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1、Intraoral Radiographic AnatomyThe following slides identify the anatomical structures that may be seen on intraoral films.These structures are more likely to be seen when using the bisecting angle technique because of the increased vertical angulation(increased positive in the maxilla and increased
2、negative in the mandible)commonly used with this technique.Since some of the structures may be confused with pathology,it is important to understand their normal appearance in order to make a proper diagnosis.,Maxillary Incisor,a=nasal septumb=inferior conchac=nasal fossad=anterior nasal spinee=inci
3、sive foramenf=median palatal sutureg=soft tissue of nose,b,a,g,f,e,d,c,e,f,a=nasal septumb=inferior conchac=nasal fossad=anterior nasal spine,e=incisive foramenf=median palatal suture,b,a,d,c,facial view,palatal view,Nasal septum,facial view,a,Inferior concha,facial view,Nasal fossa,facial view,Ante
4、rior nasal spine,facial view,Incisive foramen,palatal view,Median palatal suture,palatal view,Soft tissue of the nose,Red arrow points to periapical lesion(post-endo).,Red arrows=lip line,Red arrow=mesiodens(supernumerary tooth),d,f,Blue arrow=chronic periapical periodontitis.Tooth#9 is non-vital(tr
5、auma)and needs endo.,Superior foramina of the nasopalatine canals(red arrows).These foramina lie in the floor of the nasal fossa.The nasopalatine canals travel downward to join in the incisive foramen.,d,b,a,The red arrows point to an incisive canal cyst;the orange arrow identifies the root of tooth
6、#7.,All the incisors are non-vital and have periapical lesions.The purple arrows point to external resorption;the blue arrow identifies internal resorption.,f,The red arrows point to the soft tissue of the nose.The green arrows identify the lip line.,a=floor of nasal fossab=maxillary sinusc=lateral
7、fossad=nose,Maxillary Cuspid,d,c,b,a,a=floor of nasal fossab=maxillary sinusc=lateral fossa,(a&b form inverted Y),a,c,b,a,c,b,facial view,Floor of nasal fossa(red arrows)and anterior border of maxillary sinus(blue arrows),forming the inverted(upside down)Y.,Y,facial view,Lateral fossa.The radiolucen
8、cy results from a depression above and posterior to the lateral incisor.To help rule out pathology,look for an intact lamina dura surrounding the adjacent teeth.,facial view,Soft tissue of the nose,Red arrows point to nasolabial fold.Also note the inverted Y.,The maxillary sinus surrounds the root o
9、f the canine,which may be misinterpreted as pathology.,The white arrows indicate the floor of the nasal fossa.The maxillary sinus(red arrows)has pneumatized between the 2nd premolar and first molar,The red arrow identifies the lateral fossa.The pink arrow points to CPP(chronic periapical periodontit
10、is=abscess,granuloma,etc.).,a=malar processb=sinus septumc=sinus recessd=maxillary sinus,a,b,c,d,Maxillary Premolar,a=malar processb=sinus recessc=sinus septumd=maxillary sinus,b,a,c,d,b,d,c,a,facial view,Malar(zygomatic)process.U or j-shaped radiopacity,often superimposed over the roots of the mola
11、rs,especially when using the bisecting-angle technique.The red arrows define the lower border of the zygomatic bone.,facial view,Sinus septum.This septum is composed of folds of cortical bone that arise from the floor and walls of the maxillary sinus,extending several millimeters into the sinus.In r
12、are cases,the septum completely divides the sinus into separate compartments.,facial view,Sinus recess.Increased area of radiolucency caused by outpocketing(localized expansion)of sinus wall.If superimposed over roots,may mimic pathology.,facial view,Maxillary Sinus.An air-filled cavity lined with m
13、ucous membrane.Communicates with nasal cavity through 3-6 mm opening below middle concha.Red arrows point to neurovascular canal containing superior alveolar vessels and nerves.,facial view,Blue arrows identify radiopacity which is a mucous retention cyst.Note relatively recent premolar extraction s
14、ites.Green arrow points to neurovascular canal.,The red arrows point to the nasolabial fold.The thicker cheek tissue makes the area more radiopaque posterior to the line.,Pneumatization.Expansion of sinus wall into surrounding bone,usually in areas where teeth have been lost prematurely.Increases wi
15、th age.,Maxillary Molar,a=maxillary tuberosityb=coronoid processc=hamular processd=pterygoid platese=zygomaf=maxillary sinus,f,e,d,c,b,a,g,d,a,e,f,a=maxillary tuberosity*e=zygoma(dotted lines)b=coronoid process f=maxillary sinusc=hamular process g=sinus recessd=pterygoid plates*image of impacted thi
16、rd molar superimposed,c,b,facial view,d,b,a,e,c,f,g,Maxillary Tuberosity.The rounded elevation located at the posterior aspect of both sides of the maxilla.Aids in the retention of dentures.,facial view,Coronoid process.A mandibular structure sometimes seen on the maxillary molar periapical film whe
17、n using the bisecting angle technique with finger retention(The mouth is opened wide,moving the coronoid down and forward).Note the supernumerary molar.,facial view,Hamular process(white arrows)and pterygoid plates(purple arrows).The hamular process is an extension of the medial pterygoid plate of t
18、he sphenoid bone,positioned just posterior to the maxillary tuberosity.,facial view,Zygomatic(malar)bone/process/arch.The zygomatic bone(white/black arrows)starts in the anterior aspect with the zygomatic process(blue arrow),which has a U-shape.The zygomatic bone extends posteriorly into the zygomat
19、ic arch(green arrow).,facial view,Maxillary sinus.As seen in the above film,the floor of the maxillary sinus flows around the roots of the maxillary molars and premolars.The walls of the sinus may become very thin.As a result,sinusitis may put pressure on the superior alveolar nerves resulting in ap
20、parent tooth pain,even though the tooth is perfectly healthy.Note coronoid process(green arrow),zygomatic bone(blue arrow),sinus septum(yellow arrow)and neurovascular canal(orange arrows).,facial view,The maxillary sinus is evident anterior to the second molar(black arrows)but it disappears posterio
21、rly due to the superimposition of the zygomatic bone.The orange arrows identify a mucous retention cyst(retention pseudocyst)within the sinus.,This film shows the coronoid process(green arrow)and a distomolar(blue arrow)that has erupted ahead of the third molar(red arrow).A distomolar is a supernume
22、rary tooth that erupts distal(posterior)to the other molars.,The zygomatic process(green arrows)is a prominent U-shaped radiopacity.Normally the zygomatic bone posterior to this is very dense and radiopaque.In this patient,however,the maxillary sinus has expanded into the zygomatic bone and makes th
23、e area more radiolucent(red arrows).The coronoid process(orange arrow),the pterygoid plates(blue arrows)and the maxillary tuberosity(pink arrows)are also identified.,This film shows the expansion of the borders of the maxillary sinus through pneumatization(red arrows).This expansion increases with a
24、ge and it may be accelerated as a result of chronic sinus infections.It is most commonly seen when the first molar is extracted prematurely,as in the film at right(the second and third molars have migrated anteriorly to close the space).The coronoid process is seen in the lower left-hand corner of e
25、ach film.The green arrow identifies a sinus recess.Note the two distomolars in film at right(blue arrows).,a.lingual foramenb.genial tuberclesc.mental ridged.mental fossa,Mandibular Incisor,a,b,c,d,b=genial tubercles,a=lingual foramen,c=mental ridge,d=mental fossa,a,b,c,d,facial view,lingual view,Li
26、ngual foramen.Radiolucent“hole”in center of genial tubercles.Lingual nutrient vessels pass through this foramen.,lingual view,Genial tubercles.Radiopaque area in the midline,midway between the inferior border of the mandible and the apices of the incisors.Serve as attachments for the genioglossus an
27、d geniohyoid muscles.May have radiolucent hole in center(lingual foramen),but not on this film.Note double rooted canine(red arrows).,lingual view,Mental ridge.These represent the raised portions of the mental protuberance on either side of the midline.More commonly seen when using the bisecting ang
28、le technique,when the x-ray beam is directed at an upward angle through the ridges.,facial view,Mental fossa.This represents a depression on the labial aspect of the mandible overlying the roots of the incisors.The resulting radiolucency may be mistaken for pathology.,facial view,The radiolucent are
29、a above corresponds to the location of the mental fossa.However,this slide represents chronic periapical periodontitis;these teeth are non-vital,due to trauma.,The orange arrows above identify nutrient canals.They are most often seen in older persons with thin bone,and in those with high blood press
30、ure or advanced periodontitis.,Mandibular Canine,a,b,a=mental ridgeb=genial tubercles/lingual foramenc=mental foramen,c,b2,a=mental ridgec=mental foramen,b2=lingual foramen,b1=genial tubercles,facial view,lingual view,d,c,d,a,d,b1,d,b2,Mental ridge.The raised portions of the mental protuberance,slop
31、ing downward and backward from the midline.,facial view,Lingual foramen/genial tubercles.(See description under mandibular incisor above).,lingual view,The red arrows identify the mandibular canal and the blue arrow points to the mental foramen.,facial view,Mandibular Premolar,a=mylohyoid ridgeb=man
32、dibular canalc=submandibular gland fossad=mental foramen,c,b=mandibular canald=mental foramen,a=mylohyoid ridge(internal oblique)c=submandibular gland fossa,facial view,lingual view,b,Mylohyoid(internal oblique)ridge.This radiopaque ridge is the attachment for the mylohyoid muscle.The ridge runs dow
33、nward and forward from the third molar region to the area of the premolars.,lingual view,facial view,Mandibular canal.(Inferior alveolar canal).Runs downward from the mandibular foramen to the mental foramen,passing close to the roots of the molars.More easily seen in the molar periapical.,lingual v
34、iew,Submandibular gland fossa.The depression below the mylohyoid ridge where the submandibular gland is located.More obvious in the molar periapical film.,Mental foramen.Usually located midway between the upper and lower borders of the body of the mandible,in the area of the premolars.May mimic path
35、ology if superimposed over the apex of one of the premolars.,facial view,The mental foramen(blue arrow)is adjacent to a periapical lesion associated with tooth#21(red arrow).There is slight external resorption on#21.,The green arrow points to the mental foramen.The yellow arrow identifies a periapic
36、al lesion on#30.Note the overextension of the silver point in the distal root,the perforation of the mesial root and the amalgam protruding through the perforation from the pulp chamber.,Mandibular Molar,a=external oblique ridgeb=mylohyoid ridgec=mandibular canald=submandibular gland fossa,facial vi
37、ew,lingual view,b,b,a=external oblique ridgec=mandibular canal,b=mylohyoid ridged=submandibular gland fossa,a=external oblique ridgeb=mylohyoid ridgec=mandibular canald=submandibular gland fossa,External oblique ridge.A continuation of the anterior border of the ramus,passing downward and forward on
38、 the buccal side of the mandible.It appears as a distinct radiopaque line which usually ends anteriorly in the area of the first molar.Serves as an attachment of the buccinator muscle.(The red arrows point to the mylohyoid ridge).,facial view,Mylohyoid ridge(internal oblique).Located on the lingual
39、surface of the mandible,extending from the third molar area to the premolar region.Serves as the attachment of the mylohyoid muscle.,lingual view,facial view,Mandibular(inferior alveolar)canal.Arises at the mandibular foramen on the lingual side of the ramus and passes downward and forward,moving fr
40、om the lingual side of the mandible in the third molar region to the buccal side of the mandible in the premolar region.Contains the inferior alveolar nerve and vessels.,lingual view,Submandibular gland fossa.A depression on the lingual side of the mandible below the mylohyoid ridge.The submandibula
41、r gland is located in this region.Due to the thinness of bone,the trabecular pattern of the bone is very sparse and results in the area being very radiolucent.The fact that it occurs bilaterally helps to differentiate it from pathology.,The external oblique ridge(red arrows)and the mylohyoid ridge(b
42、lue arrows)usually run parallel with each other,with the external oblique ridge always being higher on the film.,The mandibular canal(red arrows identify inferior border of canal)usually runs very close to the roots of the molars,especially the third molar.This can be a problem when extracting these
43、 teeth.Note the extreme dilaceration(curving)of the roots of the third molar(green arrow)in the film at left.The film at right shows“kissing”impactions located at the superior border of the canal.,Identify the anatomical structures on the following eight slides.The answers are on the last slide.,Sli
44、de#1,A.The red arrows identify the?,Slide#2,A.The red arrow points to the?B.The white arrows identify the?C.The blue arrow points to the?D.The yellow arrow identifies the?,Slide#3,The small radioluceny identified by the green arrow is the?,Slide#4,The radiopacity identified by the blue arrows is the
45、?B.The orange arrow identifies the?,Slide#5,The yellow arrows point to the?The red arrows identify the?,Slide#6,The red arrow points to the?The orange arrow points to the?The blue arrows point to the radiolucent line known as the?,Slide#7,A.The red arrows point to the?,Slide#8,The red arrows identif
46、y the?What is the name of the radiolucent area surrounding the canal?,KEYSlide#1:A.Floor of the nasal fossaSlide#2:A.Coronoid process B.Maxillary sinus(pneumatized into maxillary tuberosity)C.Sinus septum D.Zygomatic processSlide#3:A.Lingual foramenSlide#4:A.Mylohyoid ridge B.Submandibular gland fossaSlide#5:A.Zygomatic process B.Maxillary sinusSlide#6:A.Inferior concha B.Nasal septum C.Median palatal sutureSlide#7:A.Mental ridgeSlide#8:A.Mandibular canal B.Submandibular gland fossa,
