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Periapical radiograph is a type of Intra oral view in which the film is placed
inside patient’s mouth and radio graphed using various techniques. . (Bisected
angle, paralleling. .)
The interpretation of radiographs plays an important role in the dental office.
Several abnormalities are diagnosed solely by or with help of radiographs. For
this reason the training in the interpretation of dental radiographs plays an
import-ant role in the curriculum of dental students and hygienists. Primarily a
thorough knowledge of the anatomy of upper and lower jaws is required.
However, more is needed to interpret the radiographic images. A radiographic
image is not just determined by the anatomical landmarks but also for instance
by the direction of the x-ray beam. Due to a different projection angle of the x-
ray beam anatomical structures can be displaced relative to each other.
Students do need much practicing to get familiar with the normal anatomy at
dental radiographs. At most dental schools in small student classes’ attention
is paid to this subject. At the Dental School in Amsterdam students follow a
practical course in making radiographs after their theoretical training is
completed. Parallel to or before this course they have to take the CAI program
on anatomical landmarks.
RO=Radio opaque
RL=Radiolucent
1-Anterior Region:
Radolucent Structures:
Nasal Fossa:
Incisive Foramen:
is the line down the center of the maxilla where embryonic palatal shelves joined at
the midline to form the hard palate.It Should Not be misdiagnosed As fracture line
nor fistulous tract . . .
To diffrentiate . . .
Fracture line will be acoompaigned by history of trauma, it will be irregular
RL Line, Will not be bordered By 2 RO Lines . . .
Fistulous tract: by applying RO material through the lesion . . . the tortuous
course of the tract can be observed
Incisive Fossa:
Also Called Canine Fossa . . And It Is the indentation between the roots of the
central and lateral incisors, and the canine fossa is between the roots of the
lateral incisor and canine.
It should not be Misdiagnosed As pathological condition. . If So Radiograph
the other side for comparison. .
Nasopalatine Canals:
Rdiopaque Structures:
It is the thin wall of bone in the midline of the face that separates the
right and left nasal fossae. . In Some cases unusual density may denote
supernumerary tooth, mesiodens, or a retained root . . . .
Nasal Turbinates:
Nasal Cartilage:
2-Canine Region:
Maxillary Sinus:
Nasal Fossa
Maxillary Sinus
Incisive Fossa
Rdiopaque Structures:
They Appear AS Inverted Y Shape Of RO Lines
Separating Two RL Areas( Nasal Cavity And
Maxillary Sinus)
Called Inverter Y Shape Of Innus . . .
Rdiopaque Structures:
Malar
It Is where Zeugmatic Bone:
Bone Attach To Maxilla
…
It Appears As Well Defined RO Area super
Imposed over Maxillary Molar Roots. .
Radiolucent structures:
○ Hamular Notch:
It Is found between hamular process and maxillary
tuberosity . . .
Hamular Process
Hamular Notch
Maxillary tuberosity
Radiopaque Structures:
○ Maxillary Tuberosity:
It appears radiographically. The maxillary tuberosity is the rounded bony eminence just
posterior to the most distal molar, at the distal end of the maxillary alveolar ridge.
This photograph shows both tuberosities well. This inferior view shows the area of
the tuberosities, as indicated by the pencil. It is a little difficult to see the rounded
shape of the maxillary tuberosity from this view. This periapical radiographic
projection of the maxillary second molar region clearly demonstrates the
maxillary tuberosity area.It Contains Spongy one although It Is The Hardest
Structure In Maxilla. .It May be pneumatized by extension of maxillary sinus
resulting in a very fragile tuberosity . . . . ..
○ Hamular Process:
In this close-up view you can clearly see the genial tubercles
on the lingual midline. Notice also the small opening right in
the middle of the tubercles. This is called the lingual
foramen, an opening in the lingual midline of the mandible
for a small vessel. This illustration demonstrates the
function of the genial tubercles, or mental spines Mandibular
Normal as they are
sometimes called, as a locus for the attachment of the
geniohyoid and genioglossus muscles. Anatomical
This occlusal Landmarks:
radiograph of an edentulous mandible depicts the genial
tubercles as seen in an axial plane.
1-Anterior Region:
RadioLucencies
If you look Radiopacities
closely here you can also discern the attached
muscles,
Lingual which make up the floor of Genial
Foramen the mouth. In this
Tubercles
periapical radiograph
Interdental Nutient Canals of the mandibular
Mental Ridge region,
anterior
the genial tubercles appear as a distinct circular
radiopacity, an area of dense bone, near the midline below
1)-GENIAL
the apices of the teeth. The lingual foramen appears asTUBERCLES:
a
small circular radiolucent area surrounded by the genial
tubercles.
3)-Lingual Foramen:
Discussed before. .
Sometimes these canals can be seen running toward the apices of teeth as
accessory branches of the inferior alveolar canal. In this instance the canals
contain both blood vessel and nerve supplies to the tooth and are termed
accessory canals.
Nutrient canals are most noticeable when they appear between roots or within
edentulous areas where they lie against the bony wall and reduce the thickness of
bone in the area of the vessel.
2-Premolar Region:
The Most Important Structure In This Area Is Mental foramen . . . . .
The mental foramen is an opening in the facial aspect of the mandible in the premolar area.
This photograph of the mandible demonstrates the usual location of the mental foramen. We can
see that its position will cause it to appear radiographically near the apex of the lower second
premolar. As this drawing demonstrates, the mental foramen provides the exit point from within
the mandible for the mental nerve, as well as the inferior alveolar artery.
In periapical radiographs the mental foramen appears as a rounded radiolucency in the apical
region distal to the canine and mesial to the first molar. Often it is not as distinct as some other
landmarks, but recognizing it is important. Sometimes the mental foramen will be superimposed
on the apex of a premolar, and will give the appearance of pulpal pathology.
The best way to differentiate periapical disease from the mental foramen is to identify the
periodontal membrane space to see if it is confluent with the radiolucent opening.
If the apical radiolucency is due to periapical pathology, the periodontal membrane will appear
to join the radiolucency, but if the lucent area is due to the mental foramen, then the periodontal
membrane space will remain intact, and can be distinctly followed around the tooth apex. Notice
the difference in appearance of the pathology at the apex of the distal root of the first molar and
the radiolucency of the mental foramen which superimposes on the apex of the second premolar.
3-Molar Region:
Mandibular Canal:
SubMandibular Fossa:
Int O R:
Ext O R: