Revision Aligner Therapy – RevAT

A Dental Solution for Those with Sleep Disorders, Tinnitus, Temporomandibular Disorders, Malocclusion and Periodontal Disease

Executive Summary:

Over the past few decades, dentists and physicians have seen large increases in visits for orthodontics, sleep disordered breathing (SDB), obstructive sleep apnea (OSA), continuous positive airway pressure (CPAP) devices, temporomandibular joint (TMJ) disorder (TMD) and tinnitus that have far exceeded the population growth rate. Peer-reviewed studies suggest that a cause-and-effect relationship exists.

By reducing undesirable forces emanating from the teeth, Revision Aligner Therapy (RevAT) is curbing triggers known to adversely impact SDB, OSA, TMD and tinnitus.

RevAT’s respect for the essential fundamental biomechanical physiologic principles is a major reason why it yields benefits seldom seen with traditional aligners.

The consultation is the right time to discuss what steps will be taken to minimize the likelihood that the recommended dental care will not adversely impact sleep, TMJ, tinnitus, bite or periodontal health.

An examination of peer-reviewed research findings points to why it is likely that interrelationships exist between sleep disordered breathing (SDB), obstructive sleep apnea (OSA), temporomandibular joint (TMJ) disorder (TMD), tinnitus, malocclusion, periodontal disease and dental (orthodontic) care.

Sequential removable revision aligner therapy (RevAT) is a recently developed novel dental remedy that has provided relief for some struggling with SDB, OSA, TMD, CPAP usage, tinnitus, malocclusion and periodontal disease. RevAT’s primary focus involves moving teeth so the tooth-touching forces passed through to the supporting bone (basal alveolar osseous process) are reduced to a less uncomfortable, less-disturbing or non-disturbing level. While the smile takes a bit longer to become pleasing and the bite takes a bit longer to become more efficient, the diminished impacts from SDB, tinnitus, OSA and TMD are warmly appreciated by patients who were suffering at the start of care.

It has long been known that on occasion dental treatment, or the lack of it, will create or exacerbate periodontal disease and malocclusion (occlusal disease).1,2,3,4,5,6,7,8,9,10

What is less widely known, but increasingly being brought to our attention by researchers, is dentistry’s growing likelihood as a nexus for sleep health problems, tinnitus issues and chronic pain from TMD.11,12

According to studies funded by the National Institutes of Health (NIH) and other sources, if one has SDB, TMD or tinnitus, there is a 20%–70% chance they will have two or three of those conditions.13,14,15,16,17,18

Health updates reported by RevAT patients regarding their SDB, OSA, chronic TMJ, periodontal and tinnitus status matched or surpassed findings detailed in those studies.

The pace that teeth are repositioned with RevAT is slower when compared to conventional orthodontic braces and traditional aligners. RevAT patients need patience, because their treatment will always take longer. The reduced pace is valuable however, because it facilitates the highly desirable reformulation (improved quality) of the supporting bone and the gingiva (gums).19

A Phase 1 Clinical Trial (P1CT) that will measure RevAT’s efficacy for helping with SDB, tinnitus, OSA and TMD is warranted.20 The results from the P1CT could yield significant implications for many health fields (otolaryngology, sleep medicine, chronic pain management, dentistry, mental health).

SDB and TMD

There is an association between sleep disordered breathing (SDB), such as obstructive sleep apnea (OSA), and temporomandibular disorder (TMD). Research has shown that about half (52%) of the patients who have SDB will also have TMD.21,22,23 Some treatments both improved sleep quality and reduced TMD pain.24,25,26

SDB and Tinnitus

When an SDB treatment was successful, tinnitus often also improved.27,28 That is good news since almost ¾ of patients (71%) suffering with tinnitus report having SDB.29 The elderly are the demographic most likely to have both SDB and tinnitus.30

More than a dozen patients who faithfully followed the RevAT protocol obtained relief from SDB, TMD, tinnitus, OSA, malocclusion and/or periodontal disease. Compared to observations reported in peer-reviewed scientific journals, RevAT patients’ improvements exceeded expectations. It is also important that some whose RevAT compliance was deemed inadequate experienced increases in discomfort, pain and/or annoyance.

Those observations confirm the value created when a novel concept (five USPTO patents), physiologically sound tooth repositioning patterns and sophisticated designs are combined with a strict adherence to the RevAT protocol. Based on results reported after traditional aligner care, RevAT patients consistently had more comfortable and healthier outcomes.

SDB and Periodontal Disease

Traditional periodontal care successfully manages the disease for some patients. When periodontal disease does not respond to standard therapies, the possibility that the underlying cause is due to a systemic, not an oral origin, needs to be considered.

One study evaluated the efficacy of four at-home sleep disordered breathing (SDB) screening and measuring tools; Papillary Bleeding Index (PBI), Epworth Sleepiness Scale (ESS) questionnaire, STOP-Bang (OSA) questionnaire, and salivary cortisol testing. 46 of the 71 subjects (65%) had an apnea-hypopnea index ≥ 5, signifying probable obstructive sleep apnea (OSA). PBI readings successfully identified (63%) of those possessing SDB, STOP-Bang (18%), ESS (6%), and salivary cortisol (0%). These results point to PBI being a reliable, objective means for dentists to identify SDB in patients with unresolved periodontal disease.31

These findings validate the importance of using a comprehensive evaluation system having dental and non-dental gauges. Tracking the health status of the TMJ, tinnitus, gums, bite and sleep at regular intervals elevates the likelihood that optimum comfort and results will be obtained during and after orthodontic care, and RevAT.

TMD and Tinnitus

Evidence continues to mount supporting an association between TMD and tinnitus. According to the American Tinnitus Association (ATA), tinnitus affects 10–15% (33–50 million) of the United States (US) population. Tinnitus is a perceived sound that is initiated by an internal source, not from an external source.

TMD complaints in subjects with severe tinnitus (36%) was nearly double compared to all who had tinnitus (19%).32 While it could be viewed as TMD being a contributor to tinnitus severity, it is also possible that tinnitus patients with TMJ complaints are a distinct subgroup, since both conditions responded favorably to the same treatment.33

The presence of tinnitus was eight times higher in participants having TMD than in participants without TMD. The statistical analysis confirmed that disparity (8x) was highly significant.34

Another plausible explanation is that the same problems are causing TMD and tinnitus.35,36 That reasoning reinforces the importance of following fundamentally sound precepts, the foundation for RevAT’s designs and protocol. The value gained from monitoring multiple disorders (SDB, TMD), ailments (tinnitus) and diseases (periodontitis, malocclusion) while moving teeth needs to be appreciated and embraced.37

Periodontal Disease and Tinnitus

Periodontal disease (gingivitis, periodontitis) is common — present in about 40% of the US adult population (Centers for Disease Control and Prevention [CDC]).

A 2021 study by researchers determined that periodontitis is associated with tinnitus.38 Data compiled after reviewing years of Taiwanese dental visits showed that patients without periodontal disease were far less likely to have tinnitus than those with periodontal disease.39

A senior informationist with the American Dental Association Science and Research Institute (ADASRI) acknowledged that the Institute is aware that periodontists, orthodontists, prosthodontists and general practitioner dentists have on occasion had to address health changes (periodontal, tinnitus, occlusion, TMJ, sleep) that occurred during and post-orthodontic care, implant rehabilitation and other dental treatments.40,41,42,43,44,45,46,47,48,49,50,51,52,53,54

Tinnitus and Orthodontic Treatment

In orthodontic patients, high points (when tooth cusps touch a bracket, band or composite addition [attachment, engager]) between opposing teeth can lead to inadequate or incomplete intercuspation (impeded bite). This problem is easily resolved by making sure there are no interferences with the other arch while at rest or during function.

In one study, multiple participants acquired tinnitus while their orthodontic treatment was being carefully monitored. A two-month pause of their orthodontic care, which included the complete debonding (removal) of brackets affixed to the teeth, was unfortunately an insufficient length of time to have the affected subjects’ tinnitus revert to being asymptomatic, as it was prior to the start of the study.55

It appears possible that occlusal forces generated from heavy touching, unfavorable axial inclinations (poor tooth angulations), insufficient parallelism or inadequate proximal contacts (sides of teeth not touching properly) might be causing tinnitus.56 That plausibility is further fed by the TMJ (temporomandibular joint) being located so close to the ear.57

During a study evaluating the efficacy of a device designed to increase the size of a maxilla (hard palate), multiple (7%) initially asymptomatic participants who received the microimplant-assisted rapid palatal expansion (MARPE) device unexpectedly developed tinnitus. The MARPE evaluators did not report that prospective participants completed a universally accepted tinnitus status questionnaire prior to being considered for inclusion in their carefully monitored orthodontic research. Fortunately, the subjects’ tinnitus was merely transient. Both patients had their tinnitus fully resolve once their maxillary skeletal expander (MSE) and microimplant were removed.58

Before initiating extensive dental therapy, patients should be made aware that the treatment can have a positive, negative, or no impact on their sleep, TMJ, tinnitus, bite health and/or periodontal health.59

These are worthy reasons to investigate the interrelationships between tinnitus (and SDB, TMD, OSA, periodontal condition…) and orthodontic procedures.

Conclusion

  • Awareness is increasing amongst health professionals that the rise of certain conditions and ailments may be due to unintended dental care consequences.
  • Unique RevAT design methods (multiple USPTO patents issued 2018–2026) and a robust protocol help mute undesirable SDB, TMD, OSA and tinnitus triggers.60
  • Strict adherence to fundamental physiologic biomechanical principles helps explain why RevAT consistently yields results seldom seen with traditional aligners.61
  • Patients appreciate learning that steps will be taken to reduce the likelihood that their dental care will have a negative impact on their sleep, TMJ, tinnitus, bite and periodontal health.62

References

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