Narval CC - Medical device ResMed - Free user manual and instructions

USER MANUAL Narval CC ResMed

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Professional - instructions for use

Please read carefully before use

Thank you for choosing the Narval CAD/CAM (computer aided design and computer aided manufacturing) oral appliance. This document provides qualified dental professionals with instructions for the Narval CC™ appliance. Please read the entire instructions for use before using the device.

Mechanism of action

The Narval CC appliance maintains the lower jaw (mandible) in a forward position, which in turn draws the base of the tongue forward and widens the airways in the pharyngeal area behind the tongue. It is designed to help open up the space behind the tongue and increase the tension of relaxed soft tissues to help reduce snoring and decrease the number of apnoeas and hypopnoeas that may disturb the physiological sleep cycle.

Airway states
Healthy patient (airway open)

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Patient with untreated snoring (airway partially closed)

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Patient with untreated OSA (airway closed - apnoea)

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Patient treated with Narval CC appliance

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Indications

The Narval CC appliance is a custom-made mandibular advancement device (MAD), available under medical prescription and intended to treat adults with:

• Mild to moderate obstructive sleep apnoea (OSA)
• Severe obstructive sleep apnoea in the case of continuous positive airway pressure (CPAP) failure, non-compliance or refusal (second-line treatment)
• Snoring

Contraindications

The Narval CC appliance is contraindicated for patients who:

General contraindications

• Have central sleep apnoea
- Have severe respiratory disorders (other than OSA)
- Are under 18 years of age

Dental contraindications

• Have loose teeth or advanced periodontal disease
• Have a completely edentulous lower arch unless a complete denture mechanically retained is present (e.g. retained by implants)
• Have a completely edentulous upper arch unless a complete upper denture is present
• Have short teeth and/or insufficient undercuts to retain the device

General warnings and precautions

Information related to warnings and precautions in the instructions for use explains special measures to be taken for the safe and effective use of the Narval CC appliance and informs on potential side effects.

Any serious incident that occurs in relation to this device should be reported to ResMed and to the competent authority in your country.

PRECAUTION

• Prior to prescribing the Narval CC appliance to the patient, the dental practitioner shall check for relevant issues in the patient's medical history, such as respiratory disorders, asthma and allergies. Patients with any such problem should be referred to a qualified health professional before treatment.

• It is necessary to perform a dental, periodontal, prosthetic and temporomandibular joint (TMJ) examination. The following dental issues must be treated by a dental practitioner before MAD treatment:

• Periodontal disease

• Cysts and mouth ulcers
• Teeth that need to be extracted
• Prosthodontics – such as crown or bridge
• Orthodontics

• Temporomandibular joint pain needs to be further assessed by patient's treating physician as well as any other TMJ disorder.

• The dental practitioner shall check if the teeth (natural or dental implant) anchoring value and retentive morphology are sufficient to ensure the efficacy of the MAD without significant side effect of treatment.

• Regular dental review is recommended as well as a follow-up by a sleep specialist for OSA patient to monitor treatment.
• The Narval CC appliance has been custom-made for a particular individual and is intended for use only by that individual.

• For any product modification other than the ones described in these instructions for use, please contact ResMed.
  • Patients treated with a Narval CC appliance must comply with the following instructions:

• Do not eat while wearing the Narval CC appliance.

• Only wear the Narval CC appliance when sleeping.
• Brush and rinse teeth before wearing the Narval CC appliance

• Patients must check their Narval CC appliance regularly. They must stop using it and contact a dental practitioner if they observe:

• any visible damage or cracking of a component,

• a connecting rod that detaches or must be replaced. In this case, the dental practitioner will provide a replacement connecting rod that is suitable for their treatment.

- Patients must contact you in case an elastic band needs to be replaced (if you ordered an appliance with slots for elastic bands).

- They must not perform any product modification.

WARNING

- Using the Narval CC appliance may cause the following expected side effects:

• Temporomandibular joint disorders
• Discomfort (e.g. mouth dryness, hyper salivation, nausea)
• Occlusion change
• Mouth pain, irritation or injury (e.g. gingivitis, mouth ulcer)
• Dental pain
• Tooth migration or dental mobility
• Dental fracture or prosthesis loosening
• Allergy.

- In extremely rare cases, an obstruction of oral breathing may occur.

If the patient experiences any serious or persistent side effect or aggravation of an existing dental condition, they must stop using the Narval CC appliance and contact their dental practitioner or a qualified health professional.

• Tooth pain may be experienced when using the Narval CC appliance. This is most likely to happen upon waking up. The pain usually disappears as the patient gets used to the treatment. If pain persists, the patient must contact a dental practitioner.
• On very rare occasions, fixed prosthetics (crown, bridge, veneer, etc.) may detach or upper removable dentures may need to be adjusted. If this occurs, patients must contact a dental practitioner. The prosthetics or dentures must be adjusted and the Narval CC appliance must be adapted to reduce the risk of further detachment.

Contents of the packaging

The Narval CC appliance is shown on page 2 of this leaflet. It is made of polyamide and comprises the following components:

1. Lower splint
2. Upper splint
3. Connectingrods

The Narval CC appliance is delivered with the following items:

1. A storage box
2. Connecting rod kit(s) to allow you to adjust the mandibular advancement - not shown
3. Instructions for use (one for patients and one for professionals) - not shown

Fitting and adjustment

PRECAUTION: The first fitting in mouth must take place under a dental practitioner's supervision.

Fitting the device

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• Clean the Narval CC appliance.
• Moisten the splints with water and validate the fit of each splint in the patient's mouth.
• In case of insertion difficulty, please read the section "Adjusting retention".

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- Position the MAD in the patient's mouth with the upper splint against the upper teeth.

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- Ask the patient to press firmly with their fingers on the upper splint until it fits in place. Instruct the patient no to pull or press on the connecting rods to adjust the position. You may hear a 'snap' as the Narval CC appliance engages the undercuts.

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- Bring the patient's lower jaw forward and let them follow the same process to slide in the lower splint. In some cases, it may be easier to insert the lower splint first, particularly where there is limited protrusive range. Instruct the patient not to bite down on the splint to insert it on to their teeth.

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- To remove the Narval CC appliance, place your fingers on each side of the lower splint and apply gentle, even pressure to lift it. Proceed in a similar way with the upper splint.

Adjusting retention

If needed, you can add or remove some retention from the Narval CC appliance.

When retention is too high.

If you want to relieve retention on specific areas of the Narval CC appliance, you can do so at chairside by simply making small incremental adjustments and checking the device on the model and patient along the way.

When retention is too low.

You can use the following protocol to increase retention on specific areas of the splints.

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1. Remove material

• Use a scalpel or a stone bur at low speed to gradually remove excess material from the inside surface.
• Reduce edges in the interdental spaces and remove material corresponding to the side of teeth that have a significant undercut.

2. Polish

• Finish by polishing spots where material has been removed using a rubber bur for polishing.
• You can also use a scalpel to remove flash created by grinding on the appliance.

If you remove material on the band, it should not result in a height of less than 7.5 mm in total (including a cap) or a thickness of less than 1.2 mm.

Always remove localised layers step by step in small increments. Try the device on the model and then on the patient.

Removing material on wide or deep surfaces could weaken the splint. Assess the transparency of the device to estimate the remaining thickness. If in doubt, check with a caliper: the thickness must remain greater than 1.2 mm. If you remove material, always check the splints for possible weakness or breakage before fitting them in the patient's mouth.

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1. Heat one side of the relevant quadrant of the device. Focus the heat on the lingual and palatal sides of the splints.
   Do not heat the internal surfaces or the edges of the splints. Always use lateral movements while applying heat with a flameless heater so as not to burn the splint.

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1. Squeeze the splint with your fingers to tighten it a bit.

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1. Cool completely with compressed air and replace the splint on the plaster model and then on the patient to test retention. If retention is still too low, repeat the process on the other side of the quadrant.

Adjusting lateral deviation

To prevent the splints from popping out due to unbalanced forces, the length of the connecting rods can be adjusted to obtain a natural deviation of the mandible.

In this example, the patient has a 2 mm deviation to the right. This means:

• The connecting rod on the right needs to be 1 mm longer (30 mm in length).
• The connecting rod on the left needs to be 1 mm shorter (28 mm in length).

30 mm 28 mm

Lateral deviation of 2 mm to the right

Table showing length of connecting rods relative to midline deviation:

Deviation Length of left rod Length of right rod

1 mm - 0.5 mm + 0.5 mm

2 mm - 1 mm + 1 mm

3 mm - 1.5 mm + 1.5 mm

4 mm - 2 mm + 2 mm

Adjusting the balance of the slip plane

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1. The patient should bite down on coloured articulating paper while wearing the appliance.
2. Remove the coloured premature contacts with a large, long and abrasive bur in order to increase the stability of the planes.

Always remove layers step by step in small increments. Removing significant amounts of material could weaken the splint. Try the device on the patient.

Hold the device to the light to estimate the remaining thickness and, in case of doubt, check with a caliper: the thickness must remain greater than 1.2 mm.

1. Use a polishing bur then unmodified pure alcohol to remove any residual colour left by the articulating paper.
2. Rinse the splints.

Adding elastic bands

Create elastic slots by making two incisions with a drill or a cutting disk on the vestibular face of the lower splint between two teeth. Try to ensure the incisions are vertically aligned with the connecting rod button.

Respect the following dimensions:

• Height of the slots: 2 to 3 mm. Do not touch the margins.
• Distance between slots: 5 mm. Do not touch the margins.

2 mm 5 mm

Requirements to follow when choosing elastic bands:

• Use non-latex orthodontic elastic bands intended for intra-oral use.
• Use similar elastic bands on each side of the device (do not mix elastics with different characteristics).
• Select elastic force and size considering the comfort/efficacy compromise. Check tolerance by asking the patient to try the device during the appointment.
• Prefer a lower elastic force in the case of low retention.

Recommendations for initial elastic setup:

• Diameter: 4.8 mm (3/16 ^th inch)
- Force: 170 g (6 oz) when stretched at 3 times its initial diameter

Setting process for elastic bands

1. Disassemble the connecting rod from the upper splint by rotating the rod until it is perpendicular to the splint (bow-tie shapes aligned) and pushing it out with your thumb.
2. Insert the head of the connecting rod in the elastic band.
3. Reassemble the connecting rod on the splint by aligning the bow-tie shapes and pressing the connecting rod back into place.
4. Place the elastic band in the slot in the lower splint.
   Follow these steps for each side of the Narval CC appliance.
   The elastics must only be set in place, replaced or changed by a dental practitioner.

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Device titration

IMPORTANT

The Narval CC appliance is a traction-based appliance. Consequently, the protrusion is increased by shortening the connecting rods.

Titration is the process of adjusting the protrusion of the device and the mandible to find the best balance between efficacy and comfort.

MAD therapy has a well proven non-linear dose response to the level of protrusion until the efficacy plateau is reached. This means that the greater the protrusion, the more efficient the MAD will be (up to a limit - the efficacy plateau). However, as the protrusion increases, the pressure on the teeth and TMJ also increase, making the MAD less comfortable for the patient.

Protrude 36 34 32 30 28 26 23 21 Retrude

How to determine the right protrusion

The initial mandibular protrusion of the Narval CC appliance is set at approximately 60% of the patient's maximum protrusion, unless you provided a bite registration. If you provided a bite registration, the initial setting corresponds to the position indicated by the registration.

In most cases, the initial setting will not correspond to the optimal protrusion for your patient and you will need to progressively adjust and find the right protrusion based on ongoing symptoms such as:

• Snoring frequency and intensity
• Tiredness
  • Daytime sleepiness and tendency to fall asleep
  • Quality of sleep and nocturia

Recommended titration process for a Narval CC appliance

The protrusion of the Narval CC appliance can be adjusted in increments of 1 mm. It can be fine-tuned in increments of 0.5 mm.

Step 1: At the fitting appointment, the patient should not experience any muscle/TMJ pain. If there is any pain, reduce the protrusion by replacing the connecting rods with longer ones until the patient feels comfortable.

Step 2: At the follow-up appointment, once the patient is used to sleeping with the Narval CC appliance, ask about symptom improvements. If all symptoms are resolved, proceed to step 4.

Step 3: If some symptoms persist and the patient can tolerate a greater protrusion, replace the existing connecting rods with shorter ones to increase protrusion. Protrusion should not be increased by more than 1 mm a week. Set up another follow-up appointment one or two weeks later and repeat step 3 until the symptoms are resolved or you reach the tolerance limit of your patient, whichever happens first.

Step 4: If the patient has OSA, inform your sleep specialist partner of their status and MAD titration. The patient should undertake a controlled sleep recording with their Narval CC appliance to measure treatment efficacy on breathing parameters.

How to adjust Narval CC appliance protrusion

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1. Turn the Narval CC appliance so that the bow tie shape of the connecting rod is aligned with the cut out on the splint.

2. Disconnect the lower side first, as the bow tie-shaped cut out is more visible here.

3. Remove the connecting rod by firmly pushing with your thumb at the top of the rod where

it meets the triangular portion of the splint. Repeat for the other side of the lower splint, then for both sides of the upper splint.

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1. Select the appropriate connecting rods:

- to increase protrusion, use a shorter connecting rod.

- to decrease protrusion, use a longer connecting rod.

1. Hold the connecting rod perpendicular to the splint. Line up the bow tie on the connecting rod with the cut out on the splint.

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1. Click into place to re-engage the connecting rod.

Treatment follow-up

Once the titration process is complete, it is important to schedule regular follow-ups with the patient to assess potential side effects and ensure treatment efficacy and safety in the long term.

Patients can be directed to their sleep specialist to evaluate the efficacy of their Narval CC appliance via an objective monitoring process (PG or PSG).

For OSA patients, if a satisfactory improvement in symptoms and an objective sleep recording validation cannot be achieved after titration, discuss about alternative treatments with your sleep specialist partner.

Cleaning

The patient must clean the Narval CC appliance as per the instructions supplied in the patient instructions for use:

PRECAUTION

• Before choosing an antibacterial denture cleanser, the patient should verify that they are not allergic to any of its ingredients. The patient must always follow the instructions provided with it.
• The Narval CC appliance must not be put in water that is warmer than 45 °C/113 °F.
• The Narval CC appliance must not be cleaned using toothpaste, mouthwash or soap.
• The Narval CC appliance must not be cleaned using chlorine-based products, bleach, acetic acid, household cleaning products or alcoholic solutions.

After every use, the patient shall proceed as follows:

1. Remove the Narval CC appliance from mouth and immerse it in lukewarm drinking-quality water in a clean glass or container.
2. Brush the Narval CC appliance all over for at least 1 minute, paying particular attention to the inner surface. Use a denture brush or a toothbrush that is only used for cleaning the Narval CC appliance. Replace the brush when the bristles fray.
3. Rinse well with clean, lukewarm drinking-quality water.
4. Carefully inspect the Narval CC appliance to confirm it is visibly clean (e.g. no visible particles remaining on the appliance). If necessary, clean the appliance again, repeating steps 2 through 4.
5. Once clean, dry the Narval CC appliance with a clean towel and place it back in its storage box.

Whitening protocol

If your patients complain about persistent unaesthetic stains appearing on their device over time, a specific whitening protocol for the Narval CC appliance can be followed. This protocol can be requested to your local ResMed representative.

Twice a week, the patient should clean their Narval CC appliance more thoroughly, using an antibacterial denture cleanser intended for orthodontic appliances, and proceed as follows:

1. Read the instructions on the antibacterial denture cleanser carefully before use.
2. Clean the Narval CC appliance following the instructions provided by the cleanser manufacturer.
3. Rinse it well with clean, drinking-quality water.
4. Dry it with a clean towel and place back in its storage box.

Over time, the splints of the Narval CC appliance might change colour. This may be due to the acidity of the patient's saliva, coloured drinks or how well they take care of their Narval CC appliance. This will not affect its performance.

Storage and disposal

Please make sure the patient understands that:

• The Narval CC appliance must be clean and dry before storage.
• The Narval CC appliance must be stored in its storage box at room temperature in a dry place away from direct sunlight.
• The Narval CC appliance and items do not present specific hazards and can be disposed of with normal household refuse.

Symbols

MD

Medical device

LOT

Batch code

Use by date (yyyy/mm)

Single patient-multiple use

Information dedicated to the dental practitioner

Read instructions

REF

Catalogue number

Manufacturer

Consult instructions for use

Keep away from sunlight

Maximum protrusion including overjet

Finished device protrusion

SN

Serial number

Date of manufacture (yyyy/mm)

Caution

Keep dry

Connecting rod size (Left/Right)

inished device midline deviation

REPC

Swiss Authorised Representative

Warranty

ResMed acknowledges all consumer rights granted under the EU Directive 1999/44/EC and the respective national laws within the EU for products sold within the European Union.

The warranty below is a voluntary manufacturer's warranty offered by ResMed SAS ("ResMed"). It is in addition and without prejudice to your mandatory rights under applicable law.

1. ResMed guarantees all Narval CC appliances supplied to be free from defects in materials and workmanship for a period of 2 years from the manufacturing date shown in the packaging. In specific circumstances, which may vary from region to region, your warranty period may be longer than 2 years. For details, please contact your local ResMed dealer.
   During the warranty period and at its complete discretion, ResMed will adjust or replace any Narval CC appliance that is covered by the warranty.

2. The warranty does not cover:

3. damage that is not caused by manufacturing defects,

4. devices that do not fit due to defective or distorted impressions and/or defective or distorted bite registrations,
5. dental calculus deposits, stains, changes of colour or odours,

6. damage caused by a pet.

7. The warranty shall be void if:

8. the patient had dental restorative work or dental modifications (e.g. tooth extractions, new crowns, new dental prosthetics) during the warranty period and the defect results from the work or modification,

9. the Narval CC appliance was not used and cleaned in accordance with the instructions for use, or

10. the Narval CC appliance was modified by a non-authorised party.

11. For the warranty to be honoured, the following elements must be returned to ResMed by the dental practitioner: both splints with their connecting rods, storage box and the patient's dental models.

Introduction

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Indications

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Black-and-white photo of a medical professional and a patient examining a tooth (no visible text or symbols)

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Suivi du traitement

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Patient med ubehandlet snorken (luftvej delvis lukket)

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Patient behandlet med Narval CC- tandskinne

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Indikationer

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1. Fjern materiale

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Standardisering af tandskinne

VIGTIGT

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Maksimal protrusion, inklusive overbid

V/H

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Mit Narval CC behandelter Patient

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Indikationen

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Ravimata norskamisega patsient (hingamisteed osaliselt suletud)

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Ravimata OUAgapatsient (hingamisteed on suletud – apnoe)

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Narval CC sead- mega ravitud patsient

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Näidustused

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1. Materjali eemaldamine

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Seadme tiitrimine

OLULINE

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Indicaciones

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Close-up of gloved hands holding a small object, possibly a tool or device, with no visible text or symbols.

Abstract circular logo with wave-like patterns inside, no text or symbols present

Circular icon depicting stylized waves with a downward arrow, no text or symbols present

Circular icon depicting stylized mountain peaks with a downward arrow, no text or symbols present.

Abstract circular logo with wave and arrow elements (no text or symbols)

Close-up of hands washing a baby in a kitchen sink with a faucet (no text or symbols visible)

Medical professional examining a patient's mouth in a clinical setting (no visible text or symbols)

Black-and-white photo of a medical professional examining a patient's mouth with both hands (no visible text or symbols)

Black-and-white photo of a medical professional examining a patient's mouth (no visible text or symbols)

Dental clinic scene showing a dental procedure with a patient using a toothbrush (no visible text or symbols)

Close-up of gloved hands holding a white cloth or paper (no visible text or symbols)

Close-up of a person's hands holding a baby bottle, no visible text or symbols

Close-up of gloved hands using a power tool to apply white adhesive onto a small white object (no text or symbols visible)

Close-up of gloved hands holding a white plastic object, possibly a tool or device (no visible text or symbols)

Close-up of gloved hands holding a white plastic object, possibly a dental or mechanical component (no visible text or symbols)

Close-up of a person's mouth with tongue sticking out (no visible text or symbols)

Close-up of gloved hands using a pipette to apply material (no visible text or symbols)

Close-up of a medical procedure in progress, showing gloved hands and a surgical instrument (no visible text or symbols)

Close-up of a gloved hand holding a transparent plastic object, possibly a medical or laboratory device (no visible text or symbols)

Close-up of gloved hands performing a medical procedure on a small object (no visible text or symbols)

Close-up of gloved hands performing a medical procedure on a small object (no visible text or symbols)

Close-up of gloved hands holding a small object, possibly a tool or device, with no visible text or symbols.

Abstract circular logo with stylized wave and fish design (no text or symbols)

Abstract circular graphic with wave-like shapes and a downward arrow, no text or symbols present.

Abstract circular logo with stylized wave and arrow elements (no text or symbols)

Abstract circular logo with wave-like patterns and arrows, no text or symbols present

Beoogd gebruik

Hand washing a small glass in a kitchen sink with a faucet (no text or symbols visible)

Medical professional examining a patient's mouth in a clinical setting (no visible text or symbols)

Black-and-white photo of a medical professional examining a patient's mouth with both hands (no visible text or symbols)

Black-and-white photo of a medical professional examining a patient's mouth (no visible text or symbols)

Dental professional examining a patient's mouth in a clinical setting (no visible text or symbols)

Close-up of hands holding a white cloth or paper, no visible text or symbols

Close-up of a person's hand holding a small white object, possibly a medical or laboratory device (no visible text or symbols)

Close-up of gloved hands using a power tool to apply white adhesive onto a small white object (no text or symbols visible)

Close-up of gloved hands holding a white plastic object, possibly a small object or tool, with no visible text or symbols.

Close-up of gloved hands holding a white plastic object, possibly a dental or ceramic tool (no visible text or symbols)

Close-up of a person's mouth with teeth and tongue, no visible text or symbols

Close-up of gloved hands using a screwdriver to apply material (no visible text or symbols)

Close-up of a medical procedure in progress, showing tissue and surgical instruments (no visible text or symbols)

Inrichting titratie

BELANGRIJK

Close-up of a person applying a medical or laboratory procedure to a patient's arm (no visible text or symbols)

Close-up of gloved hands performing a medical procedure on a patient's abdomen (no visible text or symbols)

Close-up of gloved hands performing a medical procedure on a small object (no visible text or symbols)

Close-up of gloved hands holding a small object, possibly a tool or device (no visible text or symbols)

Behandeling follow-up

Abstract circular logo with stylized wave or waveforms inside (no text or symbols)

Pasient med ubehandlet snorking (delvis stengt luftvei)

Circular icon depicting stylized waves with a downward arrow, no text or symbols present

Pasient med ubehandlet OSA (stengt luftvei – apné)

Circular icon depicting stylized mountain peaks with a downward arrow, no text or symbols present.

Pasient behandlet med Narval-skinne

Abstract circular logo with wave and arrow elements (no text or symbols)

Indikasjoner

Close-up of hands washing a small glass in a kitchen sink with a faucet (no text or symbols visible)

Black-and-white photo of a medical professional examining a patient's mouth, both smiling (no visible text or symbols)

Dental professional examining a patient's mouth in a clinic setting (no visible text or symbols)

Medical professional examining a patient's mouth in a clinical setting (no visible text or symbols)

Black-and-white photo of a medical professional examining a patient's mouth (no visible text or symbols)

Close-up of hands holding a white cloth or paper, no visible text or symbols

Close-up of a person's lower body and upper torso, showing a white object near the waist (no visible text or symbols)

1. Fjerne materiale

Close-up of gloved hands using a power tool to apply white adhesive onto a small white object (no text or symbols visible)

Close-up of gloved hands holding a white plastic object, no visible text or symbols

Close-up of gloved hands holding a white plastic object, possibly a dental or dental tool (no visible text or symbols)

Close-up of a person's mouth with teeth, no visible text or symbols

Close-up of gloved hands using a tool to apply material (no visible text or symbols)

Close-up of a medical procedure showing tissue and a dark object (no visible text or symbols)

Close-up of a gloved hand holding a transparent plastic object, possibly a medical or laboratory device (no visible text or symbols)

Close-up of gloved hands holding a small object, possibly a medical or lab item (no visible text or symbols)

Close-up of hands performing a medical procedure on a patient's leg (no visible text or symbols)

Close-up of gloved hands holding a small object, possibly a tool or device (no visible text or symbols)

Abstract circular logo with wave-like patterns inside (no text or symbols)

Circular icon depicting stylized waves with a downward arrow, no text or symbols present

Abstract circular logo with stylized wave and arrow elements (no text or symbols)

Abstract circular logo with wave and arrow elements (no text or symbols)

Indicações

Close-up of hands washing a glass in a kitchen sink with a faucet (no text or symbols visible)

Medical professional examining a patient's mouth in a clinical setting (no visible text or symbols)

Black-and-white photo of a medical professional examining a patient's mouth with both hands (no visible text or symbols)

Black-and-white photo of a medical professional examining a patient's mouth (no visible text or symbols)

Dental examination scene with a dental instructor and patient in jaw (no visible text or symbols)

Close-up of hands holding a white object, possibly a medical or industrial component (no visible text or symbols)

Close-up of a person's hands holding a white object, possibly a medical or cosmetic item (no visible text or symbols)

1. Remover o material

Close-up of gloved hands using a power tool to apply white adhesive onto a small white object (no text or symbols visible)

Close-up of gloved hands holding a white plastic object (no text or symbols visible)

Close-up of gloved hands holding a white plastic object, possibly a dental or mechanical component (no visible text or symbols)

Close-up of a person's mouth with a black object near the mouth (no visible text or symbols)

Close-up of gloved hands holding a small mechanical component (no visible text or symbols)

Close-up of a medical procedure in progress, showing tissue and surgical instruments (no visible text or symbols)

Close-up of a gloved hand holding a small transparent object, possibly a medical or laboratory device (no visible text or symbols)

Close-up of gloved hands performing a medical procedure on a patient's head (no visible text or symbols)

Close-up of a person performing a medical or therapeutic procedure on the knee, with no visible text or symbols.

Abstract circular logo with stylized wave or waveforms inside (no text or symbols)

Circular icon depicting stylized waves with a downward arrow, no text or symbols present

Circular icon with abstract wave-like shapes and a downward arrow, no text or symbols present.

Abstract circular logo with wave-like patterns and arrows, no text or symbols present

Käyttötarkoitus

Hand washing a small glass in a kitchen sink with a faucet (no text or symbols visible)

Medical professional examining a patient's mouth in a clinical setting (no visible text or symbols)

Black-and-white photo of a medical professional examining a patient's mouth with teeth (no visible text or symbols)

Black-and-white photo of a medical professional examining a patient's mouth (no visible text or symbols)

Dental care scene showing a dental professional assisting a patient with teeth (no visible text or symbols)

Close-up of hands holding a white, textured object (no visible text or symbols)

Close-up of a gloved hand holding a small white object, possibly a medical or laboratory device (no visible text or symbols)

Close-up of gloved hands using a power tool to apply white adhesive onto a small white object (no text or symbols visible)

Close-up of gloved hands holding a white plastic object, possibly a medical or laboratory device (no visible text or symbols)

Close-up of gloved hands holding a white object, possibly a medical or cosmetic item (no visible text or symbols)

Close-up of a person's mouth with tongue sticking out (no visible text or symbols)

Close-up of gloved hands holding a small mechanical component (no visible text or symbols)

Close-up of a medical procedure showing gloved hands performing a catheter insertion (no visible text or symbols)

Kiskon titraus

TÄRKEÄÄ

Close-up of gloved hands performing a medical procedure with a transparent tube (no visible text or symbols)

Close-up of gloved hands performing a medical procedure on a patient's head (no visible text or symbols)

Close-up of hands performing a medical procedure on a patient's abdomen (no visible text or symbols)

Close-up of gloved hands holding a small object, possibly a tool or device, with no visible text or symbols.

Hoidon seuranta

Abstract circular logo with stylized wave and cloud design (no text or symbols)

Circular icon depicting stylized waves with a downward arrow, no text or symbols present

Abstract circular logo with stylized fish and wave elements (no text or symbols)

Abstract circular logo with wave and arrow elements (no text or symbols)

Indikationer

Hand washing a small glass in a kitchen sink with a faucet (no text or symbols visible)

Medical professional examining a patient's mouth in a clinical setting (no visible text or symbols)

Black-and-white photo of a medical professional examining a patient's mouth with teeth (no visible text or symbols)

Black-and-white photo of a medical professional examining a patient's mouth (no visible text or symbols)

Dental professional examining a patient's mouth in a clinical setting (no visible text or symbols)

Close-up of gloved hands holding a white cloth or paper (no visible text or symbols)

Close-up of a person sitting with hands holding a baby wrapped in a blanket (no visible text or symbols)

Close-up of gloved hands using a soldering iron to apply white adhesive onto a small white object (no text or symbols visible)

Close-up of gloved hands holding a white plastic object, possibly a medical or dental model (no text or symbols visible)

Close-up of gloved hands holding a white plastic object, possibly a dental or dental tool (no visible text or symbols)

Close-up of a person's mouth with a toothbrush near the mouth (no visible text or symbols)

Close-up of gloved hands holding a small mechanical component (no visible text or symbols)

Close-up of a medical procedure in progress, showing gloved hands and a surgical instrument (no visible text or symbols)

Close-up of a gloved hand holding a small transparent object, possibly a medical or laboratory device (no visible text or symbols)

Close-up of gloved hands performing a medical procedure on a patient's neck (no visible text or symbols)

Close-up of gloved hands performing a medical procedure on a patient's leg (no visible text or symbols)

4.Väljlämpliga

länkarmar: