Large lobulated palatal torus preventing denture construction

§Chief complaint

Cannot wear a new upper denture because of a bony lump on the palate

§Medical & dental history

• 01Hypertension controlled; no antiresorptive or anticoagulant drugs
• 02Recently edentulous upper arch; denture rocks and ulcerates the torus

§Clinical examination

• 01Hard, lobulated bony midline mass 30 x 20 mm with thin, traumatised mucosa
• 02Small ulcer at the denture contact point, healing after the denture was left out
• 03No other bony lesions; no lymphadenopathy

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§Differential diagnosis

§Final diagnosis

Lobulated torus palatinus interfering with complete denture

A hard, midline, lobulated bony growth of the palate is a torus; removal is only indicated when it interferes with a prosthesis, speech, or keeps ulcerating.

§Investigations

• 01CBCT to assess thickness and nasal floor proximity

§Radiology

• 01CBCT — dense bony mass 9 mm thick with a thin layer of bone separating it from the nasal floor

§Treatment plan

• 01Surgical reduction of the torus
• 02Pre-made acrylic palatal stent to protect the wound
• 03New denture after 6-8 weeks

§Surgical procedure

• 01Double-Y midline incision, full-thickness flaps lifted carefully over thin mucosa
• 02Torus divided into segments with a fissure bur and removed with chisels, then smoothed
• 03Flaps trimmed and sutured; stent fitted

§Histopathology report

Dense lamellar cortical bone with a small amount of fatty marrow. Consistent with torus.

§Follow-up & outcome

• 01Day 7 — flaps healing, no communication with the nose
• 02Week 8 — new denture fitted with good retention

Outcome: Stable, comfortable upper denture after torus reduction.

§Discussion

• 01Tori are developmental, not neoplastic; most need no treatment.
• 02Risks of removal include perforation into the nose, flap tearing and haematoma, so a stent and gentle technique matter.

§Clinical pearls / learning points

• 01Section the torus in pieces rather than removing it in one block — this avoids fracturing into the nasal floor.

§Viva questions

§MCQs

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