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User guide
Instructions on Narval CC ordering from digital impressions
Compatible with
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The Narval CC mandibular advancement device can now be ordered with digital impressions obtained from two intraoral scanners.
The aim of this document is to provide step-by-step instructions to dental practitioners who want to use the 3shape TRIOS ® or Dentsply Sirona CEREC Omnicam intraoral scanner to order a Narval CC appliance.
How do I order Narval CC?
For more information about the Narval CC appliance ordering, please refer to the Narval CC
Order Guide.
IMPORTANT
• 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.
Contact your ResMed certified Dental Lab
Delivery of your Narval CC within 10 days
Quality control of
Narval CC
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DLP Logo
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Connect to your ResMed certified Dental Lab via
3shape Communicate ™ or Sirona Connect
Scan upper and lower arches
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3D printing of Narval CC and its biocompatible model
Design of
Narval CC device
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Reception and quality control of your scans at ResMed
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DLP Logo
Verification of the order by the
Dental Lab, and transmission to
ResMed
Name:
Date:
DLP use only / Usage DLP
ASHFORD
FTP order #:
Internal use only / Usage interne
DEP Chèq Poste TNT
Reçu le:
Plâtre PE GG Mordu
N° Série
PATIENT INFORMATION /
Order form for Narval CC™
INFORMATIONS PATIENT
Name / Nom First Name / Prénom
Patient is reimbursed by the social security / OSA indication Remboursé / indication SAOS
ANGLETERRE
Patient is not reimbursed / snoring indication Non remboursé / indication ronflement
Name / Nom
PROTRUSION SETTINGS /
RENEWAL: This patient was fitted with Narval CC
In this case we produce a new MRD based on the data provided on this order form, please make sure that you fully complete it with protrusion settings and design preferences expectations.
BITE REGISTRATION IN DESIRED PROTRUSION
Narval CC is available in 5 designs variation to better meet the specific anatomical constraints of your patients.
but in all cases no retention is taken on anterior teeth.
Each design can be applied independently on the lower
in the past /
Mordu
DESIGN PREFERENCES /
PRÉFÉRENCES DE DESIGN
Without anterior
Ce patient a déjà été équipé d’une Narval CC™
Narval CC initial mandibular protrusion wil be set according to the bite registration recorded
Veuillez réduire au maximum la dimension verticale fournie par le mordu
We will reduce it to a minimum of 4 mm to allow proper design of the splints
Reproduce the vertical dimension recorded by the bite registration
Veuillez reproduire la dimension verticale fournie par le mordu
A minimum of 4 mm will be needed to allow proper design of the splints
With
First Name /
OR
Prénom
MEASUREMENTS IN MAXIMUM PROTRUSION
Distance from incisor 11 to 41:
Distance entre les incisives maxillaires et mandibulaires in maximum protrusion
Déviation des milieux inter-incisifs
Mordu en occlusion d’intercuspidie maximale en cas d’occlusion particulière
In case of renewal:
Upper /
Lower /
Upper /
Lower /
Haut
Bas
Haut
Mesures
Narval CC Initial mandibular protrusion will be set at approx. 60% of maximum protrusion mm
Left patient
Gauche
you can choose a specific Narval CC protrusion setting: %
En cas de renouvellement, propulsion à réaliser en %
DENTAL PARTICULARITIES TO BE TAKEN INTO ACCOUNT / PARTICULARITÉS DENTAIRES À NOUS SIGNALER
Teeth to protect:
Dents à protéger
Restauration dentaire (implant/couronne) prévue sur dents N°
Broken teeth:
Dents cassées mm Right patient
Droite
Complete lower implant retained over-denture
Prothèse totale inférieure sur implant
(overdenture) / Prothèse totale supérieure
Presence of removable partial denture(s) of maximum protrusion and on the upper splint.
Without any design specification, ResMed will select a different design.
Upper /
Lower /
Haut
Bas
Upper /
Lower /
Upper /
Lower /
Haut
Bas
Haut
Upper /
Lower /
Upper /
Lower /
Haut
Bas
Haut
Upper /
Lower /
Haut
Bas
Not available Not available
Please cover all the molars (by default splints cover at least teeth #6 on the upper and #7 on the lower - extended coverage can be applied in case of low retention) / Je souhaite inclure toutes les molaires
Please inform me if my design preferences cannot be fulfilled / Je souhaite être informé si mes préférences ne peuvent être respectées
Please add slots for elastic bands / Je souhaite des encoches pour élastiques
DENTIST SIGNATURE & DELIVERY TIME: 15 WORKING DAYS FROM RECEPTION OF YOUR ORDER BY RESMED SAS
Dentist Name:
Nom du dentiste
Date / /
Stamp
Signature
Pays
Email:
Tel:
TO ENSURE YOUR ORDER IS PROCESSED, PLEASE PROVIDE ALL INFORMATION REQUESTED AND FOLLOW THE ORDERING INSTRUCTIONS
LF-R2-18 ENG-ENG-ASHFORD V11 2017-11
Send your completed order form to your
Dental Lab
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Scan the bite registration
Verify your scan before sending
Send your scan to your ResMed certified Dental
Lab via 3shape
Communicate™ or Sirona Connect
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Content
Prerequisites
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Digital impressions
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Connecting to your ResMed certified Dental Lab
Scanner configuration
Patient/order creation
Scanning
1. Getting started
2. General scanning instructions
3. Specific scanning instructions for Narval CC
4. Scan of the bite registration
Scan verification
Scan sending
Complete the order form
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Support
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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 CEREC Omnicam 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.
There are no specific configuration requirements to scan for Narval CC (the bite alignment is always automatic).
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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.
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). during the first swipe (highlighted in yellow) are later completely scanned.
3. 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 :
For more details, refer to the information provided by the manufacturer/reseller of your equipement.
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4. 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 measurements
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 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. 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:
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.
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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.
• Surface flaws
Insuficient scan in the posterior section.
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.
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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 (see previous page).
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Support
DLP Logo
For more information or customer support, please contact your ResMed certified
Dental Lab Partner at [email protected] - 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
Narval CC is a trademark of ResMed SAS. TRIOS and 3shape Communicate are registered trademarks of 3shape A/S.
See www.resmed.com for other ResMed locations worldwide.
© 2020 ResMed Ltd. LT-008/2 2020-09
