Torus Mandibularis Research Articles

Oral Tori Findings in an Adult Albanian Population: A Single-Center Pilot Study.

Tori are bony growths in the mouth caused by genetic and environmental factors. Oral tori may grow over time and interfere with oral hygiene, speech, mastication, and the application of dentures. The aim of this study was to evaluate the prevalence and patterns of torus mandibularis and torus palatinus according to age and gender among people in Albania. A single-center pilot study was conducted at Diamond Dental Hospital (DDH) from 1 February to 30 April 2024 in Tirana, Albania. Written consent was obtained from each participant. The patients were interviewed by one trained researcher and examined intraorally by one experienced examiner. Photographs were taken of any positive findings. The prevalence of oral tori in this sample from Albania was very high at 48%, and the peak incidence was in the 18-29 age group (54%). The most common type was torus mandibularis, with a prevalence of 39%. The most prevalent form of torus palatinus was flat (71%) and of torus mandibularis was solitary bilateral (48%). This single-center pilot study found a high prevalence of oral tori among people in Tirana, Albania. Its prevalence was not related to gender or bruxism. Dental professionals should note the high occurrence of oral tori and their importance in dental practice.

Genetic Variants in KCTD1 Are Associated with Isolated Dental Anomalies.

KCTD1 plays crucial roles in regulating both the SHH and WNT/β-catenin signaling pathways, which are essential for tooth development. The objective of this study was to investigate if genetic variants in KCTD1 might also be associated with isolated dental anomalies. We clinically and radiographically investigated 362 patients affected with isolated dental anomalies. Whole exome sequencing identified two unrelated families with rare (p.Arg241Gln) or novel (p.Pro243Ser) variants in KCTD1. The variants segregated with the dental anomalies in all nine patients from the two families. Clinical findings of the patients included taurodontism, unseparated roots, long roots, tooth agenesis, a supernumerary tooth, torus palatinus, and torus mandibularis. The role of Kctd1 in root development is supported by our immunohistochemical study showing high expression of Kctd1 in Hertwig epithelial root sheath. The KCTD1 variants in our patients are the first variants found to be located in the C-terminal domain, which might disrupt protein-protein interactions and/or SUMOylation and subsequently result in aberrant WNT-SHH-BMP signaling and isolated dental anomalies. Functional studies on the p.Arg241Gln variant are consistent with an impact on β-catenin levels and canonical WNT signaling. This is the first report of the association of KCTD1 variants and isolated dental anomalies.

Frenotomy Provides Improved Direct Laryngoscopy Exposure in Select Adult Patients With Ankyloglossia.

Objective: To analyze the effects of lingual frenotomy on adults with restrictive ankyloglossia and difficult direct laryngoscopy exposure. Methods: A case series study was conducted. Restriction of tongue protrusion due to ankyloglossia was identified in 2 patients who had a history of suboptimal true vocal fold (TVF) exposure on direct laryngoscopy for phonomicrosurgery. Inadequate exposure of the vocal folds was achieved on direct laryngoscopy attempts with manual tongue protrusion. Mandibular tori were not present in these patients. An intraoperative lingual frenotomy was performed in both patients. Results: After frenotomy and with manual tongue protrusion, direct laryngoscopy exposure was substantially improved allowing for considerably more visualization of the anterior TVFs. Conclusion: Lingual frenulum procedures with manual tongue protrusion should be considered in select adult patients with restrictive ankyloglossia affecting optimal direct laryngoscopy exposure.

An Atypical Midline Anterior Torus Mandibularis: A Case Report

Benign bony growths called tori can develop in various places throughout the mandible and maxilla, although their exact origin is still unknown. There have been numerous reports of unilateral or bilateral Mandibular Tori (MT); however, no reports of a midline anterior mandibular tori have been made yet. A 27-year-old female patient reported with a complaint of a bony growth on her lower jaw below the tongue. The tori are unusually situated at the midline on the lingual side of the mandibular central incisor. The elements shown to be causal were the gender of the male, the ethnicity of Asians, and developmental in origin. The cornerstone of treatment for Tori is surgical resection. After a year of follow-up, there was no recurrence. The present case highlighted the significance of etiological factors for bony exostosis management and recurrence, which, in conjunction with origin, gender, ethnic and racial factors, may account for the patient’s lack of recurrence.

Characteristics and Risk Factors for the Fracture of One-Piece Implants.

The one-piece dental implant was originally designed to overcome the structural weaknesses of the two-piece implant. However, a fractured one-piece implant requires removal because the abutment cannot be repaired or replaced to support new prosthetic restorations. The aim of this study was to clarify the features and risk factors for fracture of the one-piece implant. This study was designed as a retrospective case series research. The subjects were patients who were treated for fractures of the one-piece implant at a clinic in Japan between 2012 and 2021. Fractures of the one-piece implant were diagnosed by cone-beam computed tomography, and the association between age and duration from implant placement to fracture was analyzed by one-way ANOVA followed by the Tukey test. Eighteen patients and 20 one-piece implants (under 39years: 5 patients and 6 implants; 40-59years: 7 patients and 7 implants; over 60years: 6 patients and 7 implants) had fractures in their one-piece implants. Of the fractured implants, 11 had a diameter of 3mm, and 9 had a diameter of 4mm. The mean durations up to implant fracture were 662days in the younger group, 1467days in the middle group, and 1239days in older group, and the duration was significantly shorter in the younger group. In addition, 83.3% of fracture implants in the younger group were in the molar region. All fractures of the one-piece implants occurred under the bone margin. Two patients had torus mandibularis, and 1 patient was had bruxism. One-piece implants in younger patients that are located in the lower molar position are the most susceptible to implant fracture, and the fracture occurred under the bone margin in all cases.

TORUS PALATINUS AND TORUS MANDIBULARIS: A LITERATURE REVIEW UPDATE

Torus palatinus and torus mandibularis are common localised bony overgrowths of cortical bone, which are non-pathological. As tori have been widely discovered for ages, there are some new findings in the 21st century. This review aims to summarise the aspect of aetiology, sociodemographic features, clinical features, treatments and functions of tori. A search was performed in PubMed and Google Scholar databases from 1950 until 2022. From the total of 4,150 studies evaluated, 61 articles were included in this review. The aetiology of tori has shown that Y chromosomes and some signal factors (Notch3, SMAD9, LRP5 V171) may affect its occurrence. The prevalence among people of East Asian is higher than among West African heritage, and the age range is 20-50 years old. Clinical features of tori are represented by size, shape and location, and sometimes by symptoms. Patients who need the removal of tori are treated by surgical removal using burs/bone chisel and mallet/peeling it with Er:YAG laser/piezoelectric surgery, plus postoperative anti-inflammatory drugs, which give a good healing effect. In addition, tori can be used as an autogenous bone graft to repair periodontitis bone defects in maxillary sinus lift cases and to increase bone thickness for dental implants. Tori can also be a marker for hyperparathyroidism and bioarcheological investigation. In conclusion, updates on these aspects have been found. However, complex aetiology needs to be further confirmed. Moreover, treatment is worth tracking, and its function as autologous bone deserves to be studied in other body parts.

A modified impression technique for a patient with mandibular exostosis

The mandibular torus is an exophytic osseous asymptomatic overgrowth often found bilaterally in the premolar region. Recording this structure in an impression is difficult. This article describes a technique of recording the mandibular tori with a modified stock tray. This novel method reduces discomfort and trauma to the patient and the entire surface of the tori is recorded.

Mutations in the WLS are associated with dental anomalies, torus palatinus, and torus mandibularis.

Canonical and non-canonical WNT signaling are important for odontogenesis. WNT ligand secretion mediator (WLS; MIM611514) is required to transport lipid-modified WNT proteins from the Golgi to the cell membrane, where canonical and non-canonical WNT proteins are released into the extracellular milieu. Biallelic pathogenic variants in WLS are implicated in autosomal recessive Zaki syndrome (ZKS; MIM 619648), the only genetic condition known to be caused by pathogenic variants in WLS. To investigate molecular etiology of dental anomalies in 250 patients with or without oral exostoses. Clinical and radiographic examination, and whole exome sequencing, were performed in the case of 250 patients with dental anomalies with or without oral exostoses. Four extremely rare heterozygous missense variants (p.Ile20Thr, p.Met46Leu, p.Ser453Ile and p.Leu516Phe) in WLS were identified in 11 patients with dental anomalies. In five of these patients, a torus palatinus or a torus mandibularis was observed. We report for the first time the heterozygous WLS variants in patients with dental anomalies. Root maldevelopments in patients with WLS variants supports the role of canonical and non-canonical WNT signaling in root development. We also show that variants in WLS were implicated in torus palatinus and torus mandibularis. In addition, this is the first time that heterozygous carriers of WLS variants were found to manifest phenotypes. WLS variants were likely to have adverse effects on the concentration of WNT ligands delivered to the cell membrane, resulting in aberrant canonical and non-canonical WNT signaling, and subsequent phenotypes. Patient's positioning during the acquisition of panoramic radiography might have affected the appearance of the tooth structures. If we had all family members of each patient to study co-segregation between genotype and phenotype, it would have strengthened the association of WLS variants and the phenotypes.

RF30 | PSAT134 Autosomal Dominant Hereditary Multiple Osteochondromas Misdiagnosed As Paget's Disease of Bone

Abstract Background Autosomal dominant hereditary multiple osteochondromas is a rare genetic disorder with variable clinical manifestations. We present the case of a patient misdiagnosed with Paget's disease of bone found to have hereditary multiple osteochondromas. Clinical Case We present a 55-year-old male with history of chronic back and hip pain who presented to endocrinology clinic for evaluation of Paget's disease of bone. He was diagnosed with Paget's disease at age 16 after a bike accident resulting in knee pain where a "knot" was removed from his knee. He reported multiple "knots" in bones throughout adulthood but never sought treatment. He had history of elevated alkaline phosphatase on prior chemistries. He developed debilitating back, hip, and thigh pain resulting in immobility and suffered vertebral osteomyelitis from MRSA requiring laminectomy at age 52. On physical exam, massive maxillary and mandibular tori were noted along with bilateral cataracts and decreased muscle strength in upper and lower extremities. He underwent evaluation by oral surgery for extensive tooth decay and was recommended for extraction of teeth #12, 14, 15, and 17 with restorative needs for teeth #2, 4, 5, 13, 28, 30, 32. Labs notable for serum calcium 10.1 (ref: 8.4-10.5 mg/dl), phosphorus 4.2 (ref: 2.3-4.7 mg/dl), magnesium 1.8 (ref: 1.6-2.6mg/dl), PTH 34 (ref: 16-77 pg/ml), 25-OH Vit D 28 (ref: 25-80 ng/ml), 1,25 dihydroxyvitamin D 45.9 (ref: 19.9-79.3pg/ml), alkaline phosphatase 199 (ref: 40-150 unit/L), bone-specific alkaline phosphatase 52.5 (ref: 6.5 - 20.1 mcg/L). 24-hr urine calcium 0.06 g/24hr (ref: 0.04-0.35) from an 850ml urine volume. Procollagen type 1 n-terminal propeptide 179 (ref 22-105 UG/L). Prior MRI right hip showed "abnormal appearance of pelvic bony ring and proximal femurs with heterogenous marrow signal and cortical thickening suspicious for Paget's disease", as well as a 1.2cm circumscribed cystic focus within proximal right femoral diaphysis. Prior bone scan demonstrated diffusely uptake in pelvis, uptake in proximal right femur, focally intense uptake in L5 vertebrae. Plain film imaging demonstrated severe diffuse degenerative changes in cervical, thoracic and lumbar vertebrae and sessile osteochondromas arising from both scapulae, mild thoracic levoscoliosis. Genetic testing demonstrated loss-of-function mutation in the EXT-1 gene, diagnostic of hereditary multiple osteochondromas. Currently, there are no FDA-approved treatments for osteochondromas though studies involving biologic therapy are ongoing. This patient was referred to orthopedic oncology and OMFS for dental extraction and decision for conservative treatment with observation. Conclusion This case demonstrates how the rare entity of hereditary multiple osteochondromas can have variable clinical presentations leading to its misdiagnosis and highlights the need for ongoing research into non-surgical treatment options. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Monday, June 13, 2022 12:36 p.m. - 12:41 p.m.

Flangeless horseshoe maxillary complete denture: a prosthodontic solution to maxillary tori

Tori may present difficulties in achieving a retentive prosthesis with full palatal coverage. Management of tori in such cases may involve attempting to avoid coverage of the torus, providing relief over the torus, or surgical reduction/removal. This article presents a case where a patient who presented with a large maxillary torus was managed with a non-surgical approach, which enabled provision of a successful prosthesis. Dental practitioners could consider this approach for selected cases. CPD/Clinical Relevance: Thorough prior planning and a modified denture design can be used to provide an effective clinical solution for maxillary and mandibular tori.

Prevalence of Oral Exostoses in Northern China During the Past Six Millennia-From a Sex and Age Perspective.

This study is intended to investigate oral exostoses of 5 sample populations, spanning over 6000 years, from the same region of Northern China, to determine the significance of sex and age on the development of oral exostoses during each time period. The samples analyzed were 306 dry jaws from human skeletons, which were excavated from 4 archeological sites: Banpo (6700-5600y BP), Shaolingyuan (3000y BP), Shanren (2200y BP), and Chang'an (1000-1300y BP), as well as the modern Xi'an district. The sex and the age of the samples at death were estimated. The degree of buccal exostosis (BE), torus mandibularis (TM), and torus palatinus (TP) and the TP shape were recorded. The results showed BEs in the Banpo and Chang'an regions, TMs in the Banpo region were more often diagnosed in males than in females. Conversely, females in Shaolingyuan showed a higher prevalence and severity of TM than that in males. The occurrence of BEs in the Shanren and Xi'an regions, TMs in the Banpo, Chang'an, and Xi'an regions, as well as TPs in the Banpo region significantly increased with age at death. In conclusion, sex differences and increasing trends with age in relation to oral exostoses were found in samples from Northern China during the past six millennia.

Prevalence and Pattern of Tori among Edentulous patients of Dental College Islamabad

Aim: To find out the prevalence and patterns of tori in edentulous patients and determine their association with gender and age. Study design: A cross-sectional observational study. Place and duration: Prosthodontic Department of Islamic International Dental College, Islamabad from 1st September 2021 to 1st December 2021. Methodology: A total of 165 edentulous patients of both genders were selected using non-probability purposive sampling. After collecting demographic data, intra-oral examination was carried out. Maxillary and mandibular stone casts were made after taking alginate impressions. Sharp graphite pencil was used to mark torus mandibularis and torus palatinus and the stone casts were carefully analyzed for size, shape and location of tori. Results: Total prevalence of tori in present study was 11.5%. 7.7% males and 14.9% female patients reported having tori. No gender association with tori existence found; p>0.05. Maximum number of tori reported in age group 71-80 years (21.4%). Chi square test showed association of tori presence with age; p <0.05. The flat and spindle shaped tori were (1.2%) whereas lobular and nodular shaped accounted for 1(0.6%) torus palatinus. The prevalence of small sized tori was mostly reported (7.9%). Unilateral single tori were frequently found (6.7%). Conclusion: The prevalence of tori occurrence in edentulous patients is low. There was no significant difference in the prevalence of tori among male and female patients however tori exitance increases with increasing age. Key words: Torus Palatinus, Torus Mandibularis, frequency, edentulous, prevalence.

Mutations in LRP5 and BMP4 are associated with mesiodens, tooth agenesis, root malformation, and oral exostoses.

WNT/β-catenin and BMP signaling pathways play important roles in the process of tooth development. Dysregulation of WNT/β-catenin and BMP signaling is implicated in a number of human malformations, including dental anomalies. Whole exome and Sanger sequencing identified seven patients with LRP5 mutations (p.Asn1121Asp, p.Asp856Asn, p.Val1433Met, and p.Val1245Met) and six patients with BMP4 mutations (p.Asn150Lys, p.Gly168Arg, p.Arg269Gln, and p.Ala42Glu). All patients were affected with isolated dental anomalies (dental anomalies with no other structural defects), including mesiodens, tooth agenesis, unseparated roots, narrow roots, shortened and tapered roots, and taurodontism. Five patients with LRP5 and one with BMP4 mutations had oral exostoses. Protein models of LRP5 mutations indicate the possible functional effects of the mutations. Here we report for the first time that mutations in LRP5 are associated with dental anomalies. LRP5 appears to be the first gene related to pathogenesis of mesiodens. We also show for the first time that in addition to tooth agenesis, mutations in BMP4 are also implicated in root maldevelopment and torus mandibularis. Sharing of the phenotypes of the patients with LRP5 and BMP4 mutations, which include root maldevelopment, tooth agenesis, and torus mandibularis, implicates cross talks between the WNT/β-catenin and BMP signaling pathways, especially during root development.

A Case Report and Review on Mandibular Compact and Cancellous Osteomas

Osteomas are benign osteogenic tumors that are characterized by the proliferation of either cancellous, compact or a combination of both. Central and peripheral are two types of osteomas. In this article, we report two cases of osteomas that were clinically diagnosed as mandibular tori. The radiographic, computed tomography, three-dimensional computed tomography (3DCT) and histopathological investigations were employed in achieving final diagnosis. Both cases were managed by surgical excision. This article aims to discuss the cases presented with literature review on diagnosis and management.

An atypical large unilateral torus mandibularis: Case report and review of literature

Benign bony exostosis can be present in the maxilla or mandible. They are non-odontogenic sclerotic lesions which present as bony outgrowths on the jaws. On the lingual aspect of the mandible, these benign bony exostoses resemble peripheral osteomas and when present adjacent to bicuspids they are known as torus mandibularis (TM). Usually these TM are small, bilateral and asymptomatic. This article presents an atypical case of large nodule of unilateral TM associated with discomfort in a 46-year-old male patient with partially edentulous jaws. The bony outgrowth was surgically removed and follow up period of 6 months was uneventful. Review of the literature was undertaken for various etiological factors, clinical features and management of torus mandibularis.

Intra- and Extraoral Signs of Probable Bruxism (Scoping Review)


 Bruxism is a repetitive masticatory muscle activity that has received attention in dental literature for its association with dental restoration failures, orofacial pain, neurological disease, and obstructive sleep apnea. As a determining factor in the diagnosis, parameters regarding the type and classification of intraoral and extraoral signs of probable bruxism are needed. This study aimed to identify the intraoral and extraoral signs of bruxism in the literature. A literature search was performed in the National Library of Medicine (PubMed) to identify all the articles published assessing intra and extraoral signs of bruxism. The selected articles were then screened and structurally read by three persons and summarized in PICO tables. Out of 551 initially retrieved references, 39 articles met the inclusion criteria and were thus included in the scoping review. The studies were divided into six categories based on the type of oral signs: buccal mucosa ridge (n=4), masseter hypertrophy (n=3), tongue indentation (n=4), tooth fracture (n=5), torus mandibularis (n=3), and tooth wear (n=20). This study concluded that the available studies utilize various methods in subjective and clinical data collection. Buccal mucosa ridge, tongue indentation, and torus mandibularis were common in subjects with bruxism. The association of masseter hypertrophy and tooth fracture with bruxism is not conclusive. Although studies on tooth wear in bruxism subjects are the most prevalent among other oral signs, no study has been able to establish a direct link between bruxism and tooth wear.

Oral exostoses; a rare case report and literature review

Oral Buccal Exostoses are benign bony protuberances that arise from the cortical bone. They are named after their location such as torus palatinus if it arises in the palate and torus mandibularis, if it arises from the mandible. The etiopathogenesis is still unclear with various authors citing racial, genetic, teeth attrition, parafunctional habits and even nutritional factors. Though asymptomatic, surgical intervention becomes mandatory when esthetics are of concern or during denture fabrication in terms of edentulous alveolar ridge.

Relationship between torus mandibularis and mandibular cortical bone width using computed tomography

AbstractPurposeThis study aimed to investigate the relationship between mandibular cortical width (MCW) and torus mandibularis (TM) using computed tomography (CT).Materials and methodsThis retrospective case–control study included 34 patients with TM and 34 age‐ and sex‐matched patients without TM who underwent CT at our hospital between April 2017 and December 2020. TM was identified by a radiologist from CT scans as an exostosis continuous with the lingual cortical bone of the mandible. Patients with a history of bisphosphonate use, malignancy, or mandibular fractures were excluded from this study. The MCW was measured by estimating the thickness of the cortical bone at the lower edge of the bilateral mandible using a CT coronal slice and calculating the average value. Nonparametric Mann–Whitney U tests were used to assess the differences in continuous variables based on the MCW and mandibular cortical index status.ResultsThe MCW was significantly associated with the TM.ConclusionThe results of this study suggested that the MCW may be associated with the development of TM. MCW on CT images may help predict the future development of TM.

Prevalence of Oral Normal Variances in Cigarette Factory Workers in Lamongan, Indonesia

Abstract Objective This study aims to observe the distribution of oral normal variances in cigarette factory workers. An essential aspect of diagnosing oral mucosal lesions is differentiating between abnormalities and normal oral variances. Workers from cigarette factories tend to neglect their oral health because of their occupational environment. Lack of awareness in identifying oral mucosal conditions led to poor oral health of cigarette factory worker. Materials and Methods A cross-sectional study; the sample population included 101 cigarette factory workers who participated in oral screening. The predictor variables in this study included all oral normal variances. Results The prevalence of oral normal variances in this study was as the following: torus palatinus (62.38%), crenated tongue (51.49%), coated tongue (46.53%), linea alba buccalis (37.62%), fissured tongue (25.74%), prominent Stensen's duct (17.82%), lingual varix (9.90%), ankyloglossia (4.95%), torus mandibularis (3.96%), Fordyce's spots (1.98%), frictional keratosis (1.98%), and macroglossia (0.99%). Conclusion Top three common normal oral variances among cigarette factory workers are torus palatinus followed by crenated tongue and coated tongue.

A case of prosthetic treatment after alveolar bone surgery for a patient with severe torus mandibularis

A case of prosthetic treatment after alveolar bone surgery for a patient with severe torus mandibularis