Orthotown January/February 2021 - 20

message board

Ringing in the Ears
During Invisalign Therapy
Townies review possible causes for tinnitus-like symptoms in two separate cases

drbkreddy
Member Since: 05/01/13
Post: 1 of 7

Hi, Townies. Two of my Invisalign patients informed me that they started experiencing
ringing in their ears. They both said it was transient. Both had got their hearing tested by the
ENT with no issues detected. One was a chartered accountant, and one was a gym instructor.
So, no similarities there. Just wondering if anyone out there heard of something like this or
is this something new that has to be researched or it's just coincidental. ■
10/21/2020

Dr-T
Member Since: 05/19/09
Post: 2 of 7

Most likely coincidental, but I have had a few patients chew/brux on the trays, leading to TMJ
muscle fatigue and soreness. It may be a stretch, but that is the only connection I can think of. ■
10/21/2020

davidharnick
Member Since: 08/28/02
Post: 3 of 7

If problems arise during aligner TX, a number of times they hit only the 7s. We section the
distal half of the lower and this seems to help. ■
10/21/2020

mmclaugh
Member Since: 03/10/08
Post: 4 of 7

Although signs like tinnitus may not be common with aligner therapy, the underlying cause
is very common. Clear aligner therapy is an amazing tool for closing anterior open bites. This
is because posterior teeth are easily intruded with clear aligner treatment. I had a number of
cases showing posterior bite separation and heavy anterior dental contact, 20 or so aligners into
treatment. So, I changed my aligner protocols as a result.
Now, whenever an aligner patient returns for additional aligners, I perform an occlusion test
in addition to all my normal aligner patient protocols. In addition to palpating the TMJ, and
asking the patient about possible TMJ symptoms, I will ask the patient about their bite. ( " Are
you feeling heavy contact between front teeth when chewing? " )
I will then use mylar paper or thin blue articulating paper to test the patients' bite without
aligners in place. I am looking for strong vertical stops posteriorly, testing the most distal molars
first. I also want the articulating paper to " slide " between the incisors when fully intercuspated.
In other words, the articulating paper can " drag " between incisors when biting but I do not want
the patient to " hold " the articulating paper anteriorly in centric occlusion (CO).
In the two examples you mentioned and in the numerous cases I where have noted posterior
separation, there are a couple of options to help correct the situation. One, build up the most
terminal mandibular molars occlusally with triad or composite until the articulating paper " draws "
between incisors in CO. Then cut off these terminal teeth from the remaining lower aligners.
Or you can rescan at this time, with the occlusal build-ups in place and request vertical elastic
buttons to erupt the posterior dentition as well as lingual bite turbos on upper incisors, canines
or both. Then once posterior occlusion is properly re-established, tinnitus eliminated,
You can remove the build-ups and send in an additional scan to try to further erupt the
posterior teeth. (Remember the upper lingual bite turbos.) An easier and quicker fi x is simply to
cut off the molars from their current upper and lower aligners and hope to get some eruption prior

JANUARY/FEBRUARY 2021 // orthotown.com

OT0121_MB2_Invisalign.indd 20

1/15/21 11:26 AM

https://www.orthotown.com/messageboard/thread.aspx?s=6&f=693&t=349083&g=1 http://www.orthotown.com

Orthotown January/February 2021

Table of Contents for the Digital Edition of Orthotown January/February 2021