INTERPRETATION OF NORMAL RADIOGRAPHIC ANATOMY

DRG. SHANTY CHAIRANI

TEETH AND THE SUPPORTING STRUCTURES

The

most dense area of a normal tooth is the enamel cap, which typically appears more radiopaque (white) than the other tissues. The dentin is less dense and appears as a uniform grey area. The junction between the enamel and dentin is very distinct.

 The

layer of cementum on the root surface is nearly the same density as the dentin, thus it is usually not apparent radiographically. The soft tissues of the pulp are much less dense than the other tooth structures and typically appear radiolucent. In normal, fully-formed teeth the root canal may be apparent extending to the apex of the root with a recognizable apical foramen.

 Supporting

structures of the tooth that are visible radiographically include the lamina dura, the alveolar crest, the periodontal ligament space, and the cancellous bone. When the x-ray beam is projected directly through the long axis of the lamina dura, it is seen clearly as a thin, white line. If the beam passes through at an angle, the lamina dura may appear more diffuse or not be visible at all.

 The

radiographic appearance of the alveolar crest varies from a dense layer of cortical bone to a smooth surface without cortical bone. The level of the bony crest is considered normal when it is not more than 1.5 mm from the cementoenamel junction of the adjacent teeth. The periodontal ligament space appears as a radiolucent space between the root and lamina dura, beginning at the alveolar crest, extending around the portion of the root within the alveolus, and returning to the alveolar crest on the opposite side. The width of the PDL varies from tooth to tooth, although it is typically thinner in the middle of the root and wider near the alveolar crest and root apex.

 Cancellous

bone lies between the cortical plates of both jaws and shows many small radiolucent pockets of marrow which create the trabecular pattern. The trabecular pattern varies considerably from patient to patient and even within the same patient. The trabeculae in the maxilla are typically small and form a dense granular pattern while the trabecular pattern of the mandible is larger and coarser.

LANDMARKS IN RADIOGRAPHS OF THE MAXILLA

The

median palatal suture appears as a thin radiolucent line between the central incisors extending roughly from the alveolar crest to the apices of the central incisors. The incisive foramen is seen as an oval radiolucent area between the apices of the central incisors.

 The

nasal septum is seen as a radiopaque area extending vertically down the center of the image from the posterior of the image to the apices of the central incisors. It is bordered on each side by the nasal fossa which appear as radiolucent lines parallel to the nasal septum. If the maxillary sinus appears in the image it is seen as a radiolucent area in the posterior lateral aspect of the image.

 The

borders of the maxillary sinus are formed of thin cortical bone which appear as thin radiopaque lines on periapical radiographs. The size of the maxillary sinus varies considerably although the right and left sinuses are typically symmetrical. The floor of the sinus is seen on periapical radiographs near the apices of the molars and premolars, and may extend down as far as the crest of the alveolar ridge, particularly in edentulous areas.

 Radiopaque lines traversing the sinus either horizontally or vertically are septae, bony projections from the floor and wall of the antrum. Septae give the sinus the appearance of being divided into compartments, although this is not the case. The radiolucent compartments formed by the septae sometimes mimic periapical pathoses.

 The

zygoma appears as a U-shaped radiopaque line with the round portion superimposing the area of the first and second molars. Depending on the angle in which the x-ray beam passes through the zygoma, it will vary in size, width, and definition. The nasolabial fold may appear as an oblique line traversing the premolar region. The line of contrast is well-defined and the area of increased radiopacity is caused by the superimposition of the cheek tissue. This feature increases with age and can be used to identify the side of the maxilla if the area is edentulous.

Zygoma

Nasolabial fold

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medial and lateral pterygoid plates lying immediately posterior to the maxillary tuberosities have a variable appearance, often not being visible at all. Typical appearance is a single radiopaque shadow with no trabecular pattern. The hamulus may be seen extending inferiorly from the medial pterygoid plate and does show trabecular pattern.

Hamulus

LANDMARKS IN RADIOGRAPHS OF THE MANDIBLE

On

periapical radiographs of the central incisors the mental fossa appears as a radiolucent depression extending laterally from the midline and between the alveolar ridge and the mental ridge. Due to the thinness of the bone in the area, the mental fossa appears slightly radiolucent compared to adjacent bone and may be mistaken for periapical disease.

 In

radiograph of the lower incisor area, lingual foramen is seen as a single radiolucent area located in the midline of the mandible. Its size and prominence vary widely. Mental ridge is a bony prominence extending from the midline of the mandible to the area of the premolars. Located on the labial side, it appears as a radiopaque line parallel to the cortical plate. Its density and prominence vary widely.

Mental fossa

Mental ridge Lingual foramen

 The

inferior border of the mandible is seen in a mandibular occlusal radiograph. Typically the cortical plate can be seen as a radiopaque line along the border of the mandible. The genial tubercle appears as a small pointed protrusion extending downward from the cortical plate.

 The

mental foramen is seen on some periapical radiographs and has a varying appearance; sometimes round or oblong, sometimes slitlike.

Typically it is positioned halfway between the lower border of the mandible and the alveolar crest, in the region of the apex of the second premolar. It may appear over the apex of a tooth, mimicking periapical pathoses. A second radiograph from another angle will likely cause the appearance of the foramen to shift in relation to the apex and confirm its identity.

Mental foramen

 The

mandibular canal (inferior alveolar canal) appears inconsistently and is seen as a dark linear shadow with thin radiopaque borders. The canal extends radiographically from the mandibular foramen to the mental foramen. The mylohyoid ridge appears as a radiopaque line running from the area of the third molars to the premolar region, occasionally superimposing the molar roots. The margin of the ridge is varies and is often not well defined.

Mylohyoid ridge

Mandibular canal

 Nutrient

canals appear in a small number of patients as radiolucent lines extending vertically from the inferior dental canal to the interdental space between the mandibular incisors. Occasionally the canals may appear as small round radiolucencies perpendicular to the cortex and can be mistaken for pathology. The submandibular gland fossa is located below the mylohyoid ridge in the molar area and appears as a radiolucent area with a sparse trabecular pattern. When excessively pronounced, it may be mistaken for a radiolucent lesion.

Nutrient canals

Submandibular gland fossa

 The

external oblique ridge is the continuation of the anterior border of the mandibular ramus which disappears in the area of the first molar. On periapical radiographs it appears superior to the mylohyoid ridge, running nearly parallel to it. Radiographically it appears as a radiopaque line with varying width, density, and length. The coronoid process is often seen in the molar region and appears as a triangular opacity superimposed on the area of the third molar. Trabecular pattern may or may not be visible

External oblique ridge

Coronoid process

PANORAMIC RADIOGRAPH

INTERPRETATION OF NORMAL GROWTH AND DEVELOPMENT OF TEETH AND JAWS

Chronology of human dentition

Newborn Boy

6 Month Old

1 Year Old

2 Year Old

4 Year Old

5 Year Old

6 Year Old

7 Year Old

9 Year Old

10 Year Old

Panoramic radiograph of 6 year old

Panoramic radiograph of 9 year old

Panoramic radiograph of 12 year old

Panoramic radiograph of 15 year old

Panoramic radiograph of 18 year old