Normal Intraoral Radiographic Anatomy Final

Max.Incisor Max. Canine Max.P.M Max. Molar Mand.Incisor Mand.Canine Mand. P.M Mand.
Molar Bitewing Dental

Dental Periapical Lesion Restorative
Max.Incisor Max. Canine Max.P.M Max. Molar Mand.Incisor Mand.Canine Mand. P.M Mand.Molar Bitewing Periapical Lesion
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Submitted by:
 Sia Ming Yan P10105
 Peng han hwa P10104
 Wong Wei Yang P10106
 Denisa Khoo Fern Ying P10107
 Roseanne Chee Yen Yen P10109
 Teo Tho Yang P10130 Special thanks to: Grace Chan -B9
Sharlene Chee-B9
 Doris Tan P10131 Julius Chew-B9
 Patricia Yap Li Min P10133 Joelle Low-B9
 Gursimran Kaur Grewal P10134 Hema Manurgar-B9
 Irene Chong I Wee P09118 Shailaja Gopalan-B9
Soah Yi Wen-B8
Charleen Chia-B8
GUIDED BY:
Dr.Lahari A. Telang MDS
Asst. Prof.
Department of OMR
Dr.Subashini Gopuchandran MDS
Asst. Prof.
Department of OMR
With this opportunity, we would like to express our deepest appreciation too all those that
provided us the possibility to complete this project. The teamwork and valuable time spent by all
the members in this group to complete this project has been essential in completion of this
project, which we believe, would be able to greatly benefit the staff and students of PIDC
First of all, we would like to express our deep sense of gratitude to our lecturers, Dr. Lahari A.
Telang and Dr. Subashini Gopuchandran for their cordial support, valuable information,
guidance and encouragements throughout the course of the project, without which this project
would not be possible.
We would also like to take this opportunity to convey our gratitude to the administration of
PIDC for sponsoring the materials and monetary resources to print this flip chart.
Lastly, we would like to thank the other faculty members of PIDC for their guidance and
support which helps us greatly in our completion of the project.
Max.Incisor Max. Canine Max.P.M Max. Molar Mand.Incisor Mand.Canine Mand. P.M Mand.Molar Bitewing Dental
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Content Page
• History of radiography • 1-3
• Common anatomical landmark • 5-6
• Maxillary Incisor • 9-10
• Maxillary Canine • 11-12
• Maxillary Premolar • 13-14
• Maxillary Molar • 15-16
• Mandibular Incisor • 19-20
• Mandibular Canine • 21
• Mandibular Premolar • 22-23
• Mandibular Molar • 24-25
• Bitewing • 26-27
• Dental Caries • 28-31
• Periapical Lesion • 32-37
• Restorative Material • 38-39
• References • 40
On 8 Nov, 1895, Wilhelm Conrad Röntgen (accidentally) discovered an
image cast from his cathode ray generator, projected far beyond the
possible range of the cathode rays (now known as an electron beam).
Further investigation showed that the rays were generated at the point of
contact of the cathode ray beam on the interior of the vacuum tube, that
they were not deflected by magnetic fields, and they penetrated many
kinds of matter.
A week after his discovery, Rontgen took an X-ray photograph of his wife's
hand which clearly revealed her wedding ring and her bones.
Father of Radiography
Wilhelm Conrad Röntgen
1845-1923
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Bisecting angle technique Paralleling technique
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Is this a radiograph of the…?
Maxilla? Mandible?
Anterior region? Posterior region? Anterior region? Posterior region?
Radiopaque? Radiolucent? Radiopaque? Radiolucent? Radiopaque? Radiolucent? Radiopaque? Radiolucent?
• Nasal septum • Median • Floor of the • Maxillary • Genial • Lingual • Oblique ridge • Mental
• Anterior nasal palatine sinus sinus tubercles foramen • Mylohyoid foramen
spine suture • Septum • Mental ridge • Mental ridge • Submandibular
• Inverted Y • Incisive • Zygomatic fossa • Inferior fossa
• Soft tissue of foramen process border of the • Mandibular
the nose • Nasal fossa • Zygoma mandible canal
• Lateral fossa • Zygomatic • Torus
arch mandibularis
• Maxillary
tuberosity
• Pterygoid
plates
• Hamulus
• Coronoid
process
4
Cervical burn out
Periodontal ligament space
Lamina dura
Root caries
1) Cervical burn out
• Diffuse radiolucent areas with ill-defined borders on the mesial or distal aspects of teeth in the cervical regions between the edge of the enamel cap
and the crest of the alveolar ridge.
• Close inspection will reveal intact edges of the proximal surfaces.
• Should not be confused with root surface caries.
2) Lamina Dura
• Thin radiopaque layer of dense bone surrounding the tooth sockets.
• The presence of an intact lamina dura around the apex of a tooth strongly suggests a vital pulp. However, the absence of its image around an apex
on a radiograph may be normal.
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3) Periodontal ligament space
• Radiolucent space between the tooth root and the lamina dura.
Anterior maxilla Posterior maxilla Posterior mandible
Anterior mandible
4) Cancellous bone/ trabecular bone/ spongiosa

• It is composed of thin radiopaque plates and rods surrounding many small radiolucent pockets of marrow.
• Maxilla: Anterior maxilla – Trabeculae are typically thin and numerous, forming a fine granular, dense pattern
Posterior maxilla – Trabeculae similar to anterior maxilla but marrow spaces may be slightly larger.
• Mandible: Anterior mandible – Trabeculae somewhat thicker than in the maxilla, coarser pattern, trabecular plate oriented more horizontally.
Posterior mandible – Periradicular trabeculae and marrow spaces may be comparable to those in the anterior mandible but are usually
somewhat larger.
5) Alveolar crest
• Normally, it is not more than 1.5mm from the cementoenamel junction of the adjacent teeth.
• In the anterior region, it is reduced to only a point of bone between the closely-set incisors.
• Posteriorly, it is flat, aligned parallel with and slightly below a line connecting the CEJ of the adjacent teeth.
• Reduce in height of the alveolar crest suggests periodontitis. 6
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Anterior region:
Radiopaque: • Nasal septum Radiolucent: • Median palatine suture
• Anterior nasal spine • Incisive foramen
• Inverted “Y” • Nasal fossa
• Soft tissue of the nose • Lateral fossa
Posterior region:
Radiopaque: • Floor of the sinus Radiolucent: • Maxillary sinus
• Septum
• Zygomatic process
• Zygoma
• Zygomatic arch
• Maxillary tuberosity
• Pterygoid plate
• Hamulus 8
• Coronoid process
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Maxillary midline area. Shown are the (1) Incisive fossa, (2) Outline of the nose ,
(3) Lateral fossa, (4) Nasal fossa, (5) Nasal septum, (6) Border of nasal fossa, (7)
Anterior nasal spine, and (8) Median palatine suture/ Intermaxillary suture
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1. Incisive foramen
• Appears as ovoid radiolucency between the roots of central incisors.
• Transmits the nasopalatine vessels and nerves.

• The presence of a cyst is presumed if the width of the foramen exceeds 1cm; also, if the radiolucency of the normal foramen is projected
over the apex of one central incisor, it may suggest a pathologic periapical condition.
2. Nose
• Soft tissue of the tip of the nose, superimposed over the roots of maxillary central and lateral incisors.
• It has uniform , slightly opaque appearance with a sharp border.
3. Lateral fossa
• Depression in the maxilla near the apex of lateral incisor, appears diffusely radiolucent.
4. Nasal fossa
• Appears as somewhat elliptical radiolucent areas of various sizes separated by a radiopaque band representing the nasal septum.
5. Nasal septum
• Arises directly above the anterior nasal spine and is covered on each side by nasal mucosa.
6. Border of nasal fossa
• Appears as opaque lines extending laterally from the anterior nasal spine.
7. Anterior nasal spine
• Located in the midline, it lies some 1.5 to 2cm above the alveolar crest.
• It is radiopaque, usually V-shaped.
8. Midpalatine suture/ Intermaxillary Suture

• Appears as a curving radiolucency in the midline of the maxilla.
10
• Extends from alveolar crest between central incisors superiorly through the anterior nasal spine and continues posteriorly between
maxillary palatine process to the posterior aspect of the hard palate.
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• Maxillary canine area. (1) lateral fossa, (2) nasal fossa, (3) inverted Y (intersection of the borders of nasal
fossa and maxillary sinus), (4) maxillary sinus and (5) overlapping
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1. Lateral fossa
• Also called incisive fossa.
• It Is the gentle depression in the maxilla near the apex of the lateral incisor.
• Appears diffusely radiolucent.
2.Inverted Y
• They appear as inverted Y shape of radiopaque lines separating two radiolucent areas (Nasal cavity And Maxillary sinus)
3. Nasal fossa
• Appears as radiolucent image.
• May be misinterpreted as soft tissue tumor.
4. Maxillary sinus
It is an air-containing cavity lined with mucous membrane.
It is a 3 sided pyramid:-
- superior wall forming floor of orbit
- anterior wall extending above premolars
- posterior wall bulging above the molar teeth and
maxillary tuberosity
It is the most important structure in the premolar-molar region. It occupies the greater part of body of maxilla and appears as a radiolucent
area.
The radiopaque line represents the floor of sinus and it is in close proximity to roots of premolars and molars.
Differential diagnosis is done by:

•Lamina dura should be intact
•Teeth are vital
•Symmetrical appearance on both sides of face
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•It is air filled (clear radiolucency)
•Clear margins otherwise it indicates pathogenesis
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Maxillary premolar area. (1) border (floor) of
maxillary sinus, (2) maxillary sinus, (3) septum in
maxillary sinus dividing the sinus into two
compartments, (4) zygomatic process of maxilla, (5)
zygoma, and (6) lower border of zygomatic arch.
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1) Border of maxillary sinus
• Borders of sinus appear as thin radiopaque line.
• In older patients with loss of posterior teeth, the inferior border may extend into alveolar ridge.
• Root apices project anatomically into the floor of sinus, causing small elevation or prominences, with the thin layer of bone covering the root of
tooth is seen fusing with the floor of sinus.
2) Maxillary sinus
-Please refer maxillary canine radiographic anatomical landmarks.
3) Septa in maxillary sinus

• One or several lines of radiopacity traverse the image of maxillary sinus.
• They sometimes mimic periapical disease, and the chambers they created may complicate the search of root fragments displaced into sinus.
4) Zygomatic process
• An extension of lateral maxillary surface that arise in region of the apices of first and second molars.
• Appears as U-shaped radiopaque line with its open end directed superiorly, while the enclosed end is projected in the apical region of first and
second molars.
• Maxillary antrum may expand laterally into zygomatic process, resulting in relatively increased radiolucency within the U-shaped image of the
process.
5) Inferior border of zygomatic arch

• Extending from the inferior portion of zygomatic process.
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• Appears as uniform grey or white radiopacity over the apices of molars.
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Radiograph of maxillary molar area. This radiograph shows (1) border (floor) of maxillary
sinus, (2) maxillary sinus, (3) zygomatic process of maxilla, (4) zygoma, (5) lateral
pterygoid plate, (6) lower border of zygomatic arch, (7) maxillary tuberosity, and (8)
coronoid process of the mandible
Drawing of maxillary molar area. Illustrated in the drawing are the (1) border (floor) of
maxillary sinus, (2) maxillary sinus, (3) zygomatic process of maxilla, (4) zygoma, (5) septum
in maxillary sinus, (6) lower border of zygomatic arch, (7) hamulus (hamular process), (8)
maxillary tuberosity, and (9) coronoid process (mandible)
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1) Floor of maxillary sinus – Please refer to maxillary canine radiographic anatomical landmark.
2) Maxillary sinus – Please refer to maxillary canine radiographic anatomical landmark.
3) Zygomatic process of maxilla – Please refer to maxillary premolar radiographic anatomical landmark.
4) Zygoma – Please refer to maxillary premolar radiographic anatomical landmark
5) Lateral pterygoid plate

• Lies immediately posterior to the tuberosity of the maxilla.
• Appears as a single radiopaque homogenous shadow without any evidence of trabeculation.
6) Lower border of zygomatic arch – Please refer to maxillary canine radiographic anatomical landmark.
7) Maxillary tuberosity
• The maxillary tuberosity is the convex distal inferior border of the maxilla, curving upward from the alveolar process and distal of the third
molar. An extension of the maxillary sinus is occasionally seen within the maxillary tuberosity.
8) Coronoid process of the mandible

• Appears as triangular radiopacity, apex directed superiorly and somewhat anteriorly.
• Usually found superimposed with the third molars but may appear as far forward as second molars.
• May be mistaken for a root fragment if its shadow is dense and homogenous, can be demonstrated by obtaining two radiographs with the
mouth in different position and noting the change in position of suspected shadow.
9) Hamular process
• Extending inferiorly from the medial pterygoid plate is the hamular process, which on close inspection , can show trabeculae.
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Anterior region:
Radiopaque: • Genial tubercles
• Mental ridge
Radiolucent: • Lingual foramen

• Mental fossa
Posterior region:
Radiopaque: • Oblique ridge
• Mylohyoid ridge
• Inferior border of the mandible
• Torus mandibularis
Radiolucent: • Mental foramen

• Submandibular fossa 18
• Mandibular canal
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• Mandibular midline area.
• (1) mental ridge
• (2) nutrient canal
• (3) nutrient foramen
• (4) genial tubercles
• (5) lingual foramen
• (6) inferior border of mandible 19
1. Mental ridge
• May occasionally be seen as two radiopaque lines sweeping bilaterally forward and upward toward the midline.
2. Nutrient canal
• Carry a neurovascular bundle and appear as radiolucent lines of fairly uniform width running vertically from the inferior dental canal
directly to the apex of the tooth or into interdental space between the mandibular incisors.
• Visible in about 5% of all patients and are more frequent in blacks, males, older persons, and individuals with high blood pressure or
advanced periodontal disease.
• Also indicate thin ridge, useful in implant assessment.
3. Nutrient foramen
• Appears as single round radiolucent area.
4. Genial tubercle
• They are bony protuberances located on the lingual surface of the mandible slightly above the inferior border and in the
midline.
• Their appearance is variable, often appear as radiopaque mass (up to 3-4 mm in diameter in the midline below the
incisor roots.
5. Lingual foramen
• On the lingual side of the mandible in the region of genial tubercles. Often there are two or more.
• Typically visualized as a single round radiolucent canal with a well defined opaque border lying in the midline below the
level of the apices of the incisors.
6. Inferior border of mandible

• Dense, broad radiopaque band. 20
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1. Nutrient Canal Mandibular canine area. (1) nutrient canal, and (2) torus
mandibularis (lingual torus)
• Please refer to mandibular incisor radiographic anatomical landmarks.
2. Torus Mandibularis
• It is hyperostosis that protrudes from lingual aspect of mandibular alveolar process usually near premolar teeth
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• May be single/multiple, uni/bilateral.
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Mandibular premolar area.
(1) Torus mandibularis, (2) Mylohyoid ridge, (3) Mental
foramen, (4) Mandibular canal, (5) Nutrient canal
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1) Mylohyoid ridge
• Slightly irregular crest of bone on the lingual surface of mandibular body.
• Presents as radioapque line runs from third molars to premolar region.
• The margins are not usually well defined but can be also observed where the ridge is dense with sharp demarcated borders.
2) Mental foramen
• It is a round, oblongated canal usually seen at apex of 2nd premolar but can be seen anywhere mesial of permanent 1st molar roots to the mesial of
1st premolar root.
• It may mimic a periapical lesion.
3) Mandibular canal
• Dark linear shadow with a thin radiopaque superior and inferior borders which are sometimes only partially seen or not at all seen.
• The canal is in contact with the apex of third molar and the distance between it and the apex of the root increases as it goes anteriorly.
• When the apices of the molars are projected over the canal, the lamina dura may be overexposed causing impression of the PDL space to be
missing or thickened lamina dura.
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Mandibular molar area. (1) external
oblique ridge, (2) mylohyoid or internal
oblique ridge, (3) submandibular fossa,
and (4) mandibular canal
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1.External oblique ridge
• Continuation of anterior border of mandibular ramus, seen as radiopaque line.
• Follows an anteroinferior course lateral to alveolar process.
• Gradually flattens and disappears where the alveolar process and mandible join below the 1st molar.
• Seen superior and parallel to mylohyoid ridge
2. Mylohyoid ridge / Internal oblique ridge

• Radiopaque band running diagonally downward and forward from 3rd molar to premolar area at level of apices of posterior teeth.
3. Submandibular fossa
• Radiolucent area with sparse trabecular pattern.
• Limited superiorly by mylohyoid ridge and inferiorly by lower border of mandible
4.Mandibular canal
• Please refer to mandibular premolar radiographic anatomical landmark.
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Molar bitewing Premolar bitewing
Bitewing Tab
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1) Detection of interproximal caries in the early stages of development.
2) Reveal secondary caries that may escape recognition in the periapical views.
3) Evaluation of periodontal condition.
• They provide good perspective of the alveolar bone crest, and change in the bone height can be
assessed accurately through comparison with the adjacent teeth.
4) Detection of calculus deposition in the interproximal region.
Bitewing
Holder
27
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Pit and fissure caries
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Smooth surface caries
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Root caries
30
Secondary Caries
31
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>1.0cm
Periapical periodontitis Periapical abscess
Periapical cyst
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<1.0cm
Periapical granuloma Condensing osteitis
Periapical periodontitis
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Periapical abscess
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Periapical granuloma
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Periapical Cyst
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Condensing Osteitis
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Dental materials. The materials
present in this radiograph are:
(1) amalgam
(2) porcelain-fused-to-metal crown
(3) post and core
(4) gutta percha
(5) base material
(6) full metal crown, which is the
posterior abutment of a three-unit
bridge
(7) retention pin
(8) metal pontic (part of the three-
unit bridge).
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Metallic and Non-Metallic Restorations
Metallic Dental Material Non Metallic Dental Material
Radiopaque Less Radiopaque Sometimes Radiolucent
Amalgam Composite Composite

Gold Porcelain Acrylic resins
Stainless Steel Acrylic Resins Silicate
Retention pins Silicate
Post and core Base
Silver points Cement
Orthodontic appliances Temporary filling
Implants Gutta percha
Sealants
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• Stuart C. White, Michael J. Pharoah (2009). Oral Radiology Principles and interpretation.
6th ed. India: Mosby. p152-174.
• Freny R Karjodkar (2009). Textbook of Dental and Maxillofacial Radiology. 2nd ed. India:
Jaypee. p467-494.
• Joen Lannucci Haring, Laura Tansen Howerton (2006). Dental Radiography Principle and
Techniques. 3rd ed. India: Saunders. p481-489.
• http://dhonline.chattanoogastate.edu/Powerpoint/anatomy/Radiographic%20Interpretati
on.pdf
40

Normal Intraoral Radiographic Anatomy Final

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Max.Incisor Max. Canine Max.P.M Max. Molar Mand.Incisor Mand.Canine Mand. P.M Mand.

Molar Bitewing Dental

Anterior region? Posterior region? Anterior region? Posterior region?

Radiopaque? Radiolucent? Radiopaque? Radiolucent? Radiopaque? Radiolucent? Radiopaque? Radiolucent?

Periodontal ligament space

4) Cancellous bone/ trabecular bone/ spongiosa

• Transmits the nasopalatine vessels and nerves.

• It has uniform , slightly opaque appearance with a sharp border.

• It is radiopaque, usually V-shaped.

8. Midpalatine suture/ Intermaxillary Suture

Differential diagnosis is done by:

3) Septa in maxillary sinus

5) Inferior border of zygomatic arch

2) Maxillary sinus – Please refer to maxillary canine radiographic anatomical landmark.

4) Zygoma – Please refer to maxillary premolar radiographic anatomical landmark

5) Lateral pterygoid plate

8) Coronoid process of the mandible

Radiolucent: • Lingual foramen

Radiolucent: • Mental foramen

6. Inferior border of mandible

• Presents as radioapque line runs from third molars to premolar region.

• It may mimic a periapical lesion.

• Follows an anteroinferior course lateral to alveolar process.

• Seen superior and parallel to mylohyoid ridge

2. Mylohyoid ridge / Internal oblique ridge

• Limited superiorly by mylohyoid ridge and inferiorly by lower border of mandible

3) Evaluation of periodontal condition.

4) Detection of calculus deposition in the interproximal region.

Periapical periodontitis Periapical abscess

Amalgam Composite Composite

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