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Prevalence of Torus Mandibularis in

Young Healthy Dentate Adults


Koji Morita, DDS, PhD,* Hiroki Tsuka, DDS, PhD,y Tomoaki Shintani, DDS, PhD,z
Mitsuyoshi Yoshida, DDS, PhD,x Hidemi Kurihara, DDS, PhD,k
and Kazuhiro Tsuga, DDS, PhD{
Purpose: There have been only a few reports on the prevalence of torus mandibularis (TM) in young
adult patients, and TM can have various adverse effects on oral and occlusal states in middle-age patients.
This study was designed to determine the association between TM status and oral and occlusal states in
young healthy dentate adults.
Materials and Methods: This was a cross-sectional study; the sample population included students at
Hiroshima University (Hiroshima, Japan) who participated for practical education. The predictor variables
in this study included oral symptoms (temporomandibular joint noise, tooth clenching and grinding,
buccal mucosa ridging, dental attrition, and tongue habit), oral anatomy (occlusal vertical dimension),
and oral function (average occlusal pressure, occlusal contact area, and maximum voluntary tongue pres-
sure). The outcome variable was TM status (present or absent). Additional variables were demographic in
nature and included age, number of residual teeth, body weight, and gender. These variables were
compared among participants with and without TM using univariate analysis and multiple logistic regres-
sion analysis. Statistical analyses were carried out using SPSS Statistics 19 for Windows (IBM Corp, Armonk,
NY); a P value less than .05 was considered significant.
Results: Of 204 participants included in the study, 50% were men and 50% were women. The mean age
was 22.4  2.7 years. TM was present in 119 (58.3%). Multiple logistic regression analysis showed that TM
status was associated with dental attrition and occlusal contact area (P < .05).
Conclusions: This study showed that TM was present in more than half the young healthy dentate
participants and was closely associated with dental attrition and occlusal contact area. This study will
provide readers with useful information to help prevent the development of TM before middle age.
Ó 2017 The Authors. Published by Elsevier Inc. on behalf of American Association of Oral and Maxil-
lofacial Surgeons. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).
J Oral Maxillofac Surg 75:2593-2598, 2017

*Assistant Professor, Department of Advanced Prosthodontics, Conflict of Interest Disclosures: None of the authors have a rele-
Applied Life Sciences, Institute of Biomedical and Health Sciences, vant financial relationship(s) with a commercial interest.
Hiroshima University, Hiroshima, Japan. Address correspondence and reprint requests to Dr Morita:
yAssistant Professor, Department of Advanced Prosthodontics, Department of Advanced Prosthodontics, Applied Life Sciences,
Applied Life Sciences, Institute of Biomedical and Health Sciences, Institute of Biomedical and Health Sciences, Hiroshima University,
Hiroshima University, Hiroshima, Japan. 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan; e-mail:
zAssistant Professor, Center of Oral Clinical Examination, moritak@hiroshima-u.ac.jp
Hiroshima University Hospital, Hiroshima, Japan. Received December 26 2016
xAssociated Professor, Department of Advanced Prosthodontics, Accepted April 24 2017
Applied Life Sciences, Institute of Biomedical and Health Sciences, Ó 2017 The Authors. Published by Elsevier Inc. on behalf of American
Hiroshima University, Hiroshima, Japan. Association of Oral and Maxillofacial Surgeons. This is an open access
kProfessor, Center of Oral Clinical Examination, Hiroshima article under the CC BY-NC-ND license (http://creativecommons.org/
University Hospital, Hiroshima, Japan. licenses/by-nc-nd/4.0/).
{Professor, Department of Advanced Prosthodontics, Applied 0278-2391/17/30500-1
Life Sciences, Institute of Biomedical and Health Sciences, http://dx.doi.org/10.1016/j.joms.2017.04.044
Hiroshima University, Hiroshima, Japan.

2593
2594 TORUS MANDIBULARIS IN HEALTHY DENTATE ADULTS

Torus mandibularis (TM) is a form of exostosis caused STUDY VARIABLES AND DATA COLLECTION
by the development of extra bone mainly observed in METHODS
the lingual region of the mandibular bone in middle- The predictor variables in this study included oral
age patients.1,2 TM is frequently encountered in symptoms (temporomandibular joint [TMJ] noise,
clinical practice but is not considered a pathologic tooth clenching and grinding, buccal mucosa ridging
condition.3 However, TM can affect pronunciation, [BMR], dental attrition [DA], and tongue habit), oral
interfere with swallowing, and cause pain in the anatomy (occlusal vertical dimension [OVD]), and
mucosa under improperly designed prostheses.4 oral function (average occlusal pressure [AOP],
Moreover, it has been associated with temporoman- occlusal contact area [OCA], and maximum voluntary
dibular disorder, orofacial pain, and bone grafting for tongue pressure [MVTP]). Four dentists examined the
implant treatment.5,6 participants. One performed interviews (K.K.); one
The development of TM can be due to genetic fac- performed oral examinations (H.T.); one measured
tors, including gender and ethnicity; environmental OVD, AOP, and OCA (K.M.); and one measured
factors, such as the survival rate of teeth and malnutri- MVTP (T.S.).
tion; or functional factors, such as clenching and All participants were interviewed using the authors’
grinding.7-10 However, only a few studies have original questionnaire on oral symptoms, such as TMJ
reported on the prevalence of TM in young adults. In noise and tooth clenching or grinding. The presence
addition, to the best of the authors’ knowledge, no or absence of oral symptoms, including TMJ sounds,
studies have evaluated oral and occlusal status in tooth clenching or grinding, and tongue habit, were
relation to TM. The purpose of this study was to determined with the following questions: 1) Have
measure the difference in oral and occlusal status of you ever noticed a clicking or crepitus sound while
young healthy dentate adults with and without TM. opening or closing your jaw? 2) Have you ever been
The authors hypothesized that young adults with TM aware of tooth clenching or grinding during the day
would have a specific oral and occlusal status. If or at night? 3) Does the apex of your tongue touch
true, then this study could provide useful your teeth during swallowing?12-15
information to prevent the development of TM in BMR was defined as linear thickening where the
patients until middle age. The specific aim of this teeth occlude on the buccal mucosa, according to a
study was to determine differences in oral previous report.16 DA was defined as atypical wear pat-
symptoms, oral anatomy, and oral functions related terns on the incisal edges and cusp tips; the degree of
to TM. wear was scored from 1 to 4 in accordance with a
modified version of the Smith and Knight Tooth
Materials and Methods Wear Index.17,18 OVD was measured as the distance
from the subnasal point to the chin using vernier
STUDY DESIGN AND SAMPLE POPULATION calipers (Tsubone Bite Gauge, YDM Corporation,
To address the research purpose, the authors de- Tokyo, Japan). The oral function test was performed
signed and implemented a cross-sectional study. The as follows: the Frankfort horizontal plane of each
study population consisted of dental students who participant while sitting in a dental chair was parallel
presented at the Hiroshima University School of to the horizontal plane, and participants were asked
Dentistry (Hiroshima, Japan) from June 20, 2015 to bite down on pressure measurement film (Dental
through June 20, 2016. The prospective study partici- Prescale 50H, GC, Tokyo, Japan) for 3 seconds with
pants included all students who participated to ac- maximum voluntary effort. AOP and OCA were
quire early practical exposure. Participants who met analyzed by measuring the density and area of red
the following criteria were included in this study: 1) patches on the film from the 3 readings collected
younger than 40 years, 2) complete dentition with from the occluding pressure measurements using an
no symptoms, and 3) no history of orthodontic treat- occlusal force measuring system (Occluser 709, GC,
ment. The exclusion criteria were severe periodonti- Tokyo, Japan). The validity, reliability, and
tis, tooth pain, or history of orthodontic treatment; reproducibility of this method have been described
no participants were excluded. Before this study, the previously.19,20 Each intraclass correlation (ICC) for
authors explained the purpose and methodology of AOP and OCA showed excellent single agreement
the study to the participants. All participants signed (ICC, 0.956; 95% confidence interval [CI], 0.945-
a consent form before being enrolled. This study was 0.966; ICC, 0.917; 95% CI, 0.872-0.947).
approved by the medical ethics committee of Hirosh- To determine MVTP, participants were asked to
ima University Hospital (number 920) and conformed compress the balloon of the probe against their palate
to Strengthening the Reporting of Observational with maximum voluntary effort for 7 seconds. MVTP
Studies in Epidemiology (STROBE) guidelines.11 was evaluated as the average of 3 measurements using
MORITA ET AL 2595

a handy tongue pressure-measuring device and a partial correlation coefficients were negative, suggest-
disposable balloon probe (TPM-01, JMS, Hiroshima, ing multicollinearity. The multiple logistic regression
Japan). The authors also confirmed the reliability of analysis showed that DA and OCA were significantly
MVTP measurements in this study. The validity, reli- associated with TM (P < .05) in Table 5.
ability, and reproducibility of this method have been
described in previous reports.21,22 The ICC for MVTP
Discussion
showed good single agreement (ICC, 0.882; 95% CI,
0.854-0.906). The purpose of this study was to measure the differ-
The other variables were demographic and ence of oral and occlusal states in young healthy den-
included age, number of residual teeth, weight, and tate adults with and without TM. The authors
gender. All participants were interviewed using the au- hypothesized that young adults with TM would have
thors’ original questionnaire, including demographic specific oral and occlusal states. If so, then this study
information. should provide useful information to prevent the
The outcome variable was the presence of TM. TM development of TM until they reach middle age. The
status was identified with the naked eye and palpation specific aim of the study was to determine differences
of the unilateral or bilateral form. Determination of the in oral symptoms, oral anatomy, and oral function. The
presence or absence of TM was scored from 0 to 3 in results of this study showed that TM status was closely
accordance with the Igarashi Torus Index.23 This in- associated with DA and OCA in young healthy dentate
dex denotes class 0 as no TM recognized visually or adults. Multiple logistic regression analysis showed
by palpation, class 1 denotes TM recognized only by that participants with TM had markedly increased
palpation, class 2 denotes a visually perceptible TM DA and OCA.
high enough for a clear shadow to be seen on the sur- TM was not associated with TMJ sounds, tooth
face of the mandible, and class 3 denotes a visually clenching or grinding, or tongue habit among the par-
perceptible TM whose contour can be completely ticipants in this study. These oral parafunctions are
traced visually around the base of the TM. This study strongly associated with bruxism.24-26 Bruxism can
used the same scale in which class 0 was defined as change oral and occlusal states, such as BMR, DA,
the absence of TM and classes 1 to 3 denoted detection AOP, and OCA, over time.16,27-30 It could be the
of TM. reason TM status has been strongly associated with
TMJ sounds and tooth clenching or grinding in
DATA ANALYSES middle-age patients. In addition, there was no relevant
Spearman rank correlation coefficient test, c2 test, difference in OVD in participants with versus without
and Mann-Whitney U test were used for the compari- TM. OVD has been reported to be closely associated
son of each variable in participants with versus with jaw size, which was one of the genetic factors
without TM; a P value less than .05 was considered sig- examined in this study.31,32 This result suggests that
nificant. After adjusting for confounders, odds ratios TM status might not be due solely to genetic factors
and 95% CIs were calculated using multiple logistic such as OVD.
regression analysis to show the association between These results suggest that TM status is closely asso-
predictor variables and the outcome variable. Statisti- ciated with DA and OCA. DA and OCA also were
cal analyses were conducted using SPSS Statistics 19 closely associated with masticatory ability.33 Mechani-
for Windows (IBM Corporation, Armonk, NY). cal stimulation from a large number of occlusal
contacts from mastication could induce the
Results
In total, 204 participants were included in this study, Table 1. DESCRIPTIVE SUMMARY OF STUDY SAMPLE
consisting of 102 men and 102 women with a mean
age of 22.4  2.7 years, a mean number of residual Study Variables Descriptive Statistics
teeth of 28.8  2.0 and a mean body weight of
57.7  9.9 kg (Table 1). The association between Sample 204 (100)
age, number of residual teeth, weight, and gender Age (yr) 22.4  2.7
and the predictor variables is presented in Table 2. Residual teeth (n) 28.8  2.0
TM was identified in 119 participants (58.3%) and Body weight (kg) 57.7  9.9
Men 102 (50.0)
absent in 85 (41.7%). The association between age,
number of residual teeth, weight, and gender and Note: Data are presented as number (percentage) or
the outcome variable is presented in Table 3. The re- average  standard deviation.
sults of the multivariate analysis between all predictor Morita et al. Torus Mandibularis in Healthy Dentate Adults. J Oral
variables and TM status are presented in Table 4. Some Maxillofac Surg 2017.
2596 TORUS MANDIBULARIS IN HEALTHY DENTATE ADULTS

Table 2. AGE, NRT, BW, AND MALE GENDER VERSUS PREDICTOR VARIABLES

TJN C or G BMR

Variable Present Absent P Value Present Absent P Value Present Absent P Value

Age 23.5  3.0 22.1  2.5 .003y 23.5  2.7 21.9  2.5 <.01y 22.8  2.7 21.9  2.6 .016*
NRT 28.7  1.9 28.8  2.1 .434 28.5  2.0 28.9  2.0 .132 28.7  2.0 28.8  2.1 .746
BW 57.0  11.4 57.9  9.5 .414 56.3  10.9 58.3  9.4 .096 57.9  10.7 57.4  8.6 .883
Men 18 (37.5) 84 (53.8) .048* 26 (40.6) 76 (54.3) .070 60 (49.2) 42 (51.2) .775
DA TH

Variable Present Absent P Value Present Absent P Value

Age 24.1  2.6 22.0  2.5 <.01y 22.0  2.7 22.6  2.7 .121
NRT 28.8  2.3 28.7  2.0 .742 28.8  1.9 28.7  2.1 .812
BW 59.3  9.0 57.3  10.1 .145 57.0  11.4 58.0  9.2 .279
Men 21 (53.8) 81 (49.1) .593 26 (40.6) 76 (54.3) .070
OVD AOP OCA MVTP

Variable r P Value r P Value r P Value r P Value

Age 0.060 .393 0.028 .687 0.113 .108 0.156 .026*


NRT 0.076 .278 0.046 .510 0.178 .011* 0.178 .011*
BW 0.494 <.01y 0.080 .253 0.243 <.01y 0.461 <.01y
Men 0.479 <.01y 0.061 .387 0.208 .003y 0.525 <.01y
Note: Data are presented as number (percentage), r, or average  standard deviation.
Abbreviations: AOP, average occlusal pressure; BMR, buccal mucosa ridging; BW, body weight; C, tooth clenching; DA, dental
attrition; G, tooth grinding; MVTP, maximum voluntary tongue pressure; NRT, number of residual teeth; OCA, occlusal contact
area; OVD, occlusal vertical dimension; TH, tongue habit; TJN, temporomandibular joint noise.
*P < .05; yP < .01 by Spearman rank correlation coefficient test and c2 test.
Morita et al. Torus Mandibularis in Healthy Dentate Adults. J Oral Maxillofac Surg 2017.

development of TM. However, TM status was not asso-


Table 4. ALL PREDICTOR VARIABLES VERSUS TORUS
ciated with MVTP. MVTP has been shown to be closely MANDIBULARIS STATUS
associated with masticatory function in previous re-
ports.34 Further studies are necessary to show the as- Variable OR 95% CI P Value
sociation between TM status and masticatory
function to confirm this hypothesis. Oral symptoms
With TJN 0.583 0.271-1.256 .168
With C or G 1.268 0.593-2.712 .540
With BMR 1.846 0.941-3.622 .074
Table 3. AGE, NRT, BW, AND MALE GENDER VERSUS With DA 2.905 1.160-7.275 .023*
OUTCOME VARIABLE With TH 1.340 0.680-2.641 .397
Oral functions
With TM Without TM OVD (mm) 0.990 0.932-1.052 .742
Variable (n = 119) (n = 85) P Value AOP (N/mm2) 1.003 0.989-1.018 .642
OCA (mm2) 1.092 1.023-1.165 .008y
Age (yr) 22.7  2.6 21.9  2.7 .02* MVTP (kPa) 1.025 0.988-1.063 .186
NRT 28.9  2.0 28.6  2.0 .31
BW (kg) 58.8  10.1 56.2  9.5 .05 Note: Logistic regression analysis was used for all variables.
Men 65 (54.6) 37 (43.5) .12 Abbreviations: AOP, average occlusal pressure; BMR,
buccal mucosa ridging; C, tooth clenching; CI, confidence
Note: Data are presented as number (percentage) or interval; DA, dental attrition; G, tooth grinding; MVTP,
average  standard deviation. maximum voluntary tongue pressure; OCA, occlusal contact
Abbreviations: BW, body weight; NRT, number of residual area; OR, odds ratio; OVD, occlusal vertical dimension; TH,
teeth; TM, torus mandibularis. tongue habit; TJN, temporomandibular joint noise.
* P < .05 by Mann-Whitney U test and c2 test. *P < .05; yP < .01.
Morita et al. Torus Mandibularis in Healthy Dentate Adults. J Oral Morita et al. Torus Mandibularis in Healthy Dentate Adults. J Oral
Maxillofac Surg 2017. Maxillofac Surg 2017.
MORITA ET AL 2597

5. Sirirungrojying S, Kerdpon D: Relationship between oral tori and


Table 5. SUMMARY OF REGRESSION MODEL temporomandibular disorders. Int Dent J 49:101, 1999
6. Moraes Junior EF, Damante CA, Araujo SR: Torus palatinus: A
Variable OR 95% CI P Value graft option for alveolar ridge reconstruction. Int J Periodontics
Restorative Dent 30:283, 2010
Age 1.057 0.938-1.190 .364 7. Eggen S, Natvig B: Variation in torus mandibularis prevalence in
Norway. A statistical analysis using logistic regression. Commu-
DA 2.527 1.069-5.977 .035* nity Dent Oral Epidemiol 19:32, 1991
OCA 1.106 1.044-1.171 <.01y 8. Bernaba JM: Morphology and incidence of torus palantinus
and mandibularis in Brazilian Indians. J Dent Res 56:499,
Note: Stepwise logistic regression analysis was used. 1977
Abbreviations: CI, confidence interval; DA, dental 9. Jainkittivong A, Apinhasmit W, Swasdison S: Prevalence and clin-
attrition; OCA, occlusal contact area; OR, odds ratio. ical characteristics of oral tori in 1,520 Chulalongkorn University
*P < .05; yP < .01. Dental School patients. Surg Radiol Anat 29:125, 2007
10. Cortes AR, Jin Z, Morrison MD, et al: Mandibular tori are associ-
Morita et al. Torus Mandibularis in Healthy Dentate Adults. J Oral ated with mechanical stress and mandibular shape. J Oral Max-
Maxillofac Surg 2017. illofac Surg 72:2115, 2014
11. von Elm E, Altman DG, Egger M, et al: The Strengthening the Re-
porting of Observational Studies in Epidemiology (STROBE)
statement: Guidelines for reporting observational studies. J
Clin Epidemiol 61:344, 2008
This study had limitations. The study sample was 12. Panek H, Nawrot P, Mazan M, et al: Coincidence and awareness
relatively small and included predominantly Japanese of oral parafunctions in college students. Community Dent
students at Hiroshima University, which could limit Health 29:74, 2012
13. Motghare V, Kumar J, Kamate S, et al: Association between
the ability to extrapolate the results to young adults harmful oral habits and sign and symptoms of temporoman-
of all races. However, the prevalence of TM status dibular joint disorders among adolescents. J Clin Diagn Res
without gender differences was similar to results of 9:ZC45, 2015
14. Jang JY, Kwon JS, Lee DH, et al: Clinical signs and subjective
other studies.35-37 Therefore, the difference of race symptoms of temporomandibular disorders in instrumentalists.
might not have strongly influenced the results. The Yonsei Med J 57:1500, 2016
authors did not examine malocclusion factors,25 15. Valentim AF, Furlan RM, Perilo TV, et al: Relationship between
perception of tongue position and measures of tongue force
such as crowding, overjet, overbite, or crossbite, other on the teeth. Codas 28:546, 2016
parafunctions,29 eating habits,38 or genetic factors.36 16. Mizutani S, Ekuni D, Tomofuji T, et al: Factors related to the for-
However, to the best of the authors’ knowledge, no mation of buccal mucosa ridging in university students. Acta
Odontol Scand 72:58, 2014
studies have examined the influence of oral and 17. Smith BG, Knight JK: An index for measuring the wear of teeth.
occlusal states on the development of TM, and this Br Dent J 156:435, 1984
study showed the association between TM status and 18. Morrison MD, Tamimi F: Oral tori are associated with local
mechanical and systemic factors: A case-control study. J Oral
some oral and occlusal states for the first time. Maxillofac Surg 71:14, 2013
TM was recognized in more than half the young den- 19. Hidaka O, Iwasaki M, Saito M, et al: Influence of clenching inten-
tate participants and was closely associated with DA sity on bite force balance, occlusal contact area, and average bite
pressure. J Dent Res 78:1336, 1999
and OCA. Oral conditions, including mastication, 20. Choi YJ, Lim H, Chung CJ, et al: Two-year follow-up of changes in
were found to be relevant factors in the development bite force and occlusal contact area after intraoral vertical ramus
of TM, even in young adults. Therefore, these factors osteotomy with and without Le Fort I osteotomy. Int J Oral
Maxillofac Surg 43:742, 2014
must be evaluated using longitudinal studies to deter- 21. Hayashi R, Tsuga K, Hosokawa R, et al: A novel handy probe
mine a cause-and-effect relation. for tongue pressure measurement. Int J Prosthodont 15:385,
2002
22. Nakamori M, Hosomi N, Ishikawa K, et al: Prediction of pneu-
Acknowledgments monia in acute stroke patients using tongue pressure measure-
ments. PLoS One 11:e0165837, 2016
The authors thank all the medical staff at the Department of 23. Igarashi Y: Frequency of mandibular tori in prehistoric and
Advanced Prosthodontics, Hiroshima University for data collection historic Japanese island populations. Quat Int 405:87, 2016
and engaged participation. (in Japanese)
24. Bektas D, Cankaya M, Livaoglu M: Nasal obstruction may alle-
viate bruxism related temporomandibular joint disorders. Med
References Hypotheses 76:204, 2011
25. Kataoka K, Ekuni D, Mizutani S, et al: Association between self-
1. Antoniades DZ, Belazi M, Papanayiotou P: Concurrence of torus reported bruxism and malocclusion in university students: A
palatinus with palatal and buccal exostoses: Case report and re- cross-sectional study. J Epidemiol 25:423, 2015
view of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 26. Unell L, Johansson A, Ekb€ack G, et al: Prevalence of troublesome
Endod 85:552, 1998 symptoms related to temporomandibular disorders and aware-
2. Chao PJ, Yang HY, Huang WH, et al: Oral tori in chronic hemodi- ness of bruxism in 65- and 75-year-old subjects. Gerodontology
alysis patients. Biomed Res Int 2015:897674, 2015 29:e772, 2012
3. Simunkovi c SK, Bozic M, Alajbeg IZ, et al: Prevalence of torus 27. Okura K, Shigemoto S, Suzuki Y, et al: Mandibular movement
palatinus and torus mandibularis in the Split-Dalmatian County, during sleep bruxism associated with current tooth attrition. J
Croatia. Coll Antropol 35:637, 2011 Prosthodont Res 61:87, 2017
4. Goncalves TM, de Oliveira JA, Sanchez-Ayala A, et al: Surgical 28. Kerdpon D, Sirirungrojying S: A clinical study of oral tori in
resection and prosthetic treatment of an extensive mandibular southern Thailand: Prevalence and the relation to parafunc-
torus. Gen Dent 61:65, 2013 tional activity. Eur J Oral Sci 107:9, 1999
2598 TORUS MANDIBULARIS IN HEALTHY DENTATE ADULTS

29. Takehara J, Takano T, Akhter R, et al: Correlations of noncarious 34. Yamada A, Kanazawa M, Komagamine Y, et al: Association
cervical lesions and occlusal factors determined by using between tongue and lip functions and masticatory performance
pressure-detecting sheet. J Dent 36:774, 2008 in young dentate adults. J Oral Rehabil 42:833, 2015
30. Alkan A, Bulut E, Arici S, et al: Evaluation of treatments 35. Hiremath VK, Husein A, Mishra N: Prevalence of torus palatinus
in patients with nocturnal bruxism on bite force and and torus mandibularis among Malay population. J Int Soc Prev
occlusal contact area: A preliminary report. Eur J Dent Community Dent 1:60, 2011
2:276, 2008 36. Auskalnis A, Bernhardt O, Putniene_ E, et al: Oral bony out-
31. Geerts GA, Stuhlinger ME, Nel DG: A comparison of the accu- growths: Prevalence and genetic factor influence. Study of
racy of two methods used by pre-doctoral students to measure twins. Medicina (Kaunas) 51:228, 2015
vertical dimension. J Prosthet Dent 91:59, 2004 37. Scrieciu M, Mercuţ V, Mercuţ R, et al: Morphological and clinical
32. Sadek MM, Sabet NE, Hassan IT: Alveolar bone mapping in sub- characteristics of the torus palatinus and torus mandibularis in a
jects with different vertical facial dimensions. Eur J Orthod 37: sample of young and adults’ Romanian people. Rom J Morphol
194, 2015 Embryol 57:139, 2016
33. Jain V, Mathur VP, Kumar A: A preliminary study to find a possible 38. Eggen S: Correlated characteristics of the jaws: Association
association between occlusal wear and maximum bite force in between torus mandibularis and marginal alveolar bone height.
humans. Acta Odontol Scand 71:96, 2013 Acta Odontol Scand 50:1, 1992