Medication-related osteonecrosis in torus palatinus: Report of a case and literature review.

BACKGROUND: Medication-related osteonecrosis of the jaw bones have been frequently reported. However, its occurrence in torus palatinus is very rare with only 10 cases published in the English-language literature. CASE REPORT: We describe an additional case in a 79-year-old woman, who was referred for evaluation of a painful swelling with areas of suppuration on the hard palate. CONCLUSION: Conservative treatment was performed and after spontaneous sequestrectomy, total healing was achieved.

Torus mandibular e palatino predisponentes em um grupo familiar: fatores genéticos e ambientais, relato de uma série de casos / Mandibular and palatine torus predisposing in a family group: genetic and environmental factors, report of a series of cases / Torus mandibular y palatino predisponente en un grupo familiar: factores genéticos y ambientales, informe de una serie de casos

As exostoses mais conhecidas são o Torus palatino e mandibular, que se desenvolvem a partir do crescimento benigno da cortical óssea, localizadas respectivamente na linha média palatina e superfície lingual de caninos e pré-molares, podendo ser unilaterais ou bilaterais. Esse trabalho tem como objetivo o estudo de um grupo familiar que apresentaram o Torus como característica em comum, buscando confirmar a presença e prevalência das características clínicas multifatoriais listadas na literatura, possibilitando o diagnóstico da etiologia e assim traçando um plano de tratamento individual, se necessário. Como metodologia, foi realizada uma triagem com cada membro familiar na clínica Odontológica da Faculdade Sete Lagoas - FACSETE, descartando a participação no estudo os membros que não apresentaram o Torus. Os indivíduos que apresentaram indicação da remoção cirúrgica foram encaminhados para clínica de cirurgia da própria instituição. Concluímos, portanto, com este estudo que fatores genéticos e ambientais colaboram como fator etiológico mais predominantes para surgimento do Torus no grupo familiar estudado... (AU)

The best known exostosis are the palatine and mandibular Torus, which develop from the benign growth of the cortical bone, located respectively in the midpalatal line and lingual surface of canines and premolars, and maybe unilateral or bilateral. This work aims to study a family group that had Torus as a common feature, confirming the presence and prevalence of multifactorial clinical features listed in the literature, enabling the diagnosis of etiology and thus outlining an in dividual treatment plan, if necessary. As a methodology, a screening was performed by each family member at the Dental Clinic of Facul dade Sete Lagoas - FACSETE, discarding the participation in the study for members who did not present Torus. Individuals who indicated surgical removal were referred to the institution's own surgery clinic. Therefore, we conclude with this study that genetic and environmental factors collaborate as the most predominant etiological factor for the emergence of Torus in the studied family group... (AU)

Las exostosis más conocidas son el Torus palatino y el Torus mandibular, las cuales se desarrollan a partir del crecimiento benigno del hueso cortical y están ubicadas respectivamente en la línea medio palatina y en la cara lingual de los caninos y de los premolares que pueden ser unilaterales o bilaterales. Este proyecto tiene como objetivo el estudio de un grupo familiar que presentó en sus características comunes el Torus, buscando confirmar la presencia y el predominio de las características clínicas multifactoriales listadas en la literatura, lo que hizo posible el diagnóstico de la etiología y diseñar un plan de tratamiento individual, caso necesiten. Como la metodología fue hecho una selección con los miembros de la familia en la clínica odontologica de la Faculdade Sete Lagoas - FACSETE, quitando de los estudios las personas de la familia que no presentaron el Torus. Los individuos que presentaron indicación de extirpación quirúrgica fueron enviados a la clínica de cirugía de la escuela. Concluimos con este estudio que los factores genéticos y ambientales colaboraron como los factores etiológicos más predominantes para la aparición del Torus en la familia analizada... (AU)

Variability of exostoses on human jaws during the past six millennia in Northern China / Variabilidad de las exostosis en las mandíbulas humanas durante los últimos seis milenios en el norte de China

SUMMARY: The aim of this study was to survey oral exostoses in human populations that belonged to the same region encompassing five periods over 6000 years, to determine the prevalence and its changing trend over time. A total of 306 human jaws belonging to the modern Xi'an region and four archeological sites, Banpo (6700-5600 years BP), Shaolingyuan (3000 years BP), Shanren (2200 years BP) and Chang'an (1000-1300 years BP), were investigated. The degree of buccal exostosis (BE), torus mandibularis (TM) and torus palatinus (TP) and the TP shape were recorded. The prevalence of BE, TM, and TP in the five groups was 20.8 %-62.5 %, 17.5 %-71.5 %, and 31.7 %-74.2 %, respectively. The differences in the three types of exostoses among the five groups were all statistically significant, but only TM and TP showed a decreasing trend over time. A high and quite diverse prevalence of oral exostoses was found in the five groups of samples. Decreasing trends in relation to time for TM and TP were detected.

RESUMEN: El objetivo de este estudio fue sondear las exostosis orales en poblaciones humanas que pertenecían a la misma región abarcando cinco períodos durante 6000 años, para determinar la prevalencia y su tendencia cambiante a lo largo del tiempo. Un total de 306 mandíbulas humanas pertenecientes a la moderna región de Xi'an y cuatro sitios arqueológicos, Banpo (6700-5600 años AP), Shaolingyuan (3000 años AP), Shanren (2200 años AP) y Chang'an (1000-1300 años AP) BP), fueron investigados. Se registró el grado de exostosis bucal (EO), torus mandibular (TM) y torus palatino (TP) y la forma de TP. La prevalencia de EO, TM y TP en los cinco grupos fue 20,8 % -62,5 %, 17,5 % -71,5 % y 31,7 % -74,2 %, respectivamente. Las diferencias en los tres tipos de exostosis entre los cinco grupos fueron todas estadísticamente significativas, pero solo TM y TP mostraron una tendencia decreciente con el tiempo. Se encontró una prevalencia alta y bastante diversa de exostosis oral en los cinco grupos de muestras. Se detectaron tendencias decrecientes en relación al tiempo para TM y TP.

Evaluation of oral stereognosis in completely edentulous patients with palatal tori / Evaluación de la estereognosia oral en pacientes completamente edéntulos con toros palatinos

Background: The corollary is not investigated in the completely edentulous patients with palatal tori. Objective: The aim of this study was to assess the oral stereognostic ability in completely edentulous patients with palatal tori. Material and Methods: Thirty-four completely edentulous patients aged 50 to 89 years were allocated to Group 1 (without palatal tori, n=18) and Group 2 (with palatal tori, n=16). The oral stereognostic test was conducted using 6 intraoral test pieces (circle/square/rectangle/triangle/plus/toroid) that were fabricated to standard dimensions using the light cure acrylic resin. Each test piece was placed in the patient's mouth and was asked to manipulate the test piece between the tongue and the palate. The patients identified the shapes by matching them on a shape chart. Each correct identification was assigned a score of 1. The response time taken to identify each shape was recorded. Statistical computation was done using a chi - square test and Mann-Whitney U test. Results: Significant difference was observed in the overall scoring percentages between the 2 groups (p<0.05). Group 2 had lower oral stereognostic scores compared to group 1 (p<0.05). There was no statistically significant difference in the mean response time for identifying the shapes among the groups, however group 2 patients had longer response time. Conclusion: Oral stereognostic ability of the completely edentulous patients with torus palatinus was lower when compared to completely edentulous patients without tori.

Antecedentes: el corolario no se investiga en los pacientes completamente desdentados con toros palatinos. Objetivo:El objetivo de este estudio fue evaluar la capacidad estereognóstica oral en pacientes completamente edéntulos con toros palatinos. Material y Métodos: Treinta y cuatro pacientes completamente edéntulos de 50 a 89 años fueron asignados al Grupo 1 (sin toros palatinos, n = 18) y al Grupo 2 (con toros palatinos, n = 16). La prueba estereognóstica oral se realizó utilizando 6 piezas de prueba intraorales (círculo / cuadrado / rectángulo / triángulo / cruz / aro) que se fabricaron a dimensiones estándar utilizando la resina acrílica fotopolimerizable. Cada pieza de prueba se colocó en la boca del paciente y se le pidió que manipulara la pieza de prueba entre la lengua y el paladar. Los pacientes identificaron las formas haciéndolas coincidir en un gráfico de formas. A cada identificación correcta se le asignó una puntuación de 1. Se registró el tiempo de respuesta necesario para identificar cada forma. El cálculo estadístico se realizó mediante la prueba de chi-cuadrado y la prueba U de Mann-Whitney. Resultados: Se observó una diferencia significativa en los porcentajes de puntuación generales entre los 2 grupos (p<0,05). El grupo 2 tuvo puntuaciones estereognósticas orales más bajas en comparación con el grupo 1 (p<0,05). No hubo diferencia estadísticamente significativa en el tiempo medio de respuesta para identificar las formas entre los grupos, sin embargo, los pacientes del grupo 2 tuvieron un tiempo de respuesta más largo.Conclusión: La capacidad estereognóstica oral de los pacientes completamente edéntulos con torus palatino fue menor en comparación con los pacientes completamente edéntulos sin torus.

Imaging features of pharyngeal hairy polyps in infants.

BACKGROUND: Hairy polyps are the most common congenital deformity of the oral-nasopharynx/oral cavity in infants, which may lead to severe complications in the newborns. However, few studies have been published with respect to their radiological features, and most are case reports. OBJECTIVE: This study aimed to analyze radiological features of the oral­nasopharyngeal hairy polyps and to identify the radiological features with the highest diagnostic value. MATERIALS AND METHODS: From 2014 to 2019, pediatric cases pathologically diagnosed as hairy polyps and having received radiological examination at the Children's Hospital Affiliated to Zhejiang University were retrospectively analyzed. Radiological evaluations were conducted on tumor size, location, morphology, density or signal features as well as the enhancement pattern. RESULTS: A total of six infants were recruited. Clinical features observed in these cases included choking on milk with cyanosis, intermittent dyspnea, oropharyngeal mass, and snoring. Lesions were derived from the left tubal torus in three out of six cases, from the left lateral aspect of soft palate in one, from the left lateral pharyngeal wall in one, and from the right tubal torus in one. They were shown as pedicled polyp-like well-circumscribed mass with fat density or signal as well as a stalk on CT or MRI. In the contrast-enhanced scan, the fat components were not enhanced, while the stalk was mildly enhanced. CONCLUSION: Hairy polyps had typical radiological features. Hairy polyps should be considered for pedicled polyp-like well-circumscribed mass in the oral-nasopharynx of infants with fat density or signal as well as a stalk.

Prevalence of oral mucosal lesions in an adult population from eight communities in Santo Domingo, Dominican Republic.

The purpose of the study was to evaluate the prevalence of Oral Mucosal Lesions (OMLs) in an adult population from Santo Domingo, Dominican Republic. 751 subjects from eight communities from Santo Domingo accepted the invitation to participate in an oral screening from October 2016 to January 2017. 248 subjects were evaluated and clinically examined, age range 18-86 years. A validated instrument was designed to record demographic factors, age group, gender, anatomical location, presence or absence of OMLs, risk factors such as tobacco consumption and its frequency, and different forms of tobacco and alcohol use. A systematic oral clinical examination was conducted by a specialist. The presence or absence, and anatomic location of OMLs were recorded. The sample consisted of 44.4% males and 55.6 % females. 228 subjects had 1 or more lesions (91.9%), the median was 3 lesions per patient. In relation to risk factors, tobacco use in general was reported by 26.2 % of the subjects, with cigarette smoking reported by 75.4%, followed by other forms as "hookah" 9.2 %, marihuana 9.2%, cigars ("puros")4.6% and pipe smoking 1.5%. Among the oral lesions detected by screening, the nonpathological group was prevalent, and included physiologic melanin pigmentation as the most frequent (25.0%) followed by palatal/mandibular tori (20.2%), Fordyce granules (7.9%), and Exostosis (5.6%). Potentially malignant disorders (Oral Leukoplakia, Oral Lichen Planus and Actinic Cheilitis) corresponded to 2.2%, 0.3 %, and 0.3%, respectively. No malignancy was observed clinically. This study Authorutes to determining the prevalence of OMLs in Dominican Republic and to identifying risk factors. This is the first study reporting the prevalence of oral mucosal lesions among the Dominican adult population. This information is vital for establishing a public health program targeting the high-risk group to improve the oral health status in this population.

El objetivo del presente estudio fue evaluar la prevalencia de lesiones de la mucosa oral (LMO) en una población adulta proveniente de Santo Domingo, República Dominicana. 751 individuos procedentes de ocho comunidades de la provincia de Santo Domingo, respondieron a la invitación para participar en el examen bucal, desde Octubre 2016 a Enero 2017. 248 sujetos con un rango de edad de 18-86 años, fueron evaluados y examinados clínicamente. Se diseñó y validó un instrumento para obtener datos de factores demográficos, grupos de edad, género, localización anatómica, presencia o ausencia de lesiones de la mucosa oral, factores de riesgo tales como: consumo de tabaco, frecuencia, diferentes formas de uso de tabaco y alcohol. Un especialista en el área, realizó un examen clínico bucal sistematizado en el cual se evaluó y registró la presencia o ausencia de lesiones y su localización anatómica. De acuerdo a la distribución por género, 44.4% correspondió a masculino y 55.6 % femenino. 228/248 sujetos presentaron 1 o más lesiones (91.9%), siendo la media de 3 lesiones por paciente. En relación a los factores de riesgo, el tabaco se reportó en 26.2%, siendo el fumar cigarrillos el 75.4%, seguido de otras formas como "hookah" 9.2%, marihuana 9.2%, cigarros ("puros") 4.6% y pipa fumada 1.5 %. En cuanto a las lesiones bucales detectadas en el examen, el grupo de condiciones no patológicas fue el más frecuente e incluía a pigmentaciones fisiológicas melánicas (25.0%), seguida de torus palatino/mandibulares (20.2 %), gránulos de Fordyce (7.9%) y exostosis (5.6%),respectivamente. Las lesiones potencialmente malignas detectadas (Leucoplasia oral, Liquen plano oral y Queilitis actínica) correspondieron al 2.2%, 0.3 % y 0.3%, respectivamente. Clínicamente, no se observó malignidad. Este estudio Authoruye a determinar la prevalencia de LMO en República Dominicana e identificar factores de riesgo. Los hallazgos representan el primer estudio que muestra la prevalencia de las lesiones de mucosa oral en la población adulta dominicana. Se recomienda la creación de un programa de salud pública orientado a grupos de alto riesgo para mejorar el estatus de salud oral en esta población.

Correlations between dental wear and oral cavity characteristics: Mandibular torus, palatine torus, and oral exostoses.

OBJECTIVE: This study evaluates the correlations amongst mandibular torus, palatine torus, oral exostoses to dental wear/loss and temporomandibular damage. METHODS: The sample consists of 504 skulls from the Hamann-Todd Osteological Collection; 223 African American and 281 European Americans aged between 30 and 80 years. The sample was analyzed using Pearson's Chi-square for significance of sex, age, ancestry, and wear as well as the interactions between the demographic variables and the presence of mandibular torus, palatine torus and oral exostoses. RESULTS: Wear was statistically significant by age and sex but not ancestry. The maxillary exostoses varied significantly by age, ancestry and wear but not sex. Mandibular torus frequencies varied significantly by wear, sex and ancestry. The palatine torus varied significantly across wear groups, sex and ancestry. DISCUSSION: The etiology of nonmetric oral cavity characteristics, mandibular torus, palatine torus and oral exostosis, is complex. The degree to which traits' presence and expression is the result of genetic and environmental interactions is not fully understood. More than age, sex or ancestry, the degree of dental wear and tooth loss influences the presence and expression of the oral cavity traits. The sample can be characterized as the presence of exostoses in higher frequencies in young African American males with little tooth loss. Males of both ancestral groups with heavy wear have higher frequencies of mandibular tori than females. The palatine torus is more common in edentulous European American females.

Giant torus mandibularis causing submandibular duct obstruction and sialadenitis.

Torus mandibularis is a benign osseous overgrowth arising from the lingual surface of the mandible. It is a common, incidental finding on imaging due to its relatively high prevalence. In the majority of cases, mandibular tori are asymptomatic. We report a novel presentation of a giant torus mandibularis causing bilateral obstruction of the submandibular ducts and consequent sialadenitis. Our patient presented with progressive pain centered in the floor of his mouth and had bilateral submandibular glandular enlargement on exam. Computed tomography showed a giant right torus mandibularis, which was causing obstruction and dilation of the bilateral submandibular ducts. Although conservative management was attempted, he ultimately underwent surgical resection of his torus with symptomatic improvement. This patient highlights a novel complication of torus mandibularis and illustrates successful treatment. Though not previously described, this complication may be underreported and should be considered in the appropriate clinical setting.

Prevalence of oral mucosal lesions in an adult population from eight communities in Santo Domingo, Dominican Republic / Prevalencia de lesiones de mucosa oral en una población adulta de ocho comunidades en Santo Domingo, República Dominicana

ABSTRACT The purpose of the study was to evaluate the prevalence of Oral Mucosal Lesions (OMLs) in an adult population from Santo Domingo, Dominican Republic. 751 subjects from eight communities from Santo Domingo accepted the invitation to participate in an oral screening from October 2016 to January 2017. 248 subjects were evaluated and clinically examined, age range 18-86 years. A validated instrument was designed to record demographic factors, age group, gender, anatomical location, presence or absence of OMLs, risk factors such as tobacco consumption and its frequency, and different forms of tobacco and alcohol use. A systematic oral clinical examination was conducted by a specialist. The presence or absence, and anatomic location of OMLs were recorded. The sample consisted of 44.4% males and 55.6 % females. 228 subjects had 1 or more lesions (91.9%), the median was 3 lesions per patient. In relation to risk factors, tobacco use in general was reported by 26.2 % of the subjects, with cigarette smoking reported by 75.4%, followed by other forms as "hookah" 9.2 %, marihuana 9.2%, cigars ("puros")4.6% and pipe smoking 1.5%. Among the oral lesions detected by screening, the nonpathological group was prevalent, and included physiologic melanin pigmentation as the most frequent (25.0%) followed by palatal/mandibular tori (20.2%), Fordyce granules (7.9%), and Exostosis (5.6%). Potentially malignant disorders (Oral Leukoplakia, Oral Lichen Planus and Actinic Cheilitis) corresponded to 2.2%, 0.3 %, and 0.3%, respectively. No malignancy was observed clinically. This study contributes to determining the prevalence of OMLs in Dominican Republic and to identifying risk factors. This is the first study reporting the prevalence of oral mucosal lesions among the Dominican adult population. This information is vital for establishing a public health program targeting the high-risk group to improve the oral health status in this population.

RESUMEN El objetivo del presente estudio fue evaluar la prevalencia de lesiones de la mucosa oral (LMO) en una población adulta proveniente de Santo Domingo, República Dominicana. 751 individuos procedentes de ocho comunidades de la provincia de Santo Domingo, respondieron a la invitación para participar en el examen bucal, desde Octubre 2016 a Enero 2017. 248 sujetos con un rango de edad de 18-86 años, fueron evaluados y examinados clínicamente. Se diseñó y validó un instrumento para obtener datos de factores demográficos, grupos de edad, género, localización anatómica, presencia o ausencia de lesiones de la mucosa oral, factores de riesgo tales como: consumo de tabaco, frecuencia, diferentes formas de uso de tabaco y alcohol. Un especialista en el área, realizó un examen clínico bucal sistematizado en el cual se evaluó y registró la presencia o ausencia de lesiones y su localización anatómica. De acuerdo a la distribución por género, 44.4% correspondió a masculino y 55.6 % femenino. 228/248 sujetos presentaron 1 o más lesiones (91.9%), siendo la media de 3 lesiones por paciente. En relación a los factores de riesgo, el tabaco se reportó en 26.2%, siendo el fumar cigarrillos el 75.4%, seguido de otras formas como "hookah" 9.2%, marihuana 9.2%, cigarros ("puros") 4.6% y pipa fumada 1.5 %. En cuanto a las lesiones bucales detectadas en el examen, el grupo de condiciones no patológicas fue el más frecuente e incluía a pigmentaciones fisiológicas melánicas (25.0%), seguida de torus palatino/mandibulares (20.2 %), gránulos de Fordyce (7.9%) y exostosis (5.6%),respectivamente. Las lesiones potencialmente malignas detectadas (Leucoplasia oral, Liquen plano oral y Queilitis actínica) correspondieron al 2.2%, 0.3 % y 0.3%, respectivamente. Clínicamente, no se observó malignidad. Este estudio contribuye a determinar la prevalencia de LMO en República Dominicana e identificar factores de riesgo. Los hallazgos representan el primer estudio que muestra la prevalencia de las lesiones de mucosa oral en la población adulta dominicana. Se recomienda la creación de un programa de salud pública orientado a grupos de alto riesgo para mejorar el estatus de salud oral en esta población.

Prevalence of Torus Palatinus and association with dental arch shape in a multi-ethnic cohort.

Objectives: Torus Palatinus (TP) is a bony projection located on the oral surface of the hard palate. The trait is typically benign, has an unknown etiology, and varies widely in phenotypic expression. Prior studies suggest differences in TP prevalence by sex and ancestry, but the reported rates vary, even within a single ancestral group. We assessed the prevalence of TP and its association with palatal shape in a large multi-ethnic cohort of normal individuals. Methodology: 1102 adults were included (625 with European ancestry, 377 with West African anscestry, and 100 with East Asian ancestry). 3D digital dental casts were obtained and rated. TP frequencies were compared between sexes and/or ethnicities using Chi-squared tests. Dental cast models were then landmarked, and canonical variates analysis was performed to test for shape differences between those with and without TP. Results: Females had a significantly higher rate of TP than males across all three ancestral groups (p≤0.004). In males, no significant differences were found among ethnicities. Ancestral differences in TP frequency were driven by females, with East Asians having the highest rate (34.69%), followed by Europeans (24.88%) and West Africans (15.22%). Shape differences were found only in Asians and Africans, indicated a shorter and wider palate in presence of TP. Conclusions: Ethnic differences in TP frequency were present only in females. Further, females have considerably higher rates of TP than males in each population tested. Further studies of TP at earlier time-points and in connection to other aspects of craniofacial growth may shed light on these sex and ethnic differences.

Exérese de extenso tórus palatino: relato de caso / Excision of extensive palatine torus: case report

Introdução: O tórus palatino se caracteriza por um desenvolvimento ósseo não patológico que ocorre ao longo da linha média do palato duro. Possui etiologia relacionada a fatores genéticos e ambientais, sendo a exostose mais comum em cavidade oral. O tratamento cirúrgico só é necessário em casos específicos quando o tórus interfere nas funções do sistema estomatognático ou na instalação de prótese total no palato. O presente estudo teve como objetivo relatar um caso clínico de tratamento cirúrgico de extenso tórus palatino onde foi empregado um acesso cirúrgico modificado. Relato de caso: Esse trabalho descreve o caso de uma paciente com um tórus palatino de dimensões atípicas com queixas fonéticas e protéticas. Devido ao tamanho da exostose e para permitir uma abordagem mais simplificada, optou-se por um acesso cirúrgico modificado, que em conjunto com a confecção de placa em resina acrílica para instalação no pós-operatório, auxiliou na recuperação e conforto da paciente. Considerações Finais: A técnica cirúrgica utilizada preveniu possíveis desvantagens relacionadas à técnica tradicional, portanto, garantiu um pós-operatório confortável, podendo ser aplicada em tratamentos de tórus palatino quando bem indicada... (AU)

Introduction: Palatine torus is characterized by a non-pathological bone development that occurs along the midline of the hard palate. It`s etiology is related to genetic and environmental factors, being the most common exostoses in the oral cavity. Surgical treatment is only necessary in specific cases when the torus interferes in the functions of the stomatognathic system or in the installation of total prosthesis in the palate. The present study aimed to report a clinical case of surgical treatment of extensive palatine torus where a modified surgical approach was employed. Case report: This article describes the case of a patient with a palatine torus of atypical dimensions with phonetic and prosthetic complaints.Due to the size of the exostoses and to allow a more simplified approach, a modified surgical access was chosen, which together with the confection of acrylic resin plaque for postoperative installationaided in patient recovery and comfort. Final considerations: The surgical technique used prevented possible disadvantages related to the traditional technique, therefore, it guaranteed a comfortable postoperative period... (AU)

Uncommon bilateral maxillary exostosis: case report / Exostose maxilar bilateral incomum: relato de caso

ABSTRACT Exostoses or hyperostoses are benign bony outgrowths originating from the cortical bone and depend on their location for a more precise designation. The most common types found in the oral cavity are the torus palatinus and the torus mandibularis. Buccal and palatal exostoses are located along the buccal aspect of the maxilla and/or the mandible (commonly in the premolar and molar areas) and on the palatal aspect of the maxilla (usually in the tuberosity area), respectively. The etiology of exostoses still hasn't been enlightened but an interaction between environmental and genetic factors is accredited. They are usually asymptomatic, unless the mucosa becomes ulcerated. The frequency of exostoses increases with age, having their biggest prevalence from 60 years old, being more common in men and suffering ethnic influences. A thorough evaluation is important for the correct diagnosis since other lesions have similar clinical characteristics to the exostoses such as osteomas. The majority of exostoses are diagnosed clinically along with radiographic interpretations, making the biopsy dispensable and the treatment is usually unnecessary. The aim of this article was to describe a case report of bilateral maxillary exostosis, unusual, in a female patient. If an excessive amount of bone is present the exostoses may exhibit a relative radiopacity on dental radiographs. Initially, periapical and panoramic radiographs were performed to evaluate the alterations. Due to the size of the exostoses a concomitant Cone Beam Computed Tomography was performed to confirm the diagnosis. The patient is in follow-up.

RESUMO Exostoses ou hiperostoses são crescimentos ósseos benignos originados da cortical óssea e dependem de sua localização para uma denominação mais precisa. Os tipos mais comuns encontrados na cavidade oral são o Tórus Palatino e o Tórus Mandibular. Exostoses bucais e palatais acometem a face vestibular do processo alveolar na maxila e/ou na mandíbula (comumente na região de molares e pré-molares) e a superfície do processo alveolar posterior (usualmente na área da tuberosidade maxilar), respectivamente. A etiologia das exostoses ainda não foi esclarecida, mas acredita-se em uma interação entre fatores ambientais e genéticos. São usualmente assintomáticas, a não ser que a mucosa se torne ulcerada. A frequência aumenta com a idade, tendo sua maior prevalência a partir de 60 anos de idade, sendo mais comuns em homens e sofrendo influências étnicas. É importante uma avaliação minuciosa para o correto diagnóstico, visto que outras lesões, como os osteomas, possuem características clínicas semelhantes às das exostoses. A maior parte das exostoses é diagnosticada clinicamente em conjunto com interpretações radiográficas, tornando a biópsia dispensável e o tratamento é usualmente desnecessário. O objetivo deste artigo foi relatar um caso clínico de exostose maxilar bilateral, incomum, em uma paciente do sexo feminino. Se uma quantidade excessiva de osso está presente, as exostoses podem mostrar uma relativa radiopacidade nas radiografias dentárias. Inicialmente foram realizadas radiografias periapicais e radiografia panorâmica para avaliar as alterações. Devido ao tamanho das exostoses, realizou-se uma Tomografia Computadorizada de Feixe Cônico, para confirmação do diagnóstico. A paciente encontra-se em acompanhamento.

The use of torus palatinus in the identification of unknown skeletal remains.

Torus palatinus (TP) is a benign, bony outgrowth located on the hard palate. Variation in this trait occurs, ranging from absent to a protuberance several millimeters in length. If a TP becomes too large, it can interfere with daily activities and thus warrant medical attention. This case utilised the unique morphology of a TP after surgical invention to identify the unknown skeletal remains of a woman missing for six years. Even though there is still much unknown regarding the aetiology, occurrence and prevalence of TP, this study demonstrates the usefulness of anatomical variants in the identification of unknown skeletal remains.

Torus palatinus / Torus Palatinus

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Torus mandibularis affects the severity and position-dependent sleep apnoea in non-obese patients.

OBJECTIVE: Various anatomical structures of upper airway and physical differences are known to be risk factors for obstructive sleep apnoea (OSA). Torus mandibularis is a structure that can appear on the inside of the mandible. Therefore, it is possible for tori to influence airway volume by occupying the space for tongue and cause sleep apnoea. The purpose of this study is to investigate the effect of torus mandibularis on the severity of OSA as one of the craniofacial risk factors. DESIGN: Retrospective case-control study. SETTING: University-based tertiary medical centre. PARTICIPANTS: Adult patients over 19-years-old who visited outpatient clinics with complaints of sleep-disordered breathing symptoms between January 2010 and December 2017 were investigated. MAIN OUTCOME MEASURES: The presence of torus mandibularis in oral cavity was confirmed by physical examination or CT image. We analysed demographic findings including age, sex, medical history, previous operation history, physical findings of upper airway and result of polysomnography. To evaluate the effect of torus mandibularis on OSA, polysomnography data of the two groups according to presence or absence of torus mandibularis were compared and analysed. RESULTS: Two-hundred and thirty-two OSA patients with BMI <25 were divided into two groups, according to either the presence or absence of torus mandibularis. We analysed 138 patients of control group and 94 of torus mandibularis group. Apnoea-hypopnoea index (AHI) was 18.8 ± 14.9 in control group and 25.1 ± 18.4 in torus mandibularis group (P = 0.006). Respiratory disturbance index (RDI) was 23.1 ± 14.7 in control group and 27.9 ± 18.4 in torus mandibularis group (P = 0.035). Supine AHI showed 26.6 ± 20.3 in control group and 32.5 ± 22.6 in torus mandibularis group (P = 0.039). Patients with torus mandibularis had a trend of increase in proportion according to the severity of sleep apnoea, such as AHI (P = 0.007) or RDI (P = 0.034). CONCLUSIONS: We newly found that the presence of torus mandibularis affects not only severity of OSA and also position-dependent OSA. These results support the necessity of torus mandibularis evaluation in OSA patients, and further study is also required to investigate its consequence in the surgical outcome.

Cone-Beam Computed Tomography Study on Morphologic Characteristics of the Posterior Region in Hard Palate.

BACKGROUND: The goal of this study is to evaluate the morphologic characteristics of the posterior palatine region among the Chinese population, more specifically, the greater palatine grooves, crests, bridges, and torus palatinus structures and make comparisons between different ethnic groups and minorities. METHODS: A total of 323 cone-beam computed tomography (CBCT) scans were collected for analysis on the presence of grooves, crests, bridges, or torus palatinus (TP). Data were collected through recognizing the grooves, crests, bridges, and TPs and calculating the number of those anatomy structures. The statistics index, including average, standard deviation, were adopted to describe the subjects and Wilcoxon test, Mann-Whitney test, and Chi-squared test were all carried out by SPSS. RESULTS: Three different morphologic manifestations of the greater palatine groove (GPG) found in the upper 1st and 2nd molar regions are as follows: no groove, 1 groove, and 2 grooves. The number of crests ranged from 0 to 3. And the incidence of torus palatines was 29%. Moreover, a positive correlation was found between the presence of crests/GPGs and age in the 2nd molar region. CONCLUSION: The results in this study reveal that GPGs in the upper 1st and 2nd molar regions have 3 different morphologic manifestations among Chinese people and the number of crests can vary from 0 to 3 crests. Although the proportion of GPG or crest and the incidence of TP are different from the proportions of other studies, this may be due to the fact that different ethnic groups and sample sizes were used in the course of this study. Information about the anatomy structures of the posterior region in hard palate directly contributed to a decrease in potential complications during palatal implant surgery and periodontal surgery.

The relationship between oral tori and bite force.

OBJECTIVE: The relationship between bite force and torus palatinus or mandibularis remains to be explained. The major aim of this study was to determine the correlation between bite force and oral tori. METHODS: The bite force of 345 patients was measured with a bite force recorder; impressions of the shape and size of the oral tori were taken on plaster models prior to orthodontic treatments. Subsequently, the relationship between oral tori and bite force was analyzed. RESULTS: The size, shape, and incidence of torus palatinus was not significantly correlated with bite force. However, the size of torus mandibularis increased significantly in proportion to the bite force (p = 0.020). The occurrence of different types of oral tori was not correlated with the bite force. DISCUSSION: The size of torus mandibularis provides information about bite force and can thus be used to clinically assess occlusal stress.

Técnica de reconstrução de rebordo alveolar utilizando tórus palatino / Reconstruction of alveolar ridge using palatine torus: technical report / Reconstruction of alveolar ridge using palatine torus: technical report

Os enxertos ósseos autógenos são considerados como padrão-ouro para reabilitações de defeitos ósseos, e a região intrabucal constitui um excelente sítio doador para a resolução de defeitos ósseos pequenos e moderados. Este relato de caso clínico teve como objetivo descrever uma técnica cirúrgica para a obtenção de enxerto ósseo autógeno proveniente do tórus palatino para a reabilitação de altura e de espessura do rebordo ósseo alveolar remanescente referente ao elemento 11. Paciente do gênero feminino, 25 anos, procurou a clínica odontológica tendo como queixa principal a ausência do dente 11, perdido devido ao insucesso de um tratamento endodôntico. Radiograficamente, observou-se defeito ósseo horizontal na região do dente 11, e clinicamente, observou-se deficiência em espessura óssea vestibulolingual que impossibilitaria a instalação imediata de implante. Ao exame físico intrabucal, notou-se a presença de tórus palatino pronunciado, que apresentava 20 mm de comprimento, localizado na região central do palato e que, como sítio doador, mostrou-se de fácil acesso para a remoção do enxerto ósseo autógeno, mostrando-se suficiente em volume para a reconstrução do rebordo envolvendo um elemento unitário. Os blocos obtidos foram fixados com parafusos corticais medindo 1,5 mm. O acompanhamento clínico mostrou que a técnica proposta para reabilitação de rebordo alveolar para posterior inserção do implante unitário mostrou-se previsível e as dimensões de altura e de espessura de osso no sítio receptor, apesar da remodelação óssea sofrida, foi aceitável após sete meses, permitindo, de forma satisfatória, a reabilitação.

Autogenous bone grafts are considered as gold standard for rehabilitation of bone defects and the intrabucal region constitutes an excellent donor site for the resolution of small and moderate bone defects. This clinical case report aimed to describe a surgical technique to obtain an autogenous bone graft from the palatine torus for rehabilitation of height and thickness of the remaining alveolar bone ridge referring to element 11. A 25-year-old female patient sought the dental clinics having as main complaint the absence of tooth 11, lost due to failure of an endodontic treatment. Radiographically, a horizontal bone defect was observed in the region of the tooth 11 and clinically a bucco-lingual bone thickness defi ciency was observed that would make it impossible to insert the implant immediately. The presence of a pronounced palatine torus that was 20 mm long, located in the central region of the palate and which, as a donor site, was easily accessible for removal of the autogenous bone graft. Sufficient volume for rebuilding the collar involving a single element. The obtained blocks were fixed with cortical screws measuring 1.5 mm. Clinical follow-up showed that the proposed technique for alveolar ridge rehabilitation for posterior implant insertion was predictable and the dimensions of height and bone thickness at the recipient site, despite the bone remodeling suffered, were acceptable after 7 months allowing the oral rehabilitation.