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Palatal and Mandibular Tori: diagnosis, clinical significance and conceptual basis
Abstract
Os toros palatino e mandibular são distúrbios do desenvolvimento do tipo anomalia de forma, com manifestação tardia no crescimento e maturação dos maxilares. Os casos familiares e a persistência dos toros com a idade e em desdentados lhes atribuem uma origem genética, que começa a ser desvendada. Há uma dificuldade para interpretar os toros como uma resposta adaptativa à sobrecarga oclusal, bruxismo e outros fatores externos, pois os toros não são hiperplasias e hipertrofias adaptativas. Os toros são protuberâncias ósseas sem cápsula fibrosa, o que os diferencia dos osteomas e lhes tira a natureza neoplásica, mesmo que benigna, especialmente porque também não apresentam crescimento contínuo e sem controle por parte do organismo. O tamanho dos toros se estabiliza ao final do crescimento dos maxilares, por volta dos 22 a 24 anos de idade. Os toros são constituídos de osso normal, do ponto de vista funcional e estrutural, e podem ser utilizados como sítio de origem de transplante ósseo autógeno para outros locais ou como sede de implantes osseointegráveis, se houver conveniência clínica para tais procedimentos. A sua remoção pode ser feita quando impedem procedimentos odontológicos terapêuticos.
... Lesion exeresis is the treatment of choice. (Consolaro et al., 2019) Mandibular tori growth may lead to phonetics disturbances, due to the impairment of tongue movement. (Lúcio et al., 2013;Sorrentino et al., 2019) When something results in impairment of tongue movement or in its related structures might cause speech disturbances, due to its ability of quick change of movements and form during speech and mastication. ...
... The treatment of choice was the use of metronidazole paste and laser therapy, which show significant progress. (Casenave et al., 2021;Consolaro et al., 2019) ...
Mandibular torus is a slow-growing bone exostosis with well-defined borders, usually oval and bilateral in shape. Diagnosis is made through clinical and radiographic findings. Surgical removal is necessary when there is a prosthetic indication, recurrent trauma, and in rare cases, due to phonetic disorders. The interference in speech caused by the torus, is due to its size and location, which interferes with the usual positioning of the tongue, changing the articulation points, and thus making pronunciation difficult. Therefore, the aim of this study is to report a clinical case of excision of a bilateral mandibular torus due to speech impairment. A 47-year-old male patient sought dental care complaining of bone growth in the mandible. The clinical examination showed a bilateral increase in the lingual region of the mandible, which was unilobular on the right side and trilobular on the left side, measuring approximately 20x20mm. The patient underwent a surgical procedure to remove the torus under local anesthesia. In the 7-day postoperative period, suture dehiscence was observed, as well as traumatic ulcers and pain complaints. The patient reported that he did not pay attention to postoperative care. As a method of treatment of suture dehiscence, a metronidazole paste was used, as well as a laser therapy protocol, ensuring soft tissue healing. After complete healing, in the clinical evaluation, the patient did not present difficulties in pronunciation. Therefore, it is concluded that, although uncommon, the torus, due to its growth, can interfere with the positioning of the tongue and, consequently, with phonetics, which is a plausible indication for the surgical procedure. Once, the normal bony contours of the mandible are re-established, as well as repositioning and lingual function.
... Microscopically, these structures consist of dense cortical bone, typically well-demarcated from surrounding tissues. They may occasionally contain trabecular bone, but are predominantly made up of cortical bone and generally lack significant vascularity or signs of infection [1][2][3]15]. These tori can be beneficial in some cases; for instance, there are reports of related growths being surgically removed for regenerative purposes and used as a donor site for an autogenous bone graft [4,14]. ...
Purpose: The objective of this study was to determine the prevalence of exostosis in the Mississippi population. Methods: The patient archives of the UMMC School of Dentistry between January 2018 and May 2021 were examined. Patients with exostosis were included in the study based on the findings from intraoral photographs, full-moth series (FMS), panoramic radiographs, and cone-beam computerized tomography (CBCT) images of the patients. Patients were excluded from the study if they did not have maxillary or mandibular exostosis. In addition, each patient’s age, gender, and ethnic origins, such as Caucasian, African-American, or Asian, were recorded. All data regarding exostosis were evaluated and categorized according to age, gender, and ethnicity. Multiple logistic regression analysis was performed for more detailed statistical analysis. Results: A total of 1242 patients were examined for the presence of maxillary and mandibular tori. In total, 303 patients were diagnosed with maxillary and/or mandibular tori among the Mississippi population, with a prevalence rate of 24.4%. Exostosis was seen more in females (57.4%) compared to males (42.6%). The highest prevalence of exostosis was seen in Caucasians (71.3%), followed by African-Americans (23.8%) and Asians (5%). Conclusions: High prevalence of exostosis was seen in the Mississippi population. Our findings will help clinicians to be more aware of these bony protuberances and, thus, better at diagnosing them. This may specifically help oral surgeons, periodontists, and prosthodontists in pre-prosthodontic surgery and denture fabrication.
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