What is Tori?
Diagnostic Phase:


Bilateral lobular mandibular torus due to functional stress in the bruxism individual. This patient request for full mouth reconstruction and thus fabrication of crowns in all the posterior teeth. Removal of the bony exostosis improved the food impaction problems occured as the bony ledges prevent food deflection away from the dentogingival junction and results in gingival overgrowth due to chronic gingival irritation. Osseous recontour also allowed improved tongue space, increased clincial crown height for crown retention.
Treatment





Notes: full thickness flap reflected on lingual; reflection shows bilateral lobulated bony protuberances of the mandibular lingual alveolar ridge; bone recontour on the lingual to remove all the exostosis; flap sutured with much improved osseous contour to improve food deflection away from the dentogingival junction and a much better architecture for crown fabrication. Also noted a much improved tongue space.
Healing



Notes: initial photo; immediately after surgery; 14 days photo. All the lobular exostosis were removed along with the bone ledge on the lingual alveolar plates.

Case treated by Dr. Bui, D.D.S., M.S., at Cosmetic Dentist of Katy


Dinh X. Bui, D.D.S., M.S.

What is tori?
Tori is a common exostosis that develops either in maxilla or mandible. When occurred in the palatal region, it is referred to as torus palatinus. When occured in the mandible, it is called torus mandibularis. They are localized bony protuberances that originates from the cortical plates.

Torri are sometimes classified according to their shape:

  • Flat torus has a broad base and slightly convex smooth surface and usually is symmetrical on to both sides of the mouth
  • Spindle torus presents as a midline ridge in the maxilla
  • Nodular arises as multiple protuberances, with individual base.
  • Lobular torus presents as a lobulated mass, but it arises from the single base.

Histologically, exostosis is a mass of dense, lamellar, cortical bone with a small amount of fibrofatty marrow and in some case a small amount of trabecular bone at the inner zone. The pathogenesis of the torus is multifactorial, including both genetic and environmental influences such as local irritation, bruxism, and malocclusion or functional stresses. Palatal tori is more common than mandibular tori, and the occurence of tori is more common in the Asian population.

Do we need to remove the tori?
Most of the time no treatment is necessary unless in the case of edentulous patient where surgical removal of the torus is required to accommodate a lower or upper denture. The exostosis prevents the seating of denture or partial and also may cause gingival irritation due to functional stress upon denture or partial insertion. In the partial edentulous patient, tori may be removed upon fabrication of the partial denture. In patient with teeth, tori may be removed to aid in improvement of food deflection from the dentogingival junction and eliminated food impaction into the areas. Bony exostosis also removed to aid in improving clinical crown height in crown fabrication. Finally, tori is also removed to improve oral hygiene by allowing better angulation of tooth brush head into the dentogingival junction.

Does the tori grow back in time?
The recurrence of tori is rare and also if occured is very slow. In edentulous patient recurrence will not occured. Functional stresses can be reduced or treated with full mouth reconstruction.

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About Us

Below is the case of maxillary exostosis preventing the insertion of a complete denture due to undercut. After a thorough examination, Dr. Bui decided to perform the osseous surgery to remove the exostosis prior to denture construction. We began to construct the complete denture approximately four to six weeks after the healing of the surgery.








Notes: Initial view; flap reflected (right and left sides) showing exostosis; bone recontour (right and left sides) to remove exostosis; suture with continuous interrupted suture


Final Comparison



Notes: before (right) and after (left); final smile with complete upper and lower dentures

For full presentation of this case done in Flash, please browse our porfolio section, under "OMFS Surgery, Exostosis/Tori Removal"