Med Oral Patol Oral Cir Bucal. 2010 Mar 1;15 (2):e353-60.

Torus palatinus and torus mandibularis

Journal section: Oral Surgery doi:10.4317/medoral.15.e353

Publication Types: Review

Current status of the torus palatinus and torus mandibularis

Andrés S. García-García 1, José-María Martínez-González 2, Rafael Gómez-Font 3, Ángeles Soto-Rivadeneira 4,

Lucia Oviedo-Roldán 5

1
Master in Oral Surgery, Implantology and Periodontics from the University of Southern Mississippi
2
Full Professor of Oral Surgery. Complutense University of Madrid
3
Director of the Master of Oral Surgery at the European University of Madrid
4
Master in Oral Surgery, Implantology and Periodontics from the University of Southern Mississippi
5
Master in Oral Surgery, Implantology and Periodontics from the University of Southern Mississippi

Correspondence:
University of Madrid. Spain García-García AS, Martínez-González JM, Gómez-Font R, Soto-Rivade-
jmargo@odon.ucm.es neira A, Oviedo-Roldán L. Current status of the torus palatinus and torus
mandibularis. Med Oral Patol Oral Cir Bucal. 2010 Mar 1;15 (2):e353-60.
http://www.medicinaoral.com/medoralfree01/v15i2/medoralv15i2p353.pdf

Received: 05/05/2008 Article Number: 1336 http://www.medicinaoral.com/

Accepted: 31/07/2009 © Medicina Oral S. L. C.I.F. B 96689336 - pISSN 1698-4447 - eISSN: 1698-6946
eMail: medicina@medicinaoral.com
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Abstract
While there is a hereditary component to tori, this does not explain all cases. Tori tend to appear more frequent-
ly during middle age of life; the torus palatinus is more commonly observed in females, but this is not the case
with the torus mandibularis. Certain ethnic groups are more prone to one torus or the other. The torus is mainly
removed due to prostodontic reasons, as it may also be used as biomaterial, not only in periodontology, but also
in implantology. The aim of this study was a review of the literature from the past twenty years.

Key words: Torus palatinus, torus mandibularis.

Introduction The discovery of these exostoses usually occurs inci-

The tori (meaning “to stand out” or “lump” in Latin) (1) dentally during a routine clinical exam, as they usually
are exostosis that are formed by a dense cortical and limi- do not produce any symptoms, except in cases of sig-
ted amount of bone marrow, and they are covered with a nificant growth or in edentulous patients, in which case
thin and poorly vascularized mucosa. They are usually lo- they may hinder the construction of the prosthesis. Des-
cated at the longitudinal ridge of the half palatine, on the pite the numerous studies of which they have been and
union of the palatine apophysis of the maxillae or on the continues to be the focus, their origin is unclear; various
internal side of the horizontal branch of the jaw, above the possible causes are presented in the literature, but none
mylohyoid line and at the level of the premolar area (1-8) of them are definitive. A certain prevalence with respect
and canine area (6, 8-10), presenting a very slow (1,2) and to ethnic groups, sex and age has also been observed. Its
progressive growth that can stop spontaneously (1). elimination in dentate patients cannot be justified, un-
Castro Reino et al. (1) define it as a congenital bony less it can be used clinically or as a filling biomaterial in
protuberance with benign characteristics, leading to the order to correct bone defects that patients may suffer in
“overworking” of osteoblasts and bone to be deposited some part of their jaw area.
along the line of fusion of the palate or on the hemi- The prevalence of occurrence of the tori, according to
mandibular bodies. the study by Al-Bayaty et al. (4) is 12.3%, very close to
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Med Oral Patol Oral Cir Bucal. 2010 Mar 1;15 (2):e353-60. Torus palatinus and torus mandibularis

that of Bruce et al. (7) with 14.6%, while Jainkittivong sociate the presence of teeth at the mandibular level with
et al. (6) showed their prevalence to be 26.9%. the presence torus. To further support this, in the study
Since there is a very limited amount of current scientific conducted by Eggen et al. (21), they found a relationship
literature that discusses the tori, given that they are very between the presence of torus and the number of teeth
common and have no pathological interest, we aim to present in the mouth. In addition, among adolescents
conduct a review of the literature of the past 20 years, in with mandibular tori, the ratio of non-erupted canines
order to analyze the etiological and epidemiological fac- was much smaller than those who did not have any tori.
tors, as well as its treatment, complications and possible Furthermore, in another study, Eggen (19) found a rela-
application in the field of bone regeneration. tionship between the presence of mandibular tori and a
normal bone height around the teeth.
Etiology
The exact cause of appearance of the tori is not clear. Frequency
(4-6, 9,11) The most widely accepted theory today is As aforementioned, the prevalence of the appearance of
genetics (1,2, 4-7, 11,12), but it has not always been tori is very important, which according to the study of
possible to show the autosomal dominant nature of its Al-Bayaty et al. (4), is 12.3%, very close to the 14.6%
appearance. (7,14) In the three clinical cases analyzed found by Bruce et al. (7).
by Curran et al. (15), in which a daughter, mother and In the majority of the studies reviewed, the appearance
grandmother had autosomal dominant osteosclerosis, of the TP is more frequent than that of the TM, (3-6,
mandibular tori (MT) and palatine tori (PT) were found 12,14,18, 22-25); however, there are reviews such as
to be present in all three women. In the study by Eggen those by Sonnier et al. (11), Sirirungrojying et al. (5)
(16), it was only possible to estimate the genetic origin and Bruce et al. (7), which show a higher presence of
of the TM in 29.5% of the cases; as for the rest of the TM than of TP.
cases, approximately 70%, the origin was attributed The only studies that we found linking the presence of
to environmental factors, mainly related to occlusal both exostosis were by Al-Bayati et al. (4), Bruce et al.
stress. (7) and Haugen (22), who reported it in 2% to 3% of
Another cause is superficial injuries (1,2) or its occur- cases, whereas Jainkittivong et al. (6) reported its pres-
rence as a functional response in individuals with well- ence in 28.12% of the cases. Haugen (22) found that the
developed chewing muscles, (2, 4-6, 11,13,16) or in pa- probability of finding TM in a person with TP is more
tients with abraded teeth due to occlusion. (2, 5-7, 11-13, than double than that of a person without TP, and vice
16,17) In the study conducted by Reichart et al. (3), they versa. In their study of Trinidad and Tobago, Al-Bayaty
found a significant correlation between the incidence of et al. (4) also believe that there is a strong association
torus and the presence of abraded teeth in Thais, but between TP and TM (50% of subjects with TM had TP,
not in Germans. In studies conducted by Sirirungroj- yet only 30% of subjects with TP had TM) (Table 1).
ying et al. (5), Clifford et al. (10) and Kerdpon et al. (12),
they found a large relationship between the TM and Age
parafunctional habits, which they did not find with the It is not easy to compare the range of ages provided in
TP. (5,12) Thus, Sirirungrojying et al. (5) determined the studies that we have analyzed, since in many cases,
that TM can be used to indicate the risk of appearance they are not standardized and each author gives a differ-
of temporomandibular disorders. ent reference. According to a study by Bruce et al. (7),
As possible causes, other authors mention eating habits, the average age when experiencing the onset of tori, is
(4,5,7) states of vitamin deficiency or supplements rich 34 years old. According to Al-Bayaty et al. (4), the ave-
in calcium (13), and also diet (4, 16-19). In the studies rage age is 30.7 years old for patients with TP and 39.2
conducted by Eggen et al. (18) and Al-Bayaty et al. (4), years old for those with TM.
they associate the consumption of fish with the presence The onset of tories appears to be earlier among those
of tori, because fish contains Ω3 unsaturated fatty acids with TP (4,13), where cases of such onset have been des-
and vitamin D, encourages bone growth. cribed from birth and the first decade of life. (13) In
Sasaki et al. (20) tried to draw a relationship between the the observations of Reichart et al. (3) (in women) and
occurrence of tori and the prolonged use of phenytoin, Al-Bayaty et al. (4) the most common age range for the
but were unable to conclude that it was what caused the onset of TP is from 11 to 20 years old. Although most
appearance of the tori. However, they did determine that studies found the more common age range for such on-
it is a factor that leads to an increase in size, because it set to be between 30 and 50 years old, third and fourth
induces an increase in calcium homeostasis, functio- decade of life (3,7,12,14,22), in the study conducted by
ning as an osteogenic agent. Haugen et al. (22), the age range that experienced the
Lastly, and possibly maintaining a certain relationship most frequent onset reached as high as 65 years old. Ac-
with the aforementioned injuries, Sonnier et al. (11) as- cording to Edmund et al. (26), TP appears during puber-

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 Table 1. Frequency and prevalence of tori according to age, sex and ethnic group.
FREQUENCY AGE SEX ETHNIC GROUPS

TP and TP and
TP TM AGE TP AGE TM TP TM TP TM
STUDY YEAR n TM SEX n n SEX n TM ORIGIN n
(%) (%) (years) (%) (years) (%) (%) (%) (%) (%)
(%) (%)

Bouquot 2361
1986 1.86 0.84 - - - - - - - - - - - - - - - - -
et al.24 6
ƃ(A) 31-40 90 21.1 31-40 90 16.6 ƃ(A) 606 11.7 8.6 -
1317 13.5 5.2 - German 1317 13.5 5.2
Reichart Ƃ(A) 11-20 149 20.8 21-30 163 4.3 Ƃ(A) 711 15.1 2.4 -
1988
et al.3 ƃ(T) 31-40 49 24.4 31-40 49 14.2 ƃ(T) 404 15.8 9.4 -
947 23.1 9.2 - Thai 947 23.1 9.2
Ƃ(T) 31-40 68 35.2 31-40 68 13.2 Ƃ(T) 543 28.5 9.0 -
Med Oral Patol Oral Cir Bucal. 2010 Mar 1;15 (2):e353-60.

326 - 31.3 -
Eggen16 1989 - - - - - - - - - - - - - - - -
245 - 49.4 -
ƃ 35-65 726 7.02 35-65 726 9.37 ƃ 2217 6.72 8.53 -
Haugen22 1992 5000 9.22 7.23 2.22 Norwegian 5000 9.22 7.23
Ƃ 35-65 854 12.3 35-65 854 7.26 Ƃ 2783 11.2 6.36 -
ƃ(L) 20-29 167 38.9 30-39 125 20.8 ƃ(L) 554 32.7 15.5 -
1181 38.35 12.7 -
Ƃ(L) 40-49 73 50.7 30-39 129 14.7 Ƃ(L) 627 43.4 10.3 -
Eggen et al.14,21 1994 Norwegian 2010 36.1 18.8
ƃ(G) 30-39 63 33.3 20-29 87 36.8 ƃ(G) 362 23.7 28.7 -
829 32.81 27.5 -
Ƃ(G) 40-49 65 54.5 20-29 131 31.3 Ƃ(G) 467 39.8 26.6 -

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ƃ 216 1.3 -
Nair et al.23 1996 550 0.9 0.54 - - - - - - - - Vietnamese 550 0.9 0.54
Ƃ 334 1.49 -

Sonnier ƃ 162 14.8 30.9 - Caucasian (USA) 254 22.8 24.8

1999 328 20.4 26.8 - - - - - - - -
et al.11 Ƃ 166 25.9 22.9 - African American 74 12.2 33.8

Kerdpon ƃ 183 48.1 31.2 -

1999 609 61.7 29.9 - ƃ and Ƃ 31-40 141 66.7 41-50 96 40.6 Thai 609 61.7 29.9
et al.12 Ƃ 426 67.6 29.3 -

Sirirungrojying 59 50.8 64.4 - - - - - - - - - - - - -

1999 Thai 412 58 33
et al.5 353 59.2 27.8 - - - - - - - - - - - - -
Jainkittivong
2000 960 43.54 10.9 28.12 - - - - - - - - - - - - - - - -
et al.6
African 367 6.2 2.45
Al-Bayaty ƃ 241 4.5 4.5 2.5
2001 667 6.6 2.8 2.8 ƃ and Ƃ 11-20 98 8.2 51-60 57 5.3 Indian 212 6.6 2.35
et al.4
Ƃ 426 7.7 1.8 3 Mized race 88 7.95 5.68

Agnihotri ƃ 79 30 15 - Caucasian - 17 16
2003 184 26 23 - - - - - - - -
et al.25 Ƃ 105 34 17 - Black - 36 28
ƃ 411 2.2 12.2 2.4
Bruce et al.7 2004 926 3.9 12.1 2.9 ƃ and Ƃ 40-49 176 5.68 50-59 73 23.28 Ghanan 926 3.9 12.1
Ƃ 515 5.2 12 3.3
Torus palatinus and torus mandibularis
Med Oral Patol Oral Cir Bucal. 2010 Mar 1;15 (2):e353-60. Torus palatinus and torus mandibularis

ty and slowly grows until the subject reaches adulthood, occurrence of tori were among North Americans (Cau-
with the possibility of their growth continuing until the casians and African Americans) (11%), Norwegians
seventh decade of life. (14.22%) and Thais (3.5%) (Table 1).
The appearance of TM is rare before the first decade of
life (4,6,7). Apart from that, there is not much variation Size
with respect to age of onset of TP; the only exception The growth of the tori is gradual, being greater in the
worth noting is that of the work of Al-Bayaty et al. (4), second or third decade of life. (7,20) As for this sec-
Bruce et al. (7) and Haugen (22), who extend the age tion, among the studies reviewed, there is no consensus
range until the sixth decade of life. For Sonnier et al. on how to classify the growth; each study classifies the
(11), the prevalence of TM is inversely proportional to growth differently.
age (Table 1). Haugen (22) and Eggen et al. (14,16,18) classify the
growth in terms of small, medium and large, less than 2
Sex mm, 2 to 4 mm and more than 4 mm, respectively. (16,18)
It is most frequent for TP to appear in women than in Thus, according to the study conducted by Haugen (22),
men (1,2,8,13,18), and it is believed that there may be a the majority of the TP were small, with 69.85% (322) of
dominant type linked to the X chromosome. (1) In all the TP found in 6.44% of individuals. The growth was
the studies reviewed, there is a higher presence of TP in also small for the TM, and was found in 60.11% (220)
females than in males, although not all the studies noted of the TM, or 4.40% of the individuals. Many times, be-
this difference to be significant. (3,4,7,11,12,14,22,23). cause these exostoses are so small, they go unnoticed in
As for the TM, some authors have found no significant the mucous coating. In the studies conducted by Eggen,
differences between men and women in their studies the small TM were also the most numerous, both in the
(13), although in all of the studies, it is more common study group, 59.5% (72), as well as in the control group,
in males. 66.7% (68) (16); as for the TP, the small TP were the
The study conducted by Nair et al. (23) refers to the most frequent, 91% (659) (18).
presence of torus in general, without differentiating Another classification is that performed by Reichart et
between TP and TM, and does not find any significant al. (3), which classifies them as grade 1, small up to 3
differences between the two. mm; grade 2, moderate up to 6 mm; and grade 3, marked
Only two studies offer results on the joint appearance above 6 mm. The size most often found in the TP of the
of TP and TM in men and women, and both results are Germans and Thai was observed to be small in 84.9%
similar, although the difference is not significant (4,7). and 94.9% of the cases, respectively. Interestingly, Ger-
(Table 1). man men were only observed to have TP of this size. As
for the TM, the size that was most common according
Ethnic Groups to their study was small, with 88.4% and 82.8% in Ger-
The appearance of tori is more common in certain eth- mans and Thais, respectively.
nic groups and countries (Eskimos, Japanese and in The studies conducted by Sonnier et al. (11) and Al-Ba-
the United States) (2). For example, a great predisposi- yaty et al. (4) coincide very little on the average measure-
tion towards the appearance of TM has been observed ments of the studies they conducted on TP. The average
among Mongols (13). measurements were 20.33 x 9.45 mm and 21 x 18 mm
We have reviewed several articles with studies on dif- respectively, and they match up significantly more for
ferent regions of the world. In the study by Sonnier et the TM, 10.9 x 6.49 mm and 10 x 9 mm respectively.
al. (11) in which they compare the incidence of torus The study conducted by Sirirungrojying et al. (5) at-
among North Americans, and African Americans tempted to link the size of the tori with the incidence of
(33.8%) were among those who presented the highest parafunction, but were unable to find a relationship.
incidence of TM, whereas Caucasians (22.8%) were
more likely to present TP. In analyzing the incidence Shapes
among Norwegians, we found two studies that give us There is a lot of variety in terms of shapes; the TP can
different results. In the first study, the percentage of be flat, nodular, lobular or spindle-shaped (3,4,8,18,22),
TP was 9.22% (22), whereas in the other study, TP was and the TM are usually nodular, unilateral or bilateral
observed to be 36.1% (14) and TM was observed to be and single or multiple. (3.4, 9-11, 22) (Fig. 1).
7.23% and 18.8% respectively. The same is true in two As it regards the shape of the TP, there is no overlap of
other studies in Thailand. In the first study, the percent- results in the articles reviewed . In the study conducted
age of TP was 23.1% (3), and in the second study, it was by Haugen (22), the most common shape was small and
58% (5), whereas the incidence of TM was 9.2% and nodular; in most cases, the more voluminous TP were
33% respectively. nodular, whereas the lobular shapes were more rare. In
The populations in which we found elevated rates of the study by Reichart et al. (3), the most frequent shape

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Med Oral Patol Oral Cir Bucal. 2010 Mar 1;15 (2):e353-60. Torus palatinus and torus mandibularis

agree that the most frequent shape in which they appear

is bilateral (3,4,7,9,11,22). In the study by Al-Bayaty
et al. (4), the most common shape was nodular in 61%
(23) of the cases, and bilateral in 87% (33) of the cases
of TM. This shape was also the most common in both
German and Thai (52.2% and 87.35% respectively), in
the study by Reichart et al. (3), as well as in the studies
conducted by Sonnier et al. (11) (73.9%) (Fig. 2).

Diagnosis
In most cases, the finding is usually incidental and ob-
served during clinical examination at the dental office.
Fig.1. Palatine tori. This is because they are asymptomatic for the most part,
and those who have torus are not aware of it (1,4). Some-
times patients may present phonatory disturbances,
limitation of masticatory mechanics, ulcerations of the
mucosa, food deposits, prosthetic instability, and some
patients may experience cancerophobia, and consult a
professional in order to look for a solution (13).
They are diagnosed by clinical examination:
The torus palatinus can be unilobular, polylobulated,
flat and spindle-shaped, located at the midline of the
hard palate (2,13).
The torus mandibularis are usually symmetrical and bi-
lateral (1,2), but can also be unilateral (1), located on the
lingual side of the mandible, above the mylohyoid line
and at the level of the premolars (4,13).
X-rays taken reveal radiodense images with a slightly
Fig. 2. Mandibular tori. higher density than that of the surrounding bone. (1,13)
Carrying out X-rays (periapical, occlusal, and pano-
ramic) is not very useful, given the simplicity of the di-
agnosis during clinical examination (13).
Histopathological examination reveals that it is similar
to the compact structure of the normal bone, having a
slightly spongy structure with marrow spaces (1).

Treatment
Removal of the tori is not always necessary. The most
frequent cause of extirpation continues to be the need
for prosthetic treatment (1,2,11) or that of being a po-
tential source of autogenous cortical bone for grafts in
periodontal surgery, cyst surgery or implant surgery
(9,11,27,28) (Fig.3), although long-term stability of the
grafts is uncertain (Table 2).
Barker et al. (9) used the bone obtained from the TM
of a patient in order to increase the thickness of his up-
Fig. 3. Mandibular tori as grafts in order to place implants. per jaw and allow the placement of implants, in order
to replace the lateral incisors and absent canines. They
determined that the TM provided a useful and local
among the Saxon population was that of the spindle- source of bone in procedures for increasing bone thick-
shape (39.8%), with the nodular shape not trailing very ness. Proussaefs (28) discusses three clinical cases in
far behind (37.6%). In the study by Al-Bayaty et al. (4), which he makes a clinical and histological evaluation
in the majority of cases 48% (30), the most common of the use of mandibular tori as grafts in order to place
shape was flat. implants, in which he obtained up to a 4.33 mm increase
As for the TM, it was found that the majority of studies in thickness and an absorption rate similar to the grafts

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that are made with bone from other donor areas of the Initially, the excision will be performed using a fissure
oral cavity. bur, which we use to divide the torus; then we will use a
Other authors do not recommend the removal of tori chisel to cut into each of the divisions, or alternatively,
except in very extreme cases, and they recommended a large burr or a file may be used to reshape the bone
the removal of the prosthesis in these areas (2) or the or to even it out. (2,26) If the torus is not very large, it
use of soft acrylics on the edges of the prosthesis (29). is not necessary to divide it; it can be removed directly
We can now avoid their removal while offering patients with a burr. Castro Reino et al. (1) advocate the use of a
another alternative for rehabilitating the jaw by means high speed turbine cooled with normal saline solution,
of a prosthetic implant. given that they consider the use of a chisel and hammer
involves a greater risk of iatrogenic injury, and also to
Surgical technique and complications avoid the bumping the patient with the chisel; however,
The instruments used will be that typically used in oral we must take into account the risk that this may cause
surgery (with a chisel and / or burrs), with local or gen- emphysema.
eral anesthesia, depending on the case, although local By removing the torus and relocating the flaps, we will
anesthesia is sufficient in most cases (1). end up with too much soft tissue, which can be remo-
For the removal of the TP, the nasopalatine nerve must ved with scissors. The suture may be made by simple
be anesthetized at its exit through the anterior palatine points, mattress sutures, etc., provided they are not too
foramen, and the anterior palatine nerves must be an- tight (1).
esthetized through the posterior palatine foramen. In Surgical cement is used to protect the wound from trau-
addition, the anesthesia will be administered by perile- matic and mechanical force during the healing process,
sional infiltration in order to facilitate the detachment of so as to achieve a bacteriostatic or bactericidal action if
the palatine fibromucosa (1). it contains an agent with these properties, and to prevent
To eliminate the TM, Castro Reino et al. (1) recommend the accumulation of food remains (1).
administering the anesthetic by means of infiltration In the TP, a surgical splint should be placed over the
in the lesion; however, in our service, we recommend surgical cement for a period of 48 hours, and is removed
a nerve block anesthesia of the inferior alveolar nerve, when reviewing the wound. The patient’s former relined
and also the lingual and mental nerves. and adjusted prosthesis can also be reseated (1,2).
The use of general anesthesia is not indicated for this Although it is uncommon, complications can occur as a
type of surgery, given that it poses a risk to the patient, result of iatrogenic maneuvers on the part of the profes-
and based on the fact that its systematic use is not justi- sional (1,2) (Table 2).
fied (1).
Different incisions can be made in order to perform the Post-operative care
removal of the TP. The most common type of incision The patient must be informed that the signs and symp-
used is the double-Y incision, because it prevents injury toms that may occur during the postoperative period
of the nasopalatine and anterior palatine blocks (1,2). will be those that are most commonly associated with
The incision will be a total thickness (1). this type of surgical procedure, such as edema, he-
To treat the TM, an incision will be made on the man- matoma, mild pain, etc. Postoperative medication will
dibular ridge, with an incision made above the torus, consist of antibiotics, analgesics and anti-inflammatory
which provides us with a good operating field (2), or medicine, as well as stressing that it is important for the
scalloped following the necks of the teeth (when they patient to continue with appropriate personal hygiene so
are present) along the tongue, sectioning the gingival that the wound may heal properly (1).
ligament (1,2).
Periostotomes will be used for the detachment, and we
will separate the fibromucosa until the lesion is exposed
(1).
As aforementioned, the mucosa that covers the torus is
very thin, which makes it tear easily if we are not care-
ful (1).
The flaps can be anchored by suturing to the teeth, or by
separating them using Farabeuf in order to avoid dama-
ging them while performing the operation (1).
In the TM, a piece of gauze may be placed between the
lingual flap and the surgical space that extends under
the torus. This will prevent the dried bone from beco-
ming lost deep within the structures of the mouth (1).

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Table 2. Causes of exeresis and complications of the tori.

POST-OPERATIVE
CAUSES FOR CARRYING OUT SURGICAL COMPLICATIONS
COMPLICATIONS
EXERESIS OF THE TORUS OF THE TORI
OF THE TORI

- Perforation of the nasal cavities 1,2

- Disturbances of phonation 1,13,22,26 - Hematoma 1,2,9,13
- Secondary anesthesia due to palatine
- Limitation of masticatory mechan- - Edema 1,2
nerve damage 1

TORUS PALATINUS
ics 1,13,22,26 - Opening of a suture 1,13
- Bone necrosis due to poor refrigeration
- Sensitivity due to the thin mucosa - Infection 1,2,9,13
during surgical drilling 1
layer 1 - Bone and mucosal necrosis1,13
- Hemorrhage due to section of palatine
- Traumatic inflammation 1 - Neuralgia 1
arteries 1,2
- Ulcer of a traumatic origin 1,2,13,26 - Poor scarring 1,2
- Dilaceration of the palatine mucosa 1,2,13
- Retention of food remains 1,2,13
- Fracture of the palatine bone 1,2
- Esthetic reasons 1
- Prosthetic instability 2,13,22 - Mandibular fracture 1,13
- Patients with cancerophobia2,13,16 - Hypoesthesia due to poor lower troncu-
- Prosthetic treatment 1,2,4,11,22,26 lar technique 1
TORUS MANDIBULARIS

- Source of autogenous cortical bone - Injection of anesthesia into blood vessel 1

for grafts 11 - Swallowing or inhalation of bone frag-
ments 1
- Devitalization of neighboring teeth 1
- Salivary duct injuries 1,2,13
- Lingual nerve injury 9,13
- Mucosal laceration 2,13
- Poor adaptation of the flap 2

References 13. Martínez-González JM. Tumores benignos de los maxilares [Be-

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