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She had no significant past medical history. The patient had no history of trauma to the involved area. She did not experience discomfort or pain.
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The patient had no history of any kind of symptoms associated with this region. She had noticed slow, but steady enlargement of the masses over the past 5 years. When treatment is elected, the lesions should be cut-off or removed from the cortex using bone cutting bur or hand instruments.Ī 20-year-old female patient reported to the Department of Periodontology, Maharana Pratap College of Dentistry and Research Centre, Gwalior (Madhya Pradesh) with bilateral masses just above the premolar and molar region in maxilla interfering in her smile and aesthetics ( Figure 1). No bony exostosis or tori requires treatment unless it becomes large enough to interfere with periodontal health, denture placement, or cause recurrent traumatic ulcerations. This autosomal dominant syndrome shows other features such as intestinal polyposis and cutaneous cysts or fibromas. The patients are having multiple bony growths or lesions which are not in the classic torus or buccal exostosis locations should be evaluated for Gardner syndrome. Biopsy should be performed if there is any dilemma regarding diagnosis. Radiographically, exostosis appears as well-defined round or oval calcified structure superimposing the roots of teeth. Buccal exostoses are usually found only on the facial surface of the maxillary alveolar bone, especially in the posterior segment. 8 Lesions may slowly enlarge up to 3-4 cm in greatest diameter, but it does not have malignant transformation potential. Clinically, the torus may appear as numerous rounded protruberanes or calcified multiple lobules, whereas the exostosis is a single, smooth broad-based mass, may have a sharp, pointed bony projection producing tenderness just beneath the mucosa. The diagnosis of a buccal exostosis is based on the clinical examination along with radiographic interpretations. 2 A very small exostosis and tori consist entirely of compact bone but when large and nodular, it consists of cancellous bone surrounded by cortical bone. The histologic features of tori and exostoses are identical. Some of the suggested causes include genetic factors, environmental factors, masticatory hyperfunction and continued jaw bone growth. The etiology of tori has been not been established yet. Usually no treatment is required, but for those possibly affecting the periodontal condition, or when the protruberances cause pain or discomfort to the patient, or when these bony enlargements cause pseudo swelling over the lip, then conservative surgical excision can be performed. Their size may increase to several centimeters thus contributing to periodontal disease of adjoining teeth by retaining food during chewing instead of flushing away. They are normally self-limiting and painless. They tend to develop during adolescence and gradually enlarge over the years. Ulcerations may be seen as a result of trauma or any injury to the mucosa. The overlying mucosa appears to be stretched but intact and normal in color. On palpation, the exostoses are hard bony mass.
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Commonly found to appear in the premolar-molar region. 1, 2, 4īuccal exostoses occur as bilateral, smooth bony growth along the facial aspect of the maxillary and/or mandibular alveolus. Buccal and palatal exostoses are multiple bony nodular masses found less frequently than tori. TM is bony protuberance found on the lingual aspect of the mandible, in the canine and premolar region. 2, 3 TP is a sessile, nodular bony mass commonly seen on the midline of the hard palate. 1 Torus palatinus (TP) and torus mandibularis (TM) are the two most common types of intraoral osseous overgrowths. Tori and exostoses are nodular protuberances of calcified bone and are designated according to their anatomic location.