of your scans, ensuring that you have completed the process successfully, while the patient is still in the chair. To benefit from this service, please contact your ResMed approuved dental lab.

Please carefully verify the scans before sending them to the Dental Lab and make sure there is no missing data or defects/artifacts.
While checking your scans, please pay particular attention to the following:

• Make sure the scan area extends 1 cm beyond the gingival margin in all directions (minimum is 5 mm).
• Check the definition and absence of holes in:
  • gingival margin,
  • occlusal surfaces,
  • intra dental spaces.
• Check to ensure there is no surface deformation that may be caused, by an excess of saliva or by presence of highly reflecting materials.
• Also make sure no soft tissue (lip, cheek) or foreign body (bite material) has been scanned.
• Verify the relative positions of the jaws whether they have been scanned in centric occlusion or in protrusion.
• Check the relevancy of the occlusion.

You can use the scanner software tool to visualise the clearance between occlusal faces. This will allow to identify if the bite that you have registered is correct.
Some defects, especially alignment, are more visible when the jaws are displayed in an open position. If needed please correct the scan or scan the patient again.

Please apply the post-processing and check the result before sending (menu “Tools” in the “Analyze” tab). Otherwise, the post-processing will be automatically applied during the sending process but you will not be able to verify the result. This means we may get an impression that is not suitable.

Once you have verified the scans, adjust the orientation and location. You can then skip the later steps of analysis and design. Especially, do not add a model base.
Example of a good scan to order a Narval CC:

Examples of unacceptable scans to order a Narval CC:

• Incomplete scans
  Missing information on sector 4 : the gengiva scan is too short, making it impossible for ResMed to position the triangle during the CAD phase.
  
  Insuficient scan in the posterior section.

• Surface flaws
  Surface flaw on the incisor; scan again.

• Incorrect scans linked to occlusion
  No contact in sector 2 and 3, occlusion should be scanned again.
  At first glance the scan looks good but a careful inspection shows the intersection as emphasised in the “pseudo color” image on the right.

Scan Sending

Send your case to your Dental lab.
Export the case to Sirona Connect, choose your Dental lab as the recipient, add the case to your cart and submit the cart.

Please take note of the order ID (automatically generated by the software – format 12345_123456789012 for 3shape, 1234567 for Dentsply Sirona). This number will have to be noted on the Narval CC order form.

Complete the Order Form

After sending your scan to your ResMed certified Dental Lab, you will have to complete Narval CC order form to finalize your order.

IMPORTANT

• Always enter the patient family and first name in the exact same way as you entered it in the scanner order creation.
• In the header of the order form, please indicate “IOS”, the scanner brand (3shape or Sirona) and the scan ID that was generated when you sent the scan.

Support

• For more information or customer support, please contact your ResMed certified Dental Lab Partner at Xxxxxxx@xxxxx.xxx – Contact DLP
• For support with your 3shape TRIOS scanner or the 3shape Communicate system, please contact your 3shape reseller/contact.
• For support with your Dentsply Sirona Omnicam scanner and its software, or the Connect system, please contact your Dentsply Dentsply Sirona reseller/contact.

ResMed SAS
Parc Technologique de Lyon
292 allée Jacques Monod
69791 Saint-Priest Cedex France
ResMed.com/Narval

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