Tori, Torus, Exostoses

Brian Palmer, D.D.S.Leawood, Kansas USA

December 2004

1

Is it due to ionization?

Tori: Non-pathologic outgrowth of bone.

I believe this is one way bone responds to stresses

applied to it.

2

HypothesisTori are very common in today’s population (2004). I believe they are a result of stresses on the bone and are mainly found on nervous, anxious and driver-type personalities. The significant increase in the number and size of tori seen today as compared to prehistoric times are the result of society stresses.

Tori, I believe, will not be found in prehistoric skulls in the frequency or size of today’s tori. Prehistoric man had stresses, but their stresses were the result of survival, not of society stresses.

Difference will be in frequency (can be seen on a daily basis in dental offices today) and size (massive today – not as massive in prehistoric times).

3

ToriMay be genetically linked.

20-25% of people have them.

Females more affected.

Mendelian Dominate.

Evidence of what causes them is lacking.

40-60% of children of parents who had them, will have them.

(Source unknown)

4

Origin Frequency Investigator (Year)

Koreans 90% Osima (1939)

Japanese 73% Sakaguchi (1939)

Eskimos/Laplanders 60% Schreiner (1935)

Venezuelans 24% Luzardo (1958)

Americans

White 21% Kolas (1953)

Black 19% Austin (1965)

Chileans .37% Witkop (1963)

Frequency of Occurrence of Toru Palatinus

Compendium of Continuing Education, Year and issue unknown.5

Enlarged mandibular angle usually associated with powerful masseters.

6

Panoramic radiograph demonstrating over developed mandibular angles in a strong

bruxer / clencher. (See next 2 slides)7

Enlargement of one side.

8

Enlargement of other side.

9

Square jaw. Typical of clencher / bruxer.10

Large mandibular angle of square jawed individual.11

Skulls from 1930-1940 eraevaluated at the

Smithsonian Natural History Museumin 1996.

12

Smithsonian skull (1930-1940). Note bony tori.13

Note bony lingual torus on this mandible. (1930-1940)

14

Maxillary bony torus. (1930-1940). 15

Same skull has tori on lingual as well.16

Bony tori on the lingual of this mandible. (1930-1940)

17

Eskimo skulls from Smithsonian that have exostoses and tori.

18

Eskimo mandible #1. Exostoses and tori.19

Eskimo mandible #2. Tori.20

Eskimo mandible #3. Exostoses and tori.

21

Tori growth cases.

Case 1

22

Mandibular tori. 199423

Same tori in 1998.24

1998

1994

Same individual.

25

1994

1998

Same individual, different pictures.

26

Case 2

27

Mandibular lingual tori. 199528

Same individual in 2004. (Post whitening.)29

1995

2004

Same individual.

(Post whitening.)30

1995 Mandibular right torus. (Mirror used)31

2004 Same mandibular right torus. (Direct view)32

1995 (Mirror used)

2004 (Direct view)

Same torus in different years.

(Post whitening.)33

1995 Mandibular left torus. (Mirror used)34

2004 Same mandibular left torus. (Direct view)35

1995 (Mirror used)

2004 (Direct view)

Mandibular left torus.

Same torus in different years.

(Post whitening.)36

1995 Maxillary left torus. (Mirror used)37

Same maxillary left torus in 2004. (Direct view)38

1995 (Mirror used)

2004 (Direct view)

(Post whitening.)

39

Individual mandibular / maxillary tori cases.

40

Mandibular tori.41

Mandibular tori.42

Mandibular tori.43

Massive tori take up tongue space. Lady had OSA.

44

Mandibular tori.45

Mandibular tori.46

Mandibular tori. Note heavy ‘wear’ marks.47

Mandibular tori.48

Mandibular tori. Note multiple gold crowns.49

Mandibular tori.50

Mandibular tori. Bonded retainer.

51

Mandibular tori.52

Mandibular lingual tori.53

Mandibular lingual tori.54

Mandibular tori.

55

Maxillary buccal tori. (Mirror used)56

Maxillary lingual tori.57

Maxillary lingual tori.58

Multiple Slide Cases

Case 1

59

Mandibular anterior tori. Lady is 92.60

Maxillary tori. Same lady. Age 92. 61

Case 2

62

Massive maxillary tori.63

Massive buccal and lingual tori. Note multiple crowns.

64

Massive buccal and lingual tori.

65

Left side. Massive buccal and lingual tori.

66

Left and right sides.

67

Occlusal view of tori and gold crowns.

68

Another view of tori and crowns. (25 years old crowns)69

Massive maxillary left buccal tori.70

Massive maxillary right buccal tori.71

Person also has a palatal torus.72

Case 3

73

Maxillary and mandibular tori.

74

Close up of maxillary buccal tori.

75

Maxillary left tori.

76

Case 4

77

Maxillary right torus..78

Maxillary left tori.79

Models of case.

Tori marked in red.

80

Case 5

81

Mandibular lingual tori.82

Measuring space between tori.83

Daughter of previous person developing tori also.84

Case 6

85

Typical powerful square jaw of bruxer / clencher.

86

Mandibular tori.87

Models of case. Tori marked in red.

88

Palatal Tori

89

Youngest torus I have seen. Age 7. 90

Different palatal torus. Age 9. 91

Palatal torus.

92

Palatal torus

93

Palatal torus.94

Palatal torus.95

Palatal torus.96

Massive palatal torus. (See next 2 slides.)

Individual thought her torus was a tongue ‘scratcher’.

97

Same palatal torus - different view. (See next slide.)

98

Same torus on model.99

Another massive palatal torus. (See next 2 slides.)100

Same torus - different view. (See next slide.)101

Another view of same torus.102

Treatment Options

103

Maxillary hard occlusal splint.104

‘Lips together - teeth apart.’

Only time your teeth should be squeezed together and touching is when you

swallow. Even when you are eating there are usually food particles keeping

your teeth apart.105

Presentation developed by:

Brian Palmer, D.D.S.

Leawood, Kansas, USA

December 2004