Xo FLEX User manual

XO FLEX
INSTRUCTIONS
FOR USE

XO FLEX – Instructions for use
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XO FLEX – Instructions for use Table of contents
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CONTENTS
1 EXTRAORDINARY DENTISTRY....................................................................................................... 7
2 Installation........................................................................................................................................ 8
3 Operation ....................................................................................................................................... 11
3.1 General.................................................................................................................................... 11
3.2 Switch the unit on ................................................................................................................... 12
3.3 Instrument bridge in parking position ..................................................................................... 13
3.4 Foot control............................................................................................................................. 13
Function............................................................................................................................ 13
Position the foot control ................................................................................................... 14
3.5 XO SMART LINK ..................................................................................................................... 15
3.6 Patient chair ............................................................................................................................ 15
Foot control of patient chair ............................................................................................. 15
Smaller adjustments of patient chair................................................................................ 15
Safety ............................................................................................................................... 16
Supine patient position..................................................................................................... 16
Neck rest .......................................................................................................................... 16
Child cushion.................................................................................................................... 17
3.7 Instrument bridge in working position..................................................................................... 17
Balanced instruments....................................................................................................... 17
Four-handed or solo work ................................................................................................ 18
Working positions............................................................................................................. 18
3.8 Instrument control................................................................................................................... 21
Foot control of instruments .............................................................................................. 21
Instruments on the instrument bridge .............................................................................. 21
Instrument bridge display................................................................................................. 21
3.9 Syringe – Luzzani .................................................................................................................... 22
3.10 Micromotor – Bien-Air MC3 / Bien-Air MX2.......................................................................... 22
3.11 XO OSSEO motor ................................................................................................................. 23
Set-up............................................................................................................................. 23
Operation........................................................................................................................ 24
Implant surgery - operation with XO Smart Link ............................................................ 25
3.12 Air instrument........................................................................................................................ 25
3.13 Ultrasonic scalers.................................................................................................................. 26
3.14 XO ODONTOSON 360 ultrasonic scaler ............................................................................... 27
How to use XO ODONTOSON 360 ................................................................................ 28
Changing the instrument ................................................................................................ 29
XO ODONTOSON 360 with antimicrobials and sterile saline......................................... 30
3.15 XO ODONTOCURE curing light ............................................................................................ 30
3.16 XO Peristaltic Pump .............................................................................................................. 32
Disposable irrigation kit.................................................................................................. 32
Attaching the pump module........................................................................................... 33
Attaching the irrigation tube ........................................................................................... 33

XO FLEX – Instructions for use Table of contents
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Irrigation bag .................................................................................................................. 35
Irrigation reservoir........................................................................................................... 35
Designation of instrument .............................................................................................. 36
Adjusting the flow level................................................................................................... 37
3.17 Intraoral HD video camera .................................................................................................... 37
3.18 Operating Light ..................................................................................................................... 38
Position the light............................................................................................................. 38
Switch the light on and adjust the light intensity............................................................ 39
Automatic functions ....................................................................................................... 40
3.19 XO HD Display ...................................................................................................................... 40
3.20 Hand instruments.................................................................................................................. 41
3.21 Suction .................................................................................................................................. 42
3.22 Cuspidor and cup filler.......................................................................................................... 42
Automatic function ......................................................................................................... 43
3.23 Assistant call ......................................................................................................................... 43
3.24 Sound generator and sounds ............................................................................................... 44
3.25 System messages................................................................................................................. 44
3.26 XO SEAT and XO STOOL...................................................................................................... 44
XO SEAT......................................................................................................................... 45
XO STOOL...................................................................................................................... 46
4 Configuration ................................................................................................................................. 48
4.1 Configuration of patient chair positions.................................................................................. 48
4.2 Configuration of general unit and patient chair functions....................................................... 48
4.3 Configuration of unit instruments............................................................................................ 49
5 Cleaning and infection control....................................................................................................... 53
5.1 Cleaning, disinfection and sterilization procedures ................................................................ 53
5.2 Detergents and disinfectants for cleaning and/or disinfection of the unit .............................. 53
5.3 General cleaning of unit and patient chair surfaces................................................................ 53
5.4 Cleaning of Comfort and skai fabric ....................................................................................... 54
5.5 General disinfection of unit surfaces....................................................................................... 54
5.6 Infection control instrument and bridge protection pad ......................................................... 54
5.7 Autoclaving handles................................................................................................................ 54
5.8 Disinfection of instrument hoses and suspensions................................................................. 55
5.9 Infection control Luzzani syringe ............................................................................................ 56
5.10 Infection control Bien-Air micromotors................................................................................. 56
5.11 Autoclaving of XO OSSEO motor.......................................................................................... 56
5.12 Infection control XO ODONTOSON 360 ............................................................................... 57
5.13 Infection control XO ODONTOCURE curing light ................................................................. 57
5.14 Infection control other instruments ....................................................................................... 58
5.15 Infection control XO Peristaltic Pump ................................................................................... 58
5.16 Disinfection of light................................................................................................................ 58
5.17 Infection control XO HD Display ........................................................................................... 59
Front panel ..................................................................................................................... 59
5.18 Disinfection of cuspidor bowl and cup holder ...................................................................... 59
5.19 Disinfection of suction lines .................................................................................................. 60
General ........................................................................................................................... 60

XO FLEX – Instructions for use Table of contents
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Suction filters.................................................................................................................. 61
Replacement of XO Suction Disinfection cartridge ........................................................ 62
5.20 Disinfection of unit water lines .............................................................................................. 63
Overnight water treatment.............................................................................................. 63
Intensive water treatment ............................................................................................... 64
Replacement of XO Water Clean cartridge .................................................................... 64
6 Maintenance and repairs ............................................................................................................... 66
6.1 Foot control............................................................................................................................. 66
6.2 XO OSSEO motor ................................................................................................................... 66
Motor repair...................................................................................................................... 66
6.3 XO ODONTOSON ................................................................................................................... 66
Handpiece repair .............................................................................................................. 66
Tightening / exchanging the ferrite rod ............................................................................ 66
6.4 XO ODONTOCURE ................................................................................................................. 67
Handpiece repair .............................................................................................................. 67
Manual measurement of curing effectiveness.................................................................. 67
6.5 XO Peristaltic Pump ................................................................................................................ 69
6.6 Adjustment of the hand instrument table................................................................................ 69
6.7 Control of the water disinfection system ................................................................................ 69
6.8 Maintenance and replacement of main filter for water supply................................................ 70
6.9 Cuspidor valve – cleaning the course filter ............................................................................. 70
6.10 Flushing of cuspidor drain..................................................................................................... 70
6.11 Suction hoses ....................................................................................................................... 70
6.12 Air and Amalgam separator .................................................................................................. 71
Dürr CS1 Combi-Sepamatic – Air separator .................................................................. 71
Dürr CAS 1 Combi-Separator – Air and amalgam separator ......................................... 71
7 Unit messages and remedial actions............................................................................................. 72
7.1 Error messages ....................................................................................................................... 72
7.2 Service messages and remedial actions................................................................................. 73
8 Preventive service, safety inspections and repairs........................................................................ 74
8.1 General.................................................................................................................................... 74
8.2 Preventive service and safety inspection................................................................................ 74
Preventive service and safety inspection A – 12, 36 etc. months after installation.......... 74
Preventive service and safety inspection B – 24, 48 etc. months after installation ......... 74
Service notification ........................................................................................................... 74
8.3 Adjustment of the arm systems .............................................................................................. 75
8.4 Adjustment of balanced instrument suspension arms............................................................ 75
8.5 Replacement of operating light source................................................................................... 75
8.6 XO HD Display ........................................................................................................................ 75
9 Infection control and maintenance checklist ................................................................................. 76
10 Accessories, detachable parts and consumables....................................................................... 78
10.1 Accessories........................................................................................................................... 78
10.2 Detachable parts................................................................................................................... 78
10.3 Consumables ........................................................................................................................ 79

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10.4 Suggested retail prices ......................................................................................................... 80
11 Legal ............................................................................................................................................ 81
11.1 Modification of the equipment .............................................................................................. 81
11.2 Warrantee.............................................................................................................................. 81
11.3 Expected Service Life ........................................................................................................... 81
11.4 3rd Party instruments and accessories.................................................................................. 82
11.5 Product updates ................................................................................................................... 82
11.6 Firmware version................................................................................................................... 82
11.7 Applicable standards ............................................................................................................ 82
11.8 Electromagnetic emission ..................................................................................................... 82
11.9 Interference Immunity ........................................................................................................... 83
11.10 Classification....................................................................................................................... 84
11.11 Applied parts....................................................................................................................... 84
11.12 Marking plate ...................................................................................................................... 84
11.13 Other labels......................................................................................................................... 85
11.14 Product disposal information .............................................................................................. 85
12 Symbols....................................................................................................................................... 86
13 Dimensions and technical data ................................................................................................... 89
13.1 Dimensions and range of movement .................................................................................... 89
13.2 Technical specifications........................................................................................................ 90
14 XO FLEX Quick Guide.................................................................................................................. 93

XO FLEX – Instructions for use EXTRAORDINARY DENTISTRY
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1EXTRAORDINARY DENTISTRY
Dear XO user,
Please read this manual carefully and explore all the equipment’s extraordinary features:
•The unit shall be installed as described in section 2
•In section 3 we describe how you use the equipment for performing extraordinary dentistry
•You may configure the unit to your own personal needs – see details in section 4
•Read details about infection control and cleaning in section 5
•Maintain the unit as described in section 6
•XO FLEX must be inspected and serviced every 12 months by an XO authorized service
provider to ensure safe operation and high uptime – see details in section 8
•In section 9 you find a checklist containing all infection control and maintenance
procedures that must be observed
•Section 10 contains a complete list of accessories, detachable parts and consumables that
you should be aware of
•In section 0 we list important legal information
•Please see section 12 for a list of symbols used and section 13 for technical product details
•Finally, in section 14 you see XO FLEX Quick Guide
Find more information at xo-care.com or contact XO customer service at [e-mail].
Best regards
Kim Sørensen
CEO XO CARE A/S
XO FLEX must be inspected and serviced every 12 months by an XO authorized
service provider to ensure safe operation and high uptime.
Authorized service providers are listed under “Distributors” at xo-care.com.
XO CARE and the XO authorized service provider offer 36 months warranty on XO
FLEX provided that the unit is serviced as prescribed.

XO FLEX – Instructions for use Installation
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2INSTALLATION
XO FLEX is intended to be permanently installed in a dental operatory at least 220 cm wide and
360 cm long1– see Figure 1 and see the required operation conditions in Table 1.
For transport and storage conditions see Table 1 and in Table 2 the installation requirements are
given.
Figure 1 – Plan of installation – XO FLEX
Table 1 – Operating and transport/storage conditions
Condition
Operation
Transport and storage
Temperature:
+15oC – +40oC
-40oC – +60oC
Relative humidity:
20% – 85%
10% – 95%
Air pressure:
800 hPa – 1060 hPa
700 hPa – 1060 hPa
Installation altitude
Max. 2,000 meters above sea level
-
1Note: This dimension depends on the depth of the cabinets – in the example shown in Figure 1 the cabinets are 50 cm deep

XO FLEX – Instructions for use Installation
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Table 2 – Installation requirements
Electrical
Requirement
Length above
floor surface
Mains supply
230 VAC + 10%, 50 – 60 Hz with earth min. 3 x 1,5 mm2
Main fuse 10 A
75 cm
Equipotential earth (if
required by national law)
1 x 4.0 mm2
Assistant call control
cable
Min. 2 x 0.1 mm2and max. 2 x 1.25 mm2
Max. 2 A / 60 VDC or 2 A / 25 VAC
75 cm
X-ray unit attached to the
XO unit
Cable for X-Ray must have its own installations pipe. Cable shall be connected to an
installation box in the floor.
Suction motor control
cable
Min. 2 x 0.1 mm2and max. 2 x 1.25 mm2
Max. 2 A / 60 VDC or 2 A / 25 VAC
75 cm
Positioning of cables in
the floor
See installation drawing YB-235.
Data
Requirement
Length above
floor surface
Isolation transformer
When connecting the external PC to the unit, the external PC must be equipped with
a medical grade power supply or be powered via a medical grade isolating
transformer! XO part number: XO-620
RS-232 cable
Connect unit and external PC through a RS-232 cable, male/female. The cable’s
male connector to the unit end.
70 cm
XO HD Display
Connect XO HD Display and an external PC through a HDMI cable.
Depending on the environment it might be necessary to use an HDMI amplifier with
the HDMI cable.
10 cm
Intraoral video camera
Connect the intraoral video camera to an external PC through a USB A cable
male/female. The cable’s female connector is in the unit end.
It is recommended to use a USB Extension 10 m cable with Repeater from Dürr
Dental - part number: 2106-155-60.
USB extension
cable: 20 cm
Suction, air and water
Requirement
Height above
floor surface
Suction
Suction machine power >600 l/min.
Vacuum pressure at the connection point under static conditions: Min = 35 mbar,
Max = 150 mbar.
Plastic pipe Ø 32 mm with socket – see YB-235. 6 cm max.
Incoming (compressed)
air
Pipe 3/8” female internal thread – preferably fitted with a ball valve – see YB-235.
Incoming air:
•Air pressure 5.5 – 7,5 bar
•Air flow rate > 55 l/min
•Humidity dew point < -20°C at atmospheric pressure
•Oil contamination max. 0.5 mg/m3
•Particulate contamination < 100 particles/m3(particle size 1 – 5 µm
If the incoming air pressure exceeds 7,5 bar a reduction valve must be fitted.
Air quality must be in accordance to local quality of air regulations.
7 cm max.
Incoming water
Pipe 3/8” female internal thread – preferably fitted with a ball valve – see YB-235
Incoming water:
•Inlet pressure 2.5 – 6 bar
•Water flow rate > 5 l/min
•Water hardness < 2.14 mmol/l (< 12 odH)
In case of poorer water quality, water softener should be replaced more often than
the normal recommendation, for example twice a year
•pH: 6.5 – 8.5
•Maximum particle size < 100µm
If the incoming water pressure exceeds 6 bar a reduction valve must be mounted
before the unit.
Water quality must be in accordance to local drinking water regulations.
7 cm max.
Backflow prevention
If the unit is not supplied with “unit backflow water prevention” it must have an
external backflow prevention device at the connection point with the water supply,
or an air gab of at least 20 mm.
Drain
Plastic pipe Ø 32 mm with socket – see YB-235.
Gradient of waste water lines > 1%
Drainage capacity > 10 l/min
6 cm max.

XO FLEX – Instructions for use Installation
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XO FLEX unit must be installed by an XO authorized service provider.
Authorized service providers are listed under “Distributors” at xo-care.com.
WARNING: To avoid the risk of electric shock, this equipment must be connected to a
supply mains with protective earth.
When connecting an external PC (including monitor) to the XO FLEX unit, the
external equipment must be powered by a medical grade isolating transformer (e.g.
XO part number: XO-620).
The external equipment must also comply with the applicable standards, e.g.:
•IEC 60950-1 (information technology equipment) or IEC 62368-1 (electronic
equipment within the field of audio, video, information and communication
technology), and
•IEC 60601-1 (medical electrical equipment)
When external equipment is connected to the XO FLEX unit to create a medical
electrical system, the requirements of IEC 60601-1, 3rd edition, must be complied
with.
It is the responsibility of the person/organization installing and/or modifying the
equipment to ensure that the system conforms to applicable legislation, e.g.
Directive 93/42/EEC, or Regulation (EU) 2017/745, and the requirements of IEC
60601-1, 3rd edition.
Installation instructions for XO FLEX can be downloaded from xo-care.com.

XO FLEX – Instructions for use Operation
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3OPERATION
3.1 GENERAL
XO FLEX is a combined dental unit and patient chair which is to be used by skilled dental
operators for prevention and treatment of diseases in the oral cavity of humans.
The unit has a compact floor-mounted stand fitted with a patient chair, a cuspidor and single-
column pivoting articulated balanced arms for the instrument bridge, operating light and display –
see Figure 2.
Figure 2 – Main XO FLEX elements: (1) unit stand, (2) patient chair, (3) cuspidor and cup filler,
(4) unit column, (5) instrument bridge, (6) operating light, (7) HD Display and (8) foot control
A complete technical description of XO FLEX is available at xo-care.com.

XO FLEX – Instructions for use Operation
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Please note that XO FLEX must be operated in accordance with this manual and by
dental professionals only!
To avoid injury to persons or material, do not use XO FLEX or its accessories if signs
of operational, electrical or mechanical defects are found.
Do not use XO FLEX in oxygen-rich environments!
This equipment does not have a gas sealed electronic enclosure and could ignite any
flammable or explosive gases in its environment.
Use of other equipment adjacent to or stacked on this equipment should be avoided
because it could result in improper operation.
Do not simultaneously touch the patient and any external electrical equipment such
as PCs, monitors, etc.
Do not simultaneously touch the patient and the connector for peristaltic pump on
the rear panel of the unit.
3.2 SWITCH THE UNIT ON
Switch the unit on (and off) using the main switch – see Figure 3.
The unit is ready for use after a few seconds when the text “XO FLEX” is shown on the instrument
bridge display and you hear the welcome tune.
Figure 3 – Main switch (1)

XO FLEX – Instructions for use Operation
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In case of emergency, use this switch to turn off the unit.
3.3 INSTRUMENT BRIDGE IN PARKING POSITION
Always place the instrument bridge to the left of the unit when the patient is
accessing the chair as shown in Figure 4.
In this position, the patient does not see the instruments when getting in and out of the chair and
the bridge will be easily accessible for cleaning and disinfection.
Figure 4 – Position of instrument bridge for optimal patient access to chair
3.4 FOOT CONTROL
FUNCTION
XO FLEX is controlled hands free by using the foot control – see Figure 5 – and the chair base
joystick – see Figure 6.
Figure 5 – Foot control
The foot control has:
•a pedal that can be moved to the right (⮕), to the left (⬅) and pressed down (⬇)
XO

XO FLEX – Instructions for use Operation
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•an Xbutton
•an Obutton
•a joystick that can be moved north (▲), west (◄), south (▼) and east (►)
When all unit instruments are at rest, the foot control manages functions related to the unit and
chair etc.
When a unit instrument is lifted forward, the foot control manages the active instrument.
The chair base joystick is used to position the patient chair.
The chair base joystick can be moved north ( ), west ( ), south ( ) and east ( ) – see Figure 6.
Figure 6 – Chair base joystick
In this manual, the above-presented terminology (e.g. ▲= move joystick to north) will
be used to explain the functions of XO FLEX.
See section 14 for an overview of the foot control and chair base joystick functions.
POSITION THE FOOT CONTROL
Place the foot control close to the unit’s supporting leg and operate it with your right foot when
working in positions 9 – 11 o’clock (see Figure 7). In working position 12 o’clock you may find it
easier to use the left foot (right-handed operator).
Figure 7 – Optimal position of foot control

XO FLEX – Instructions for use Operation
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3.5 XO SMART LINK
XO SMART LINK is an optional software running on an external PC connected to FLEX.
With XO SMART LINK you can configure the function of the foot control and you can work with
instrument programs.
Please see “XO SMART LINK instructions for use”.
3.6 PATIENT CHAIR
FOOT CONTROL OF PATIENT CHAIR
Use the foot control to position the patient chair.
Position the chair in working position 1 with .
Position the chair in working position 2 with .
When you activate the chair moves to the entry position – the position used to enter the chair
and for rinsing.
Activating brings the chair to the previous position – the last “still” position prior to the present.
See Figure 8.
Figure 8 – Position the patient chair using the chair base joystick
SMALLER ADJUSTMENTS OF PATIENT CHAIR
You make smaller adjustments of the chair with the foot control joystick:
•Lift the chair with ▲ (north)
•Lower the chair with ▼ (south)
•Increase the backrest inclination with ►(east)
•Decrease the backrest inclination with ◄(west)
See Figure 9.
Figure 9 – Smaller adjustments of the patient chair using the foot control joystick

XO FLEX – Instructions for use Operation
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SAFETY
The chair has been designed with a hinged backrest and is shaped so that the legs of the
operators will not be trapped below the chair when moving downwards.
The patient chair is equipped with a function stop:
You interrupt all automatic chair movements immediately by touching any button on
the foot control or by lifting an instrument forward.
To avoid damage never place any objects, including operators’ seats, under the
patient chair.
The patient chair is dimensioned to carry a patient with a weight of up to 150 kg!
Exceeding the maximum allowed weight will compromise the structural stability of
the unit and the patient chair.
SUPINE PATIENT POSITION
The unit is designed with over-the-patient delivery of instruments for working primarily on supine
patients. That allows you to see all tooth surfaces in good working postures – see details in section
3.7.
XO FLEX is intended to be used primarily with supine patients!
NECK REST
The patient chair is equipped with an adjustable neck rest, supporting the patient’s neck and head.
Figure 10 – Neck rest with (1) longitudinal lock and (2) release handle
To obtain the best patient experience, please follow these instructions when bringing the patient
into a working position:
1. Start positioning the chair

XO FLEX – Instructions for use Operation
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2. Release the longitudinal lock (1) – see Figure 10 – while the chair is moving
3. When in the desired working position, adjust the angular position of the neck rest using the
release handle (2)
CHILD CUSHION
For treatment of children, a child cushion is available.
Figure 11 – Child cushion
3.7 INSTRUMENT BRIDGE IN WORKING POSITION
To obtain easy access to and optimal balancing of the instruments, place the instrument bridge
close to the center of the patient’s chest – with a distance from the tips of the instruments to the
oral cavity of 30 cm – see Figure 12.
Figure 12 – Position of instrument bridge while working
Always use the handles to position the instrument bridge.
Never pull the instrument bridge using an instrument – this may damage the
instrument suspension.
BALANCED INSTRUMENTS
Grab an instrument as shown in Figure 13.

XO FLEX – Instructions for use Operation
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Figure 13 – Lifting an instrument forward
Each instrument suspension is fitted with a spring that can be adjusted so that the instrument is
perfectly balanced - see section 8.4.
FOUR-HANDED OR SOLO WORK
Figure 14 – Four-handed operation – here the operator is working in the 9 o’clock position, the chairside
assistant in the 3 o’clock position and the hand instruments are positioned near the patient’s temple
XO FLEX is equally suited for four-handed (Figure 14) and two-handed operation (Figure 15).
Figure 15 – Two-handed operation – here the operator is working in the 11 o’clock position
WORKING POSITIONS
With the patient in the supine position you may work in positions between 9 o’clock to 12 o’clock
(see Figure 16) to obtain the best possible vision while maintaining a healthy sitting position (see
section 3.24.)
The patient chair neck rest allows you to place the patient’s head in six different positions (see

XO FLEX – Instructions for use Operation
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Figure 17). This, combined with the flexibility of working in positions between 9 and 12 o’clock (see
Figure 16), provides you with the best possible view of each tooth surface without bending or
straining your neck, spine or upper body.
Figure 16 – Four operator’s positions

XO FLEX – Instructions for use Operation
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Figure 17 – Six different patient positions