At the recent American Academy of Dental Sleep Medicine Conference I had the pleasure of presenting at the ResMed evening symposium to a group of passionate Dentists wanting to hear more about the Narval CC 3D printed appliance. However, the hi-light of this event for me was meeting and conversing with the inventor of the Narval CC, Ludovic Baratier. Ludovic graciously agreed to a phone interview so that I could document the Narval CC from inception to date. So, here is the official story of the Narval CC.
When Ludovic Baratier, a self employed Dental Technician in Lyon France reviewed the oral appliance offerings for management of obstructive sleep apnea, he both saw and seized an opportunity to develop a superior appliance; one that encroached minimally on tongue space, occupied minimal space in the oral cavity, that could be advanced in small increments, that created less strain on the temporo-mandibular joint (TMJ) and promoted mouth closure rather than mouth opening. Circa 2002, Ludovic’s vision resulted in the development of a vacuum formed hand made (old-world) appliance that advances the Jaw in a different way than the appliances that already existed; this new appliance held the jaw forward in traction rather than propulsion and the forces imposed on the TMJ and dentition ran as close to parallel to the occlusal plane as possible rather than obliquely. In addition, it’s small size helped to facilitate patient adherence to therapy. In 2003, Ludovic obtained a Patent for this very unique appliance and founded the company “Narval Laboratories” in 2004.
Narval Laboratories turned out to be very influential in the practice of Sleep Disorders Dentistry in France. On October 31, 2008 Ludovic’s co-founders successfully convinced the French socialized medical system to allow for re-imbursement of oral appliance therapy for obstructive sleep apnea. Ludovic explained that the process involved demonstrating efficacy of the device based on medical study results and that the approval for re-imbursement is granted in 5-year intervals. So, an application including efficacy data must be re-submitted every 5-years to demonstrate that it still makes sense to continue with government sponsored re-imbursement. Based on the findings of this regular review, re-imbursement levels may increase, remain unchanged or even decrease. I have to admit; our Government in Canada should take notice of the sensible approach socialized medicine employs in France.
In 2006 Ludovic began to work on a CAD-CAM solution with different companies including BIOCAD; beginning the transition to a NEW WORLD approach, Computer Assisted Design-Computer Assisted Manufacture. BIOCAD was commissioned to develop the original software that was used to produce the Narval CC. Many different materials were canvassed and after much due diligence the decision to use Polyamide Nylon Type 12 was finalized. As is documented in previous articles, this type 12 nylon is remarkably well suited for an oral appliance, it demonstrates a strength and durability with minimal size simply not found in any of the materials we have been accustomed to using in dentistry to date. In 2009, using a 3D printer, type 12 nylon and a laser sintering process that printed the appliance from the inside out, the first patient Narval CC was printed in Lyon France for patient use; a milestone in Oral Appliance Therapy.
In the later part of 2008, the BIOCAD Company originally commissioned to develop the 3D software used to manufacture the Narval CC was sold to Nobel Biocare. During this era, ResMed had established an interest in having an Oral Appliance offering in their line-up. After much due diligence and interviewing a number of the currently existing appliances, including the Narval CC, ResMed finalized it’s choice and purchased Narval Laboratories from Ludovic and his co-founders in late 2009. New software was created; the IP, software, and manufacturing process are proprietary solutions wholly owned by ResMed now. Ludovic continues to work with ResMed: Narval Division.
In 2012 ResMed launched the first 3D Printed CAD-CAM appliance in North America at the annual AADSM conference. Of course, I am happy to report the original inventor, Ludovic, is still on board with ResMed and that he remains involved in the continuing development of the Narval CC appliance, researching new technologies and ways to further improve and enhance the Narval’s capabilities. I thank Ludovic for the time he took to visit with me on the phone, but more so for the “Game Changing Appliance” he brought the world, the “Narval CC”.
John Viviano DDS D ABDSM
REPRINTED FROM: SleepScholar.com