IOS Instructions How to create and submit the best scans to SomnoMed Canada for the creation of a custom SomnoDent Sleep Apnea Appliance Its a simple process: STEP 1 Connect your Scanner to SomnoMed Canada STEP 2 SOMGauge Protrusive Bite Recording - Manual STEP 3 Scanning Impressions - Lower and Upper STEP 4 Scanning the Protrusive Bite Registration STEP 5 Send your 2 scans and your order form to SomnoMed Canada SOMNODENT FUSION SomnoMed IOS User Guide 903398RevA Copyright 2018 SomnoMed Inc. 1
STEP 1 Connect Your Scanner to SomnoMed Canada Establishing communication with SomnoMed Canada IOS will depend on which scanning device you have. There are 2 methods to establish communication: 1. Create a direct link to SomnoMed Canada Lab. For 3M True Definition, Itero, 3 Shape, and Carestream scanners, you can connect directly to SomnoMed Canada for immediate upload of scans. Use the search mode on your scanning device or call your provider to search for SomnoMed Canada lab in Leamington, Ontario. It may be under our email: eorderscanada@somnomed.com or it may be listed as SomnoMed Canada. Connect directly to SomnoMed Canada Lab to send scans directly to our lab. 2. Send your STL file to our SomnoMed Canada email. For CEREC and all other scanning devices not listed above, please save your scans in an STL format and zip them for easy email transfer. Email your STL zipped file to kprevett@somnomed.com and to eorderscanada@somnomed.com. These emails are checked daily for new file arrivals. If you have any questions, please do not hesitate to contact SomnoMed Canada at 1 (800) 339-4452 Copyright 2018 SomnoMed Inc. 2
STEP 2 SOMGauge Protrusive Bite Recording - Manual! IMPORTANT TO NOTE! A desirable protrusive bite record is the most important process to ensuring a successful scan and accurate SomnoDent device. An optimum bite record maximizes patient comfort, increases compliance and reduces chair-time. SomnoMed recommends use of the SOMGauge for accurate and repeatable bite registration scanning within the digital workflow. The SOMGauge allows precise measurement of protrusion at the same time as providing stable control of occlusal vertical opening (OVD) during recording. This is particularly useful on a patient with a heavy curve of spee, over-erupted teeth and/or anterior bite opening. As such the SOMGauge has been designed to visually guide clinicians during bite recording to ensure a minimum of 3.0mm of inter-occlusal space is maintained across the arch. This 3.0mm of interocclusal space is the minimum dimension required at the two closest opposing teeth thereby ensuring SomnoMed can manufacture a SomnoDent appliance without needing any adjustment to OVD during manufacturing. If you are not using SOMGauge: Please note that SomnoMed technicians may require 3mm clearance between the narrowest points of contact of the two closest opposing teeth across the occlusal scheme. If you are using another bite registration technique and there is less than 3mm clearance between two closest opposing teeth, SomnoMed may contact you to open the bite. To accommodate the manufacture of the SomnoDent, in some cases, technicians will open bites due to curve of spee. Copyright 2018 SomnoMed Inc. 3
ve bite record SomnoMed has produced an excellent video to demonstrate the SOMGauge on youtube at youtube/t1yn0fvs5ee 3.0mm Ensure fork covers some portion of last tooth. Covering some portion of last tooth ensures adequate (3.0mm) inter-occlusal clearance maintained for SomnoDent fabrication. Complete coverage of last tooth by fork Copyright 2018 SomnoMed Inc. 4
Taking a protrusive bite record Cont'd... Inadequate coverage of last tooth by fork for a distal wrap case. If distal wrap ordered and inadequate coverage of last tooth by fork present the result can be an undesirable opening on virtual articulator leading to posterior premature contacts between splints requiring chairside adjustments. Once bite record is complete trim excessive bite registration material from fork. The fork and material should be trimmed maximally as the role now of the registration is to support the lower jaw whilst occlusion scanning takes place. Trimming excess material facilitates unobstructed direct line of sight from the camera to teeth thereby achieving fast occlusion scanning and reduced reading errors. A Remove the bite fork from the SOMGauge Registration material BEFORE trimming B Separate front part of fork from adjustable ramp. By removing front part of fork the operator may now freely access both left and right hand side of arch for protrusive scanning. Copyright 2018 SomnoMed Inc. 5
Taking a protrusive bite record Cont'd... C Maximally trim all unnecesary bite material using a sharp scalpel. Unnecessary bite material is any material obscuring the buccal surfaces of the patient s clinical crowns. Where possible, expose the clear fork which will assist faster protrusion scanning as camera cannot see the clear material. D Place fork in patient s mouth to check all buccal aspects of teeth are unobscured. Registration material AFTER trimming SomnoMed IOS User Guide 903398RevA Copyright 2018 SomnoMed Inc. 6
Taking a protrusive bite record Cont'd...! TIP! If you cannot see all buccal aspects, your scanner may not be able to automatically capture desired position. If this occurs you may need to perform a manual alignment of occlusion after scanning. Obscured dentition and undesirable. Unobscured dentition and fast automatic scanning Copyright 2018 SomnoMed Inc. 7
STEP 3 Taking the Lower & Upper Impression Scans Lower Arch Scanning Place scanner tip (mirror) facing down in order to scan lower arch. Keep patient s mouth dry (saliva control). Locate scanner tip adjacent to patient s first molar (e.g. tooth 36 or 46). Turn scanner on camera by pressing scanner switch. Once scanning, maintain a steady speed following the scanning strategy below. 1 Scanning start point: Lower 4... and go through buccal/labial side. 3 When most posterior region reached, move across occlusion continuing along lingual side 2 When anterior region reached, wave scanner lingual to labial throughout anterior region. Copyright 2018 SomnoMed Inc. 8
Saliva control is important to achieving an accurate scan. Excess saliva may cause undesirable reflections. The mouth should be dried using air before scanning. It may be necessary to redry themouth throughout scanning. Rescan the area after trimming off and drying teeth. Undesirable saliva reflection visible at 46 and 47. Rescan area to resolve. Copyright 2018 SomnoMed Inc. 9
Upper Arch Scanning Place scanner tip (mirror) facing up. Keep patient s mouth dry (saliva control). Locate scanner tip adjacent to patient s first molar (e.g. tooth 16 or 26). Turn scanner on camera by pressing scanner switch. Once scanning, maintain a steady speed following the scanning strategy below. 1 Scanning start point : Upper 2 Having reached anterior region, wave scanner palatal to labial throughout anterior region. 3 For Edentulous cases, scan all palatal areas. Refer to Appendix D 4 and go through palatal side for upper Copyright 2018 SomnoMed Inc. 10
Inspect your scan to be sure it will be easy to work with! Important note for clinicians using AccuLiner mounting: Your Scan must include incisive papilla and hamular notches in order to digitally mount upper model to HIP plane. Must include incisive papilla and hamular notches Copyright 2018 SomnoMed Inc. 11
STEP 4 Taking the Bite Registration Scans Place the prepared bite record in patient s mouth. Ask patient to gently bite and steadily hold fork between teeth to limit movement whilst scanning. Place scanner tip (mirror) facing down for scanning protrusive bite. Insert scanner tip to patient s upper right buccal posterior region. Follow below recommended scan strategy for occlusion scan. Copyright 2018 SomnoMed Inc. 12
STEP 5 Send Your Scans & Order Form to SomnoMed Canada Its easy to send your scans to SomnoMed Canada 1. Create a direct link to SomnoMed Canada Lab. For 3M True Definition, Itero, 3 Shape, and Carestream scanners, you connect directly to SomnoMed Canada for immediate upload of scans. Be sure to attach your Order Form with your scan 2. Send your STL file to our SomnoMed Canada email. For CEREC and all other scanning devices not listed above, please save your scans in an STL format and zip them for easy email transfer. Email your STL zipped file to kprevett@somnomed.com and to eorderscanada@somnomed.com. These emails are checked daily for new file arrivals. Be sure to also attach your Order Form with your scan to the email addresses or fax to 1 (226) 773-3315 Order Form You have access to our Order Form 3 ways: 1. Download an Electronic SomnoDent Order Form from our website https://somnomed.com/en/orderform/ 2. Call SomnoMed Canada at 1 (800) 339-4452 to have one emailed to you 3. Use a paper based form and scan it for sending as an attachment Copyright 2018 SomnoMed Inc. 13
Tips for Obtaining a Good Scan 1. Dry teeth lightly using compressed air. Be sure to reach the narrow regions between teeth. Consider using a saliva ejector and/or gauze pads 2. Get a good start: start at patient's right 1st molar wait for about 5 scanner 'clicks' before proceeding (helps build a good starting point) complete preparation including preparation line scan neighbouring teeth: occlusion, lingual/palatial side, buccal/labial side 3. Keep scanner head at 0-5mm from teeth. Its ok to touch the teeth occasionally 4. Move scanner slowly and smoothly, listening for a more rapid clicking sound 5. Keep lips, cheeks, and tongue out of scanner view use your finger or a dental mirror to create space between the teeth, lips, and cheeks use a lip and cheek retractor to keep lips and cheeks clear be careful not to scan your own fingers if you get lips, cheeks, or tongue in the scan, make sure to delete, especially where they have contact with the teeth 6. When scanning is complete, inspect the scan by rotating it and focusing on important areas: occlusal surfaces contact points soft tissue near gingival margins 7. Bite Scan: start from upper 2nd molar while centering the 2D image on the occlusion plain, slowly move the scanner tip in a straight mesial direction with equal coverage of the upper and lower teeth scan at least 4 teeth for optimal alignment, which should take no more than 5 seconds 8. To achieve great colours: avoid light from the dentist chair lamp pointing directly in the patient's mouth Copyright 2018 SomnoMed Inc. 14
IOS CHECKLIST FOR SOMNODENT 1 ORDER FORM A Fully completed order form with Patient and Product Details 2 SCAN QUALITY B No large holes (>0.5mm diameter) within scanned file mesh C No unnecessary details (e.g. lips, tongue, cheeks) 3 EXTENSIONS D Coverage of all teeth including some portion of last teeth E Soft tissue to 5.0mm beyond gingival margin for all lingual and palatal surfaces F Soft tissue to 2.0mm beyond gingival margin for all facial surfaces of anteriors and premolars G IMAGE UPPER LOWER IMAGE UPPER LOWER IMAGE UPPER LOWER 2.0mm Teeth and soft tissue extensions required to accommodate coupling mechanism of appliance ordered Copyright 2018 SomnoMed Inc. 15
4 OCCLUSION IMAGE UPPER LOWER H Protrusive registration set at 60-80% of maximum protrusion OR Order form states reason for protrusion 60-80% protrusion I Minimum of 3.0mm clearance between two closest teeth in opposing arches (excluding distal of last present teeth) 3.0mm 5 OPTIONAL FEATURES IMAGE UPPER LOWER J Distal Wrap Soft tissue to 5.0mm beyond gingival margin for buccal of molars K Distal Wrap Minimum of 3.0mm clearance between two closest teeth in opposing arches (including distal of last present teeth) 3.0mm 3.0mm L Anterior Opening Minimum of 5.0mm clearance between two closest opposing anteriors 5.0mm M Compliance Recorder Extension of 7.0mm in lower posterior regions on left side N/A N Edentulous Coverage of entirety of palette N/A O AccuLiner Articulator Coverage of hamular notches and incisive papilla Copyright 2018 SomnoMed Inc. 16