Mandibular tori as bone grafts: an alternative treatment for periodontal osseous defects - clinical, radiographic and histologic morphology evaluation

Alveolar bone exostoses following orthodontic treatment. Diagnostic considerations and clinical management

Alveolar bone exostoses (ABE) are benign localized convex outgrowths of buccal or lingual bone, which could be delineated from the surrounding cortical plate, also known as a buttress bone formation. Our review and case series demonstrate the development of alveolar bone exostoses during orthodontic therapy. It is crucial to keep in mind that every case presented had a history of palatal tori. In our clinical observations, higher precedence of ABE development was seen in participants during incisor retraction, especially with preexisting palatal tori. Additionally, we have successfully demonstrated surgical techniques to eliminate ABE in the event that self-remission does not occur once orthodontic forces are discontinued.

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.

Mandibular Torus Harvesting for Sinus Augmentation: Two-Year Follow-Up

Maxillary sinus grafting is a commonly used treatment alternative in cases with insufficient bone height to enable insertion of implants in the posterior maxilla. It is commonly carried out with autogenous grafts, biomaterials or both. Autogenous bone grafts are considered gold standard for this procedure; however, due to donor site morbidity, it is not as commonly used as other biomaterials. Mandibular tori are hyperostoses on the lingual side of the mandible in the premolar region. This a case in which mandibular tori were used for a sinus augmentation procedure. The patient was then followed up for 2 years with no complaints, or objective symptoms.

Asymmetric bone remodeling in mandibular and maxillary tori

OBJECTIVES

Tori are frequent paucisymptomatic bony outgrowths of the oral cavity in three locations: torus palatinus (TP), mandibularis (TM), and maxillaris (TMax). Their usually described histological characteristics are unspecific: normal cortical bone with more or less trabecular bone. The aim of this study was to describe tori's specific morphological and histomorphometric characteristics.

MATERIALS AND METHODS

Histological characteristics in a series of 18 tori collected after surgical removal were analyzed. Microcomputed tomography provided a 3D analysis. Mineral apposition rate (MAR) was measured after double tetracycline labeling. Osteoid tissue was identified by Goldner's trichrome and osteoclasts by the tartrate resistant acid phosphatase identification in undecalcified sections. Iron and aluminum were detected by histochemical staining methods. Osteoid thickness and MAR were determined at the outer surface of the torus and in the Haversian canals.

RESULTS

Tori appeared made of lamellar Haversian bone in 16/18 cases. Osteoid thickness did not differ between the outer surface and within the canals. An asymmetric bone remodeling was observed in the Haversian canals of 15 tori: osteoid seams were deposited on the side close to the free torus surface, and Howship's lacunae with numerous osteoclasts were observed on the opposite side. A high MAR was found at the surface of the tori and within the canals. There was no iron or aluminum deposit.

CONCLUSIONS

Tori may be characterized by a specific asymmetric bone remodeling which seems to determine their shape.

CLINICAL RELEVANCE

This finding could constitute a specific histological feature allowing to differentiate tori from exostoses. Graphical abstract.