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L5 Intraoral Radiographic Anatomy

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titleL5 Intraoral Radiographic Anatomy
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8 min read

Intraoral Radiographic Anatomy1

Dr Dayea Oh OMF Radiologist

BW, PA & Occlusograph Anatomy2

  • Dental structures
  • Osseous structures
  • Canals and foramina
  • Artefacts

  • Essentials of dental radiography and radiology 5th edition by Whaites, Eric; Drage, Nicholas. Churchill Livingstone 2013

  • Pocket atlas of dental radiology by Pasler, Friedrich A; Visser, Heiko. Flexibook, 2007

  • Oral radiology: principles and interpretation 7th edition by White, Stuart C; Pharoah, M. J. Permalink 2014

    • 8th edition available now

Dental Structures and Restorations

Anatomy of the Teeth4

Teeth

FIG. 12.1 Teeth are composed of pulp (arrow on the second molar), enamel (arrow on the first molar), dentin (arrow on the second premolar), and cementum (usually not visible radiographically).

Cervical Burnout5

FIG. 12.2 Cervical burnout is caused by overexposure of the lateral portion of roots between the enamel and the alveolar crest and results in an ill-defined radiolucent zone (arrows).

FIG. 12.2 Cervical burnout is caused by overexposure of the lateral portion of roots between the enamel and the alveolar crest and results in an ill-defined radiolucent zone (arrows).

Root Canal and Apical Structures

Root Canal – Apical third6

FIG. 12.6 Although the root canal is typically not radiographically visible in the apical 2 mm of a tooth, anatomically it is present and contains the vascular and neural supply to the pulp (arrow).

FIG. 12.6 Although the root canal is typically not radiographically visible in the apical 2 mm of a tooth, anatomically it is present and contains the vascular and neural supply to the pulp (arrow).

Developing Roots and Mixed Dentition

Mixed Dentition – Developing Roots7

FIG. 12.8 A developing root shown by a divergent apex around the dental papilla (arrow), which is enclosed by an opaque bony crypt. The apices of the first molar are still open but nearing closure.

FIG. 12.8 A developing root shown by a divergent apex around the dental papilla (arrow), which is enclosed by an opaque bony crypt. The apices of the first molar are still open but nearing closure.

Periodontal Ligament Space and Lamina Dura8

FIG. 12.9 The lamina dura (arrows) appears as a thin opaque layer of bone around teeth (A) and around a recent extraction socket (B).

Periodontal Ligament Space9

FIG. 12.12 The periodontal ligament space (arrows) is seen as a narrow radiolucency between the tooth root and the lamina dura.

Lamina Dura

A B

FIG. 12.12 The periodontal ligament space (arrows) is seen as a narrow radiolucency between the tooth root and the lamina dura.

Restorative and Orthodontic Therapy

Restorative Therapy10
  • FIG. 12.72 Amalgam restorations appear completely radiopaque (arrows).
  • FIG. 12.77 Gutta-percha (arrows) is a radiopaque rubber-like material used in endodontic therapy.
FIG. 12.72 Amalgam restorations appear completely radiopaque (arrows).FIG. 12.77 Gutta-percha (arrows) is a radiopaque rubber-like material used in endodontic therapy.
Orthodontic therapy & Crowns11
  • FIG. 12.80 Orthodontic appliances have a characteristic radiopaque appearance.
  • FIG. 12.79 Porcelain appears radiolucent (arrow) over a metal coping.
FIG. 12.80 Orthodontic appliances have a characteristic radiopaque appearance.FIG. 12.79 Porcelain appears radiolucent (arrow) over a metal coping.

Osseous Structures of the Maxilla

Alveolar Bone and Trabecular Pattern

Alveolar Crest12

FIG. 12.11 The alveolar crests (arrows) are seen as cortical borders of the alveolar bone. The alveolar crest is continuous with the lamina dura.

FIG. 12.11 The alveolar crests (arrows) are seen as cortical borders of the alveolar bone. The alveolar crest is continuous with the lamina dura.

Trabecular Pattern13

FIG. 12.17 The trabecular pattern in the posterior mandible is quite variable, generally showing large marrow spaces and sparse trabeculation, especially inferiorly (arrows).

FIG. 12.17 The trabecular pattern in the posterior mandible is quite variable, generally showing large marrow spaces and sparse trabeculation, especially inferiorly (arrows).

Midline Maxillary Landmarks

Intermaxillary Suture14

FIG. 12.19 The intermaxillary suture (arrows) appears as a curved radiolucency in the midline of the maxilla.

FIG. 12.20 The intermaxillary suture may terminate in a V-shaped widening (arrow) at the alveolar crest. This is a normal variation and should not be confused with alveolar bone loss associated with periodontal disease.

FIG. 12.19 The intermaxillary suture (arrows) appears as a curved radiolucency in the midline of the maxilla.FIG. 12.20 The intermaxillary suture may terminate in a V-shaped widening (arrow) at the alveolar crest. This is a normal variation and should not be confused with alveolar bone loss associated with periodontal disease.

Anterior Nasal Spine and Septum15

FIG. 12.22 The anterior floor of the nasal aperture (arrows) appears as opaque lines extending laterally from the anterior nasal spine.FIG. 12.23 The nasal septum (black arrow) arises directly above the anterior nasal spine and is covered on each side by mucosa (white arrow).
Anterior Nasal Spine16

FIG. 12.21 The anterior nasal spine is seen as an opaque, irregular, or V-shaped projection from the floor of the nasal aperture in the midline (arrow).

  • FIG. 12.22 The anterior floor of the nasal aperture (arrows) appears as opaque lines extending laterally from the anterior nasal spine.
  • FIG. 12.23 The nasal septum (black arrow) arises directly above the anterior nasal spine and is covered on each side by mucosa (white arrow).

FIG. 12.21 The anterior nasal spine is seen as an opaque, irregular, or V-shaped projection from the floor of the nasal aperture in the midline (arrow).

Nasal Cavity and Associated Canals

Nasal Floor17

  • FIG. 12.27 The floor of the nasal cavity, or hard palate (arrows), extends posteriorly, superimposed over the maxillary sinus.
  • FIG. 12.26 The floor of the nasal aperture (arrows) often may be seen extending posteriorly from the anterior nasal spine above the maxillary lateral incisor and canine.
FIG. 12.27 The floor of the nasal cavity, or hard palate (arrows), extends posteriorly, superimposed over the maxillary sinus.FIG. 12.26 The floor of the nasal aperture (arrows) often may be seen extending posteriorly from the anterior nasal spine above the maxillary lateral incisor and canine.

Incisive Canal and Nasopalatine Foramina181920

Incisive Canal

FIG. 12.30 The superior foramina of the nasopalatine canal (arrows) appear just lateral to the nasal septum and posterior to the anterior nasal spine.

A and B. Radiographs showing the incisive canal.
FIG. 12.31 (A) and (B) Sagittal cone beam computed tomography sections through the midsagittal plane showing the course of the nasopalatine canal (yellow arrow) and the opening of the incisive foramen (white arrow). Note the range of normal variation in the size of these structures.FIG. 12.30 The superior foramina of the nasopalatine canal (arrows) appear just lateral to the nasal septum and posterior to the anterior nasal spine.

Lateral Fossa21

FIG. 12.32 (A) Cone beam computed tomography section through the long axis of a maxillary lateral incisor showing the lateral fossa as a depression on the buccal surface (arrow). (B) The lateral fossa is a diffuse radiolucency (arrows) in the region of the apex of the lateral incisor.

FIG. 12.32 (A) Cone beam computed tomography section through the long axis of a maxillary lateral incisor showing the lateral fossa as a depression on the buccal surface (arrow). (B) The lateral fossa is a diffuse radiolucency (arrows) in the region of the apex of the lateral incisor.

Maxillary Sinus and Soft Tissue22

Soft Tissue of the Nose

FIG. 12.33 The soft tissue outline of the nose (arrows) is superimposed on the anterior maxilla.

Nasolacrimal Canals23

FIG. 12.35 The nasolacrimal canals are commonly seen as ovoid radiolucencies (arrows) on maxillary occlusal projections. They should not be confused with the greater palatine foramina, which are not apparent on maxillary occlusal projections.

FIG. 12.35 The nasolacrimal canals are commonly seen as ovoid radiolucencies (arrows) on maxillary occlusal projections. They should not be confused with the greater palatine foramina, which are not apparent on maxillary occlusal projections.

Maxillary Sinus Anatomy242526

  • FIG. 12.36 The inferior border of the maxillary sinus (arrows) appears as a thin radiopaque line near the apices of the maxillary premolars and molars.
  • FIG. 12.37 The anterior border of the maxillary sinus (white arrows) crosses the floor of the nasal fossa (black arrow).

Dental X-ray showing neurovascular canals in the maxillary sinus

FIG. 12.36 The inferior border of the maxillary sinus (arrows) appears as a thin radiopaque line near the apices of the maxillary premolars and molars.FIG. 12.37 The anterior border of the maxillary sinus (white arrows) crosses the floor of the nasal fossa (black arrow).FIG. 12.40 Neurovascular canals (arrows) in the lateral wall of the maxillary sinus. Such vascular canals, although typically less prominent, are commonly seen in the walls of the normal maxillary sinus.
FIG. 12.40 Neurovascular canals (arrows) in the lateral wall of the maxillary sinus. Such vascular canals, although typically less prominent, are commonly seen in the walls of the normal maxillary sinus.FIG. 12.43 The zygomatic process of the maxilla (arrows) protrudes laterally from the maxillary wall. Its size may be quite variable: small with thick borders (A) or large with thin borders (B).

Nasolabial Fold and Soft Tissue2728

Soft tissue shadow line across palate

FIG. 12.45 The nasolabial soft tissue fold (arrows) extends across the canine-premolar region.FIG. 12.46 Pterygoid plates (arrows) located posterior to the maxillary tuberosity.

Osseous Structures of the Mandible

Midline Mandibular Landmarks

Genial Tubercles and Lingual Foramen2930

FIG. 12.50 The genial tubercles (arrow) appear as a radiopaque mass, in this case without evidence of the lingual foramen.

Lingual foramen. (A) Lingual foramen on a periapical view (arrow), with a sclerotic border, in the symphyseal region of the mandible. (B) Cone beam sagittal section through mandibular midline shows superior lingual foramen extending deep into the mandible from the lingual surface.

FIG. 12.50 The genial tubercles (arrow) appear as a radiopaque mass, in this case without evidence of the lingual foramen.FIG. 12.51 Lingual foramen. (A) Lingual foramen on a periapical view (arrow), with a sclerotic border, in the symphyseal region of the mandible. (B) Cone beam sagittal section through mandibular midline shows superior lingual foramen extending deep into the mandible from the lingual surface.

Mental Fossa31

FIG. 12.53 The mental fossa is a depression on the anterior surface of the mandible and is seen as a radiolucent area with ill-defined borders (arrows) in the region of the incisor roots.

FIG. 12.53 The mental fossa is a depression on the anterior surface of the mandible and is seen as a radiolucent area with ill-defined borders (arrows) in the region of the incisor roots.

Mandibular Canals and Foramina

Mental Foramen32

  • FIG. 12.54 The mental foramen (arrow) appears as an oval radiolucency typically near the apex of the second premolar.
  • FIG. 12.56 The mental foramen (arrow) (over the apex of the second premolar) may simulate periapical disease. However, continuity of the lamina dura around the apex indicates the absence of periapical abnormality.
FIG. 12.54 The mental foramen (arrow) appears as an oval radiolucency typically near the apex of the second premolar.
FIG. 12.56 The mental foramen (arrow) (over the apex of the second premolar) may simulate periapical disease. However, continuity of the lamina dura around the apex indicates the absence of periapical abnormality.

Mandibular Canal and Nutrient Canals333435

FIG. 12.57 Inferior alveolar canal. (A) On periapical view, arrows denote radiopaque superior and inferior cortical borders. (B) Cone beam section through the body of the mandible (different patient) shows corticated borders of the inferior alveolar canal. (C) Cone beam cross-sectional view shows the circular inferior alveolar canal with corticated borders lying adjacent to the lingual plate.

  • FIG. 12.60 Nutrient canals (arrows), demonstrated by radiopaque cortical borders, descend from the mandibular first molar. Nutrient canals at this location are a common finding.
  • FIG. 12.61 Nutrient canals seen as vertical radiolucent structures (arrows) in the anterior mandible are often associated with periodontal disease as in this patient.
FIG. 12.57 Inferior alveolar canal. (A) On periapical view, arrows denote radiopaque superior and inferior cortical borders. (B) Cone beam section through the body of the mandible (different patient) shows corticated borders of the inferior alveolar canal. (C) Cone beam cross-sectional view shows the circular inferior alveolar canal with corticated borders lying adjacent to the lingual plate.FIG. 12.58 Superimposition of the inferior alveolar canal over the apex of a molar causes the image of the periodontal ligament space to appear wider (arrow). However, the presence of an intact lamina dura indicates that there is no periapical disease.
FIG. 12.60 Nutrient canals (arrows), demonstrated by radiopaque cortical borders, descend from the mandibular first molar. Nutrient canals at this location are a common finding.FIG. 12.61 Nutrient canals seen as vertical radiolucent structures (arrows) in the anterior mandible are often associated with periodontal disease as in this patient.

Mandibular Ridges and Fossae

Mylohyoid Ridge36

FIG. 12.62 Mylohyoid ridge (arrows) running at the level of the molar apices and above the inferior alveolar canal.

FIG. 12.62 Mylohyoid ridge (arrows) running at the level of the molar apices and above the inferior alveolar canal.

Submandibular Fossa37

FIG. 12.64 Submandibular gland fossa (arrows), indicated by a radiolucent region with ill-defined borders and sparse trabecular bone lying inferiorly to the mandibular molars.

FIG. 12.64 Submandibular gland fossa (arrows), indicated by a radiolucent region with ill-defined borders and sparse trabecular bone lying inferiorly to the mandibular molars.

External Oblique Ridge38

FIG. 12.65 External oblique ridge (arrows) on the buccal surface of the mandible, seen as a radiopaque line near the alveolar crest in the mandibular third molar region.

FIG. 12.65 External oblique ridge (arrows) on the buccal surface of the mandible, seen as a radiopaque line near the alveolar crest in the mandibular third molar region.

Inferior Cortical Border of the Mandible3940

FIG. 12.66 The inferior border of the mandible (arrows) is seen as a dense, broad radiopaque band.

End.

FIG. 12.66 The inferior border of the mandible (arrows) is seen as a dense, broad radiopaque band.

Footnotes

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