Dr Riddi Mehta
An inter-disciplinary approach for the treatment of unilateral buccal torus maxillaris.
Introduction:
The torus palatinus (TP), the torus mandibularis (TM), and the torus maxillaris (TMx) are the three types of oral tori reported in literature. The term TMx refers to either irregular bony nodules of varying sizes or a mound-like thickening of the alveolar process on the buccal and lingual sides of the maxilla.
Case Presentation:
A 30 y.o. female reported with a chief complaint of swollen gums in the upper right back region of her mouth since the past 6 months and was also a referral case from the Orthodontist for the re-evaluation of periodontal status for inadequate crown length for bracket placement.
Her medical, family and drug history were not significant.
Maxillary study cast was prepared to plan the extent of surgical resection of torus maxillaris.
Oral Examination:
Inspection:
The oral examination revealed presence of a gingival overgrowth in the region of right maxillary 2nd and 3rd molars. The gingival overgrowth was firm and tightly adherent to the underlying alveolar bone measuring about 2mm x 3mm in dimension. The gingival overgrowth was salmon pink in color with thick and rolled out marginal gingivae w.r.t. 2nd and 3rd molars. There was mild gingival inflammation and presence of soft and hard tissue deposits.
Palpation:
The inspectory findings were confirmed on palpation. The bony overgrowth was firm on palpation with smooth and even margins merging with the adjacent alveolar bone.
Radiographic investigations:
The intra-oral occlusal radiograph revealed cortical thickening of the alveolar process in the region of right 2nd and 3rd maxillary molars. The surrounding alveolar process revealed normal bony support and architecture.
Blood picture:
The blood picture was normal.
Diagnosis and treatment planning:
Based on clinical and radiographic findings, the case was diagnosed as Unilateral Buccal Torus Maxillaris in the right posterior maxillary alveolar region. The treatment plan involved scaling and root planing followed by surgical resection of torus maxillaris. The surgical resection was planned to facilitate; better soft tissue adaptation, clinical crown exposure for bracket placement and oral hygiene maintenance. After administration of local anesthesia, a full thickness mucoperiosteal flap was raised followed by surgical resection of the torus with straight fissure surgical bur and surgical handpiece under copious saline irrigation. The residual bony spicules were smoothened with Sugarman bone file. The primary closure was achieved with single interrupted silk sutures. A periodontal dressing was placed followed by post-operative instructions and pain medication. The oral hygiene instructions were reinforced.
Immediate Post-Operative:
Although there was a soft tissue tear during flap elevation, the healing was uneventful.
Follow-Up & Post-Operative Care:
The patient was recalled after one month and reported with no signs of pain and swelling. The fixed orthodontic therapy continued for another 15 months. The post orthodontic clinical pictures and radiographs could not be recorded as the patient migrated to a different location.
References:
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2. Hauser, G.; De Stefano, G. F. 1989. Epigenetic variants of the human skull. Stuttgart, E. Schweizerbart’sche Verlagsbuchhandlung.
3. Jainkittivong, A.; Langlais, R. P. 2000. Buccal and palatal exostoses: prevalence and occurrence with tori. Oral Surgery Oral Medicine Oral Pathology, 69(3): 48-53.
4. Haugen LK. Palatine and mandibular tori. A morphologic study in the current Norwegian population. Acta Odontol Scand 1992;50:65-77
5. Neville BW, Damm DD, Allen CM, Bouquot JE, editors. Oral and maxillofacial pathology. Philadelphia: WB Saunders Co; 1995. p. 17-20.
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7. Virginia Galera, Josefa María Moreno. Oral tori in a sample of the Spanish university students: prevalence and morphology.Antropologia Portuguesa 20/21, 2003/2004: 281-305
8. Woo, J.-K. 1950. Torus palatinus. American Journal of Physical Anthropology, 8(1): 81-111
9. Hrdli ka, A. 1940. Mandibular and maxillary hyperostoses. American Journal of Physical Anthropology, 27(1): 1-67.
10.Van den Broek, A. J. P. 1943-1945. On exostoses in the human skull. Acta Neerlandica
Morphologiae Normalis et Pathologiae, 5: 95-118.
Pre-operative
Occlusal radiograph
Cast Study Model
Flap Reflection
Interrupted Sutures Placed
Periodontal Dressing Placed
1 month Post-operative
