Mandibular Tori Used as Bone Graft Source For Dental Implants

Mandibular tori (bone bumps next to your tongue) can sometimes be used as bone graft source for dental implants. The images in this post are of a patient I recently treated in Burbank.

She is missing one of her first molar teeth and the bone has shrunk because it has been a long time since she lost the tooth. She came to me for a dental implant, but was also interested in removing the bumpy nodules next to her tongue.  The plan was do have one surgery where the tori on each side would be removed and that same bone used to rebuild the area that is going to have the implant!

Burbank Dental implant tori (1) 
Burbank Dental implant tori (2) 
Burbank Ramsey Amin bone graft (2) 

After removal and healing bone graft:
Burbank Dental bone graft (1) 
Mandibular tori are a bony growth (bumps) in the lower jaw  along the surface nearest to the tongue. Mandibular tori are usually present near the premolars (middle teeth) and above the location of the mylohyoid muscle's attachment to the mandible. In 90% of cases, there is a torus on both the left and right sides.

Tori are slow-growing and vary in size. Most of them do not interfere with


eating or speech. Many people have tori without knowing it. Look in the mirror; you might notice them in your own mouth!

Many people who notice tori are concerned about oral cancer. Tori are not cancerous. They also do not turn into cancer. A torus is normal bone covered with normal tissue. However, other types of growths in the mouth can turn out to be oral cancer.

The prevalence of mandibular tori ranges from 5% – 40% and are less common than bony growths occurring on the palate, known as torus palatinus. They will not disappear unless surgically removed. Tori cannot be prevented.

It is believed that mandibular tori are caused by several factors. They are more common in early adult life and are simetimes associated with grinding. The size of the tori may fluctuate throughout life, and in some cases the tori can be large enough to touch each other in the midline of mouth!

Mandibular tori are usually a clinical finding with no treatment necessary. It is possible for ulcers to form on the area of the tori due to trauma. The tori may also complicate the fabrication of dental implant or regular dentures. If removal of the tori is needed, surgery can be done to reduce the amount of bone.

Because they are on the roof of your mouth, tori palatini can be irritated by some foods. Hard foods, such as crusty bread, or hot foods, such as pizza, are most likely to cause problems. Large upper and lower tori can interfere with speech. Tori on the roof of the mouth can also be used for dental implant grafting, but there are other, easier areas to obtain your own bone if needed

Surgery  can be done under IV sedation in the office.

So…do you have tori?

Feel free to comment below or join the conversation on my Facebook page.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow of the American Academy of Implant Dentistry
Burbank, California
http://www.burbankdentalimplants.com

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23 Responses to Mandibular Tori Used as Bone Graft Source For Dental Implants

  1. RJ says:

    Wow –awesome –I didnt even know those could be removed!

  2. Josh says:

    Yeah so…it DOES hurt. i can’t even feel my jaw without being in pain…or move my tongue without hurting them…or even place my tongue properly inside my mouth…do you have any idea how annoying and tiring that is to deal with everyday? How much does it cost to have them removed? i heard it’s $1000+ for each tori removed. is this correct?

  3. Hi Josh,
    You must have some really large tori! They should only hurt when you cut them with crunchy, sharp foods.
    If they hurt on their own, you should be looked at asap!
    The cost depends on size and how they are attached.
    Ramsey A. Amin, D.D.S.
    Diplomate of the American Board of Oral Implantology /Implant Dentistry
    Fellow of the American Academy of Implant Dentistry
    Burbank, California
    http://www.burbankdentalimplants.com

  4. Andrea says:

    I live in Hawaii and I have both mandibular & palatial tori, which are all quite large. I had a problem last year when I was anesthetized for spinal surgery. The palatial one was nicked, and developed a very slow healing, painful chancre sore which later had some bone-like protrusion. I saw 3 dentists, and was told I needed oral surgery done for removal. Unfortunately, my dental doesn’t cover it, and I am financially strapped, so surgery was not done. Then about 2 weeks ago, I had gallbladder surgery, and my mandibular tori was nicked on both sides of my mouth. Now I am suffering again with painful chancres. I would like to have them all removed, but since my dental doesn’t cover that, and I don’t have the money, I guess am stuck with these tori.

    • RamseyAminDDS says:

      Hi Andrea,

      Based on what you wrote there is a chance your medical insurance might pay for the removal. There would be no guarantee, but speak to a dental surgeon that commonly bills medical. That might help.
      ;)

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  5. Dana says:

    I have large madibular tori 2-3cm (1 inch) that are scheduled for removal in a few weeks because they’ve gotten large enough that they are becoming problems. I first noticed them about 15-20 years ago as bumps, now there’s only about a half centimeter (1/4 – 3/8 inch) between them. They don’t hurt at all unluss I eat sharp foods.

    However, they are interfering with my speech. More importantly, since my tongue can’t nest properly in my jaw, I bite my tongue badly about once a week, usually in my sleep. Some of the tongue lacerations were quite severe, and after the most recent chomp, I’ve had enough.

    There will be an incision made along the top of my gums, the tissue will be peeled back, the tori shaved down, and some extra tissue excised. Then I’ll be stitched back up. Conceptually a little gruesome, but probably on par with diffucult wisdome teeth removal as far as post-operative discomfort and recovery time. I’m a little grossed out by the procedure, but not worried about it. I can’t wait to have my mouth back!

    • Judy Voorhees says:

      Im 63 and mine are now so close that the tissue under my tongue that hangs down is straining, they were always big but this is ridiculous. Probably 20 yrs ago the dentist I have now saw them and was alarmed but they werent in the way then so I blew it off. I guess Im going to have to have them removed. Did you go for your surgery, was it painful afterwards, did they put you out, how long before you can swallow without pain. Im so scared.

      • Ramsey Amin DDS says:

        Hi Judy,

        If you are going to have them removed, I suggest you have IV sedation. Most of my patients that have this done recover within a day with minimal pain or interruption of their life. If the surgical technique and your healing capability are good, this shouldn’t be so bad.

        I would definitely be sedated though. It is a bit scary.

        Ramsey A. Amin, D.D.S.
        Diplomate of the American Board of Oral Implantology /Implant Dentistry
        Fellow-American Academy of Implant Dentistry

  6. Verneal Maze says:

    I have three children, one daughter, two sons, and 2 grandchildren that have the mandibular tori and they’ve gotten very large in each of them, but I don’t know how many more of my family has them. I don’t have them, nor did my parents and neither did their father and none of the children showed any signs when they were younger. My eldest son has them and they’ve given him quite a bit of trouble, such as tooth extractions. My two grandchildren’s mandibular tori has grown much faster than their mother’s. Hers started in her late twenties and her two children in their late teens, they are now in their thirties. and they’re mother is in her fifties.

  7. Brenda Wesley says:

    I had beautiful white teeth up to a year ago or two, I even got compliments how beautiful my smile was. Then all of a sudden, little by little my teeth start breaking off to the gum. I went to the dentist and he said, you must be a big soda drinker,, wrong I hate soda, never drink it! I drink coffee in the morning and water the rest of the day,, next….we don’t know this happened, but it did. Now I just had surgery and had 13 teeth removed and upper and lower tori removed. I searched for a year for the right dentist and don’t know after all if I found the right one. I was petrified before surgery and I called to ask questions and the woman that I was supposed to talk to was not nice! when she did call back the next day she left a message on my machine, if your thinking about canceling, we set 3 hrs for you and etc,,,,,,,,,,,,,, What!!!! Who said anything about that! I just had some questions, what to eat, how long for healing etc,, then the day of surgery, when I got there, I told them how petrified I was and HER and the others said nothing!! Not even the surgeon, whom was sitting there texting!!! I’m telling you this because no matter how long you do your research on the right dentist, you need to go with your gut feelings. I knew the first day I went there that it didn’t feel right! Now I have exposed bone fragments and a big infection on the roof of my mouth were he removed the tori. well sort of! AND a $7000 bill!!!! and I have dental insurance. so my real question is am I getting ripped off? Is this how much it really cost? I know everybody’s different but you have to be able to tell me if this is even close? Now then want more money for my new teeth,, I dont have anymore,, I’ll be paying the 7000 for years and I’m single and not rich!

    • Ramsey Amin DDS says:

      Hello Brenda,

      I’m sorry to hear about your messy situation. I always believe and going with your got also too.

      Typically before starting a major procedure, most prudent offices will give you a written treatment plan describing what will be done exactly and the associated costs. Did you not receive a full treatment plan detailing the number of teeth to be extracted, the removal of your tori, and making the teeth?

      Oral surgery is complex and can become expensive. Did you have bone grafted into the sockets at the same time? How is the infection being treated?

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      • Brenda Wesley says:

        Thank you for responding, I didn’t receive any treatment plan. I have a dental card called flexible spending account, and I needed to use my 2013 money by march 15th which was 1500 and then for 2014 I had 2500 on it, plus my dental insurance had 1200. So all together they had 5200 of my money. When the lady who does all the billing took me in her office, ( same lady who called me on the phone and left the nasty message) she asked for my flexible spending card and off she went!! she couldn’t type fast enough putting my money through the computer. It was making me nervous, because I thought we did this already the first day I came in and set up surgery. So I said to her while her fingers were typing away, what are taking the rest of my money for I thought I already gave you money for surgery. Not even looking up she said SHH!!! So I never even got a answer. I wanted to get up and leave, but I needed to get these bad broken teeth out of my mouth,, and she already had my money. So anyway I had know idea how many teeth they were going to take out. I just found out when I went there last. I’m pretty sure that I didn’t get any bone grafting done. I just got 13 teeth removed and the tori removed. The tori on the roof of my mouth still is all lumpy and infected. It feels to me that he didn’t remove all the bone, it feels like he dug out the middle and left the outer bone. The infection is being treated with just antibiotics and salt water rinse. It still hurts and I still feel the sandpaper feeling which is the infection. So now that you know that I didn’t get grafting done, what is the normal cost of 13 teeth and tori removal?

        • Ramsey Amin DDS says:

          Hi Brenda,

          It would be a lot easier if you would just post what you paid for each extraction and the tori removal. I would assume there was a fee for IV sedation or general anesthesia that you’re not listing. I am guessing wrapped into that fee was anesthesia, surgical stents, initial exam, cone beam 3-D x-ray.

          Please post the details and be sure to see a different dental implant specialist for the second stage of your treatment. It sounds like you these people are not nice at all and their system of financial arrangements is horrible.

          Take care,

          Dr. Amin

  8. Brenda Wesley says:

    Hello?

  9. Kim S. says:

    Hello, I have three tori on the top of my mouth and one inside my mouth by the teeth. I have deletion 22q syndrome as well and I think my weakened immune system has made it worse with these. I have had a cough, sore throat for four years and couldn’t get any diagnosis by two ENT’s. I asked the ENT yesterday what the bumps on roof of my mouth were and he said tori. I researched them and found all this and that is my problem! I also noticed I cough when I eat. These are causing my cough and sore throat and I have had an ear ache unexplained for a year. This tori is causing all this but I have no dental insurance. They wanted too much to fix my other dental problems. I do have health insurance though. Any suggestions? I have developed loss of appetite in last year and I think this may be why.

    Thank you

  10. Kim S. says:

    Hello, I have three tori on the top of my mouth and one inside my mouth by the teeth. I have deletion 22q syndrome as well and I think my weakened immune system has made it worse with these. I have had a cough, sore throat for four years and couldn’t get any diagnosis by two ENT’s. I asked the ENT yesterday what the bumps on roof of my mouth were and he said tori. I researched them and found all this and that is my problem! I also noticed I cough when I eat. These are causing my cough and sore throat and I have had an ear ache unexplained for a year. This tori is causing all this but I have no dental insurance. They wanted too much to fix my other dental problems. I do have health insurance though. Any suggestions? I have developed loss of appetite in last year and I think this may be why.I should add for two meals so far I have been swallowing only on right side and this has helped with the pain, but obviously I cant swallow on the right side only forever. It is also quite a chore to try to do.
    Kim

    Thank you

    • Ramsey Amin DDS says:

      Hi Kim,

      I too am a very optimistic person. That being said, it is extremely unlikely that removing your Tori will help.

      The types of symptoms you describe do not align with tori.

      You should seek another opinion.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  11. Kim says:

    Ok thanks, I am seeking other opinions because from my research the food passes by the torri and causes ulcerations, this is when I cough. Since I found out what the torri were called knew this is where my cough and sore throat starts from and with research, I have been swallowing on my right side (which is not affected by the torri) and my sore throat and cough completely gone. However, one can not live their life swallowing on their right side. It is very hard to do (try it for one meal). I am working on finding a oral surgeon.

    • Ramsey Amin DDS says:

      hello Kim,

      I do removed tori when people have pain when they chew on them. The mechanical force of chewing on mandibular tori can tear the very thin gum. The torn gum turns into an ulcer. What is different here is that most people only complain about pain when the chew.

      Good luck with everything. I wish you the best

      Respectfully,

      Ramsey Amin DDS

  12. Joy says:

    Yesterday I had two implants put in on my lower right jaw, I was going to get two implants on my left lower jaw but instead my dentist was able to build up the bone on the lower left so he could put a permanent bridge in later on. As. He was working he realized that he needed to remove my mandiblar tori on my right side in order for the implants to be done so he removed that tori as well as the tori on my right side. I am all stitched up on both sides where I had the bone enhancement and the two implants. I was awake for the entire procedure which took over two hours and when I left the office I was fine. I could not believe how good I felt last night. I did take an antibiotic and a Motrin but no heavy pain medication. I iced yesterday and when I woke up today I had some discomfort and a little swelling but really not what I expected. I wish I would have removed the tori a long time ago.

    • Ramsey Amin DDS says:

      Hi Joy,
      I am happy to hear about your wonderful experience. Mandibular tori removal can be very involved. Some are huge and some are tiny. It sounds like you are tougher than most patients. ;)
      Most people could not deal with that type of a long surgery next your tongue.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  13. Sid says:

    Hello Ramsey. Thanks for the opportunity to ask you a question. I have bony growth on the outside of both lower gums. They have grown to the point that they push into my cheeks. I can feel it and also see a bump on each side where they press into my cheeks. Somewhat like Marlon Brando’s puffed cheeks in the Godfather.

    Although they do become scratched/cut when eating abrasive food like hard potato chips, I really want them removed for cosmetic reasons. I have consulted with an Oral Surgeon and he said they can be removed with no issue.

    My question and reason I hesitate to do it is that I’ve heard from my Dentist and a Dental hygienist that it would be painful. Is that true? Will it “hurt like hell” as one of them put it? Also I am 43yrs old and in good health. Thanks in advance for your response.

    • Ramsey Amin DDS says:

      Hello Sid,

      I find it interesting that your dentist and hygienist said that removing these bumps of bone would be painful. They probably are not exposed to this procedure on a routine basis though they have no basis of knowing whether or not this is painful or not.

      These are called buccal exostoses. They are like mandibular tori but on the outside. There generally not painful to remove if done correctly. I find that patients that have IV sedation and have the benefit of intravenous steroids heal so much faster than those that do not. You will have some pain, but if you’re a patient of mine I would not expect you to need anything more than Motrin 600 mg.

      I just had a patient last week that I removed his mandibular tori and about 13 of those bone bumps on the outside.

      http://www.burbankdentalimplants.com/oral-surgery/

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

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