Med Oral Patol Oral Cir Bucal. 2010 Mar 1;15 (2):e353-60. Torus palatinus and torus mandibularis Journal section: Oral Surgery doi:10.4317/medoral.15.e353 Publication Types: Review Current status of the torus palatinus and torus mandibularis Andrés S. García-García 1, José-María Martínez-González 2, Rafael Gómez-Font 3, Ángeles Soto-Rivadeneira 4, Lucia Oviedo-Roldán 5 1 Master in Oral Surgery, Implantology and Periodontics from the University of Southern Mississippi 2 Full Professor of Oral Surgery. Complutense University of Madrid 3 Director of the Master of Oral Surgery at the European University of Madrid 4 Master in Oral Surgery, Implantology and Periodontics from the University of Southern Mississippi 5 Master in Oral Surgery, Implantology and Periodontics from the University of Southern Mississippi Correspondence: University of Madrid. Spain García-García AS, Martínez-González JM, Gómez-Font R, Soto-Rivade- [email protected] neira A, Oviedo-Roldán L. Current status of the torus palatinus and torus mandibularis. Med Oral Patol Oral Cir Bucal. 2010 Mar 1;15 (2):e353-60. http://www.medicinaoral.com/medoralfree01/v15i2/medoralv15i2p353.pdf Received: 05/05/2008 Article Number: 1336 http://www.medicinaoral.com/ Accepted: 31/07/2009 © Medicina Oral S. L. C.I.F. B 96689336 - pISSN 1698-4447 - eISSN: 1698-6946 eMail: [email protected] Indexed in: -SCI EXPANDED -JOURNAL CITATION REPORTS -Index Medicus / MEDLINE / PubMed -EMBASE, Excerpta Medica -SCOPUS -Indice Médico Español Abstract While there is a hereditary component to tori, this does not explain all cases. Tori tend to appear more frequent- ly during middle age of life; the torus palatinus is more commonly observed in females, but this is not the case with the torus mandibularis. Certain ethnic groups are more prone to one torus or the other. The torus is mainly removed due to prostodontic reasons, as it may also be used as biomaterial, not only in periodontology, but also in implantology. The aim of this study was a review of the literature from the past twenty years. Key words: Torus palatinus, torus mandibularis. Introduction The discovery of these exostoses usually occurs inci- The tori (meaning “to stand out” or “lump” in Latin) (1) dentally during a routine clinical exam, as they usually are exostosis that are formed by a dense cortical and limi- do not produce any symptoms, except in cases of sig- ted amount of bone marrow, and they are covered with a nificant growth or in edentulous patients, in which case thin and poorly vascularized mucosa. They are usually lo- they may hinder the construction of the prosthesis. Des- cated at the longitudinal ridge of the half palatine, on the pite the numerous studies of which they have been and union of the palatine apophysis of the maxillae or on the continues to be the focus, their origin is unclear; various internal side of the horizontal branch of the jaw, above the possible causes are presented in the literature, but none mylohyoid line and at the level of the premolar area (1-8) of them are definitive. A certain prevalence with respect and canine area (6, 8-10), presenting a very slow (1,2) and to ethnic groups, sex and age has also been observed. Its progressive growth that can stop spontaneously (1). elimination in dentate patients cannot be justified, un- Castro Reino et al. (1) define it as a congenital bony less it can be used clinically or as a filling biomaterial in protuberance with benign characteristics, leading to the order to correct bone defects that patients may suffer in “overworking” of osteoblasts and bone to be deposited some part of their jaw area. along the line of fusion of the palate or on the hemi- The prevalence of occurrence of the tori, according to mandibular bodies. the study by Al-Bayaty et al. (4) is 12.3%, very close to e353 Med Oral Patol Oral Cir Bucal. 2010 Mar 1;15 (2):e353-60. Torus palatinus and torus mandibularis that of Bruce et al. (7) with 14.6%, while Jainkittivong sociate the presence of teeth at the mandibular level with et al. (6) showed their prevalence to be 26.9%. the presence torus. To further support this, in the study Since there is a very limited amount of current scientific conducted by Eggen et al. (21), they found a relationship literature that discusses the tori, given that they are very between the presence of torus and the number of teeth common and have no pathological interest, we aim to present in the mouth. In addition, among adolescents conduct a review of the literature of the past 20 years, in with mandibular tori, the ratio of non-erupted canines order to analyze the etiological and epidemiological fac- was much smaller than those who did not have any tori. tors, as well as its treatment, complications and possible Furthermore, in another study, Eggen (19) found a rela- application in the field of bone regeneration. tionship between the presence of mandibular tori and a normal bone height around the teeth. Etiology The exact cause of appearance of the tori is not clear. Frequency (4-6, 9,11) The most widely accepted theory today is As aforementioned, the prevalence of the appearance of genetics (1,2, 4-7, 11,12), but it has not always been tori is very important, which according to the study of possible to show the autosomal dominant nature of its Al-Bayaty et al. (4), is 12.3%, very close to the 14.6% appearance. (7,14) In the three clinical cases analyzed found by Bruce et al. (7). by Curran et al. (15), in which a daughter, mother and In the majority of the studies reviewed, the appearance grandmother had autosomal dominant osteosclerosis, of the TP is more frequent than that of the TM, (3-6, mandibular tori (MT) and palatine tori (PT) were found 12,14,18, 22-25); however, there are reviews such as to be present in all three women. In the study by Eggen those by Sonnier et al. (11), Sirirungrojying et al. (5) (16), it was only possible to estimate the genetic origin and Bruce et al. (7), which show a higher presence of of the TM in 29.5% of the cases; as for the rest of the TM than of TP. cases, approximately 70%, the origin was attributed The only studies that we found linking the presence of to environmental factors, mainly related to occlusal both exostosis were by Al-Bayati et al. (4), Bruce et al. stress. (7) and Haugen (22), who reported it in 2% to 3% of Another cause is superficial injuries (1,2) or its occur- cases, whereas Jainkittivong et al. (6) reported its pres- rence as a functional response in individuals with well- ence in 28.12% of the cases. Haugen (22) found that the developed chewing muscles, (2, 4-6, 11,13,16) or in pa- probability of finding TM in a person with TP is more tients with abraded teeth due to occlusion. (2, 5-7, 11-13, than double than that of a person without TP, and vice 16,17) In the study conducted by Reichart et al. (3), they versa. In their study of Trinidad and Tobago, Al-Bayaty found a significant correlation between the incidence of et al. (4) also believe that there is a strong association torus and the presence of abraded teeth in Thais, but between TP and TM (50% of subjects with TM had TP, not in Germans. In studies conducted by Sirirungroj- yet only 30% of subjects with TP had TM) (Table 1). ying et al. (5), Clifford et al. (10) and Kerdpon et al. (12), they found a large relationship between the TM and Age parafunctional habits, which they did not find with the It is not easy to compare the range of ages provided in TP. (5,12) Thus, Sirirungrojying et al. (5) determined the studies that we have analyzed, since in many cases, that TM can be used to indicate the risk of appearance they are not standardized and each author gives a differ- of temporomandibular disorders. ent reference. According to a study by Bruce et al. (7), As possible causes, other authors mention eating habits, the average age when experiencing the onset of tori, is (4,5,7) states of vitamin deficiency or supplements rich 34 years old. According to Al-Bayaty et al. (4), the ave- in calcium (13), and also diet (4, 16-19). In the studies rage age is 30.7 years old for patients with TP and 39.2 conducted by Eggen et al. (18) and Al-Bayaty et al. (4), years old for those with TM. they associate the consumption of fish with the presence The onset of tories appears to be earlier among those of tori, because fish contains Ω3 unsaturated fatty acids with TP (4,13), where cases of such onset have been des- and vitamin D, encourages bone growth. cribed from birth and the first decade of life. (13) In Sasaki et al. (20) tried to draw a relationship between the the observations of Reichart et al. (3) (in women) and occurrence of tori and the prolonged use of phenytoin, Al-Bayaty et al. (4) the most common age range for the but were unable to conclude that it was what caused the onset of TP is from 11 to 20 years old. Although most appearance of the tori. However, they did determine that studies found the more common age range for such on- it is a factor that leads to an increase in size, because it set to be between 30 and 50 years old, third and fourth induces an increase in calcium homeostasis, functio- decade of life (3,7,12,14,22), in the study conducted by ning as an osteogenic agent.