Radiographic Anatomy

NEGEEN MOKHTARI
General Principles of Radiologic Evaluation
•Tissues that attenuate more photons appear more radiopaque (brighter), whereas
low-attenuation tissues appear radiolucent (darker).
•On two-dimensional projections, the anatomic structures along the path of the beam are
superimposed : the clinician should combine information on the x-ray beam angulation with
knowledge of anatomy.
•CT images provide visualization of the imaged anatomy without superimposition
the skull base: the axial plane is reoriented parallel to the Frankfort plane
Teeth - Hard Tissues

The enamel cap:

1. characteristically appears more radiopaque than the other tissues because it is the most dense
naturally occurring substance in the body.
2. uniformly opaque
3. the occlusal surface reflects the complex gross anatomy
Dentin:
1. radiodensity is similar to that of bone.
2. homogeneous
Cementum:
not usually apparent : contrast between it and dentin is so low and the cementum layer is so thin.
Cervical Burnout
1. Cervical burnout is caused by the normal configuration of the teeth, which results in
decreased x-ray absorption in the areas in question
2. results from contrast with the adjacent, relatively opaque enamel and alveolar
bone.
3. should not be confused with root surface caries.
 CBCT
1. appearance of teeth on CBCT images is similar to that on intraoral
radiographs.
2. detailing is better on limited field-of-view (FOV) scans than on medium- and full-FOV
Scans for CBCT.
3. morphologic variations, such as root dilacerations in the buccolingual
dimension that are not apparent on periapical radiographs, are well demonstrated
on CBCT examinations

(A) Periapical radiograph of the mandibular right posterior region

showing close proximity of the root apices to the inferior alveolar
canal (B) Cross section through the distal root demonstrates
marked dilaceration, which was not apparent on the periapical
radiograph
Teeth - Pulp
1. The pulp appears radiolucent
2. In normal, fully
formed teeth, the pulp
canal may be apparent,
extending from the
pulp chamber to the
apex of the root. An
apical foramen is
usually recognizable.
3. the canal may appear
constricted in the
region of the apex and
not discernible in the
last 1 mm or so of its
length.
 Supporting Dentoalveolar Structures - Lamina Dura
1. the tooth sockets are bounded by a thin radiopaque layer of dense bone.
2. Its name, lamina dura (“hard layer”), is derived from its radiographic
appearance.
3. continuous with the shadow of the cortical bone at the alveolar crest.
4. the eggshell effect: the x-ray beam passes tangentially through many times the
thickness of the thin bony wall, which results in its observed attenuation.
5. The radiographic appearance of the lamina dura is determined by the
angulation of the x-ray beam relative to the tooth root. When the x-ray beam is
directed through a relatively long expanse of the structure, the lamina dura
appears radiopaque and well defined. When the beam is directed more obliquely,
the lamina dura appears more diffuse and may not be discernible.
6. The presence of an intact lamina dura around the apex of a tooth strongly
suggests a vital pulp. However, because of the variable appearance of the lamina
dura, the absence of its image around an apex on a radiograph may be normal.
(I.e: a molar root extending into the maxillary sinus)
 Alveolar Crest :The gingival margin of the alveolar process that extends between the teeth
1. The level of this bony crest is considered normal when it is 0.5 to 2 mm
apical to the
cementoenamel junction of the adjacent teeth.

2. Position vs level?

3. In the anterior region, the crest is reduced to only a point of bone between
the close-set incisors. Posteriorly it is flat, aligned parallel with and slightly
below a line connecting the cementoenamel junctions of the adjacent teeth.

4. the crest varies from a dense layer of cortical bone to a smooth surface
without cortical bone.

5. the absence of an image of cortex between the incisors is considered by

many to be a indication of incipient disease, even if the level of the bone is
not abnormal.
Periodontal Ligament Space

1. it appears as a radiolucent space between the tooth root and the lamina dura.
2. This space begins at the alveolar crest, and returns to the alveolar crest on the opposite side of
the tooth.
3. It is usually thinner in the middle of the root and slightly wider near the alveolar crest and root
apex. (the fulcrum of physiologic movement)
4. the PDL is thinnest around the roots of embedded teeth and teeth that have lost their
antagonists.
5. When the x-ray beam is directed so that two convexities of a root surface appear on a
film, a double PDL space is seen .( I.e: buccal and lingual eminences on the mesial
surface of mandibular first and second molar roots)
A double periodontal ligament space and lamina dura
(arrows)
may be seen when there is a convexity of the proximal
surface of the root resulting in two heights of contour.
 Cancellous Bone (trabecular bone or spongiosa)

1. lies between the cortical plates in both jaws.

2. composed of thin radiopaque plates and rods (trabeculae) surrounding many small radiolucent
pockets of marrow.
3. pattern of the trabeculae comes from :
 the cancellous bone itself.
the endosteal surface of the outer cortical bone (thick trabecular plates)

4. To evaluate the trabecular pattern in a specific area, the practitioner should examine the
trabecular distribution, size, and density and compare them throughout both jaws and on the
opposite side.
Cancellous Bone (trabecular bone or spongiosa)

1. trabeculae are thicker and

1. thin and numerous coarser.
2. fine, granular, dense pattern 2. More horizontally.
3. marrow spaces are consequently 3.Plates are fewer.
small and relatively numerous. 4. Marrow spaces larger.
4.the marrow spaces may be
slightly larger in posterior region.

1. Larger trabeculae and marrow spaces.

2. Horizontal
3. In some cases, the area from just below the molar roots to
the inferior border of the mandible may appear to be almost
devoid of
trabeculae.
Cancellous Bone (trabecular bone or spongiosa)

1. where the cortical plates are thick (e.g., in the posterior region of the mandibular body), internal
bracing by the trabeculae is not required, so there are relatively few except where required to
support the alveoli.
2. in the maxilla and anterior region of the mandible, where the cortical plates are relatively thin
and less rigid, trabeculae are more numerous and lend internal bolstering to the jaw.
Cortical Bone
1. Buccal and lingual cortical plates do not cast a discernible image on periapical, bitewing and
panoramic radiographs. They are well depicted on CBCT images, best visualized on the axial,
coronal, or cross-sectional images
2. buccal bone adjacent to teeth is often thin and barely discerned on radiographs
Maxilla and Midfacial Bones - Intermaxillary Suture
1. The alveolar and palatine processes articulate in the midline to form the intermaxillary suture between the
central incisors.
2. this suture appears as a thin radiolucent line in the midline between the two portions of the premaxilla.
3. extends from the alveolar crest between the central incisors superiorly through the anterior nasal spine and
continues posteriorly between the maxillary palatine processes to the posterior aspect of the hard palate and
terminates at the alveolar crest in a small rounded or V-shaped enlargement.

4. On CBCT images, the intermaxillary suture is best evaluated on coronal and

axial sections.
5. limited by two parallel radiopaque borders of thin cortical bone on each side
of the maxilla. The radiolucent region is usually of uniform width.
5. The appearance depends on anatomic variability and the angulation of the x-
ray beam through the suture.
6. evaluation is important in planning for orthodontic expansion of the palate
Anterior Nasal Spine

1. frequently demonstrated on periapical radiographs of the maxillary central incisors.

2. 1.5 to 2 cm above the alveolar crest, usually at or just below the junction of the inferior end of
the nasal septum and the inferior outline of the nasal aperture.
3. radiopaque and v-shaped.
4. On CBCT , the anterior nasal spine is best observed on axial and sagittal sections.
Nasal Aperture and Nasal Cavity

1. its radiolucent image may be apparent on intraoral radiographs of the maxillary teeth,
especially in central incisor projections.
2. the inferior border of the fossa aperture appears as a radiopaque line extending bilaterally away
from the base of the anterior nasal spine. Above this line:radiolucent space of the inferior portion
of the nasal cavity
3. The relatively radiopaque nasal septum is seen arising in the midline from the anterior nasal
spine. It may appear wider than anticipated and not sharply defined because of its
superimposition with the vomer bone. (curved)
4. The boundaries of the nasal cavity may be evaluated in the coronal, sagittal,
and axial planes on CBCT.
Nasal Conchae and Nasal Turbinates

1. On periapical radiographs of the maxillary incisor and canine

regions, the inferior nasal conchae is often visualized, extending
from the right and left lateral walls for varying distances toward the
septum. These conchae fill varying amounts of the lateral portions
of the cavity
Nasal Floor and Hard Palate

1. On periapical radiographs, the floor of the nasal aperture

and a small segment of the nasal cavity are occasionally
projected high onto a maxillary canine radiograph and
maxillary sinus.
2. the entire extent of the nasal floor (hard palate),are best
displayed on coronal and sagittal sections on CBCT.
3. Disruption of the hard palate suggests developmental
disturbances, such as a cleft palate.
Nasopalatine Canal and Incisive Foramen
1. The nasopalatine canal originates in the anterior floor of the nasal
cavity and exits on the anterior maxilla as the incisive foramen, located
in the midline on the anterior aspect of the palatine process immediately
palatal to the maxillary central incisors.
2. On intraoral and panoramic radiographs, the incisive foramen is
usually projected between the roots and in the region of the middle and
apical thirds of the central incisors.
3. ovoid radiolucency, often with diffuse borders.
4. Occasionally the lateral walls of the nasopalatine canal are seen as a
pair of radiopaque lines running vertically from the floor of the nasal
aperture to the incisive foramen.
5. When an exaggerated vertical angle is used, as in anterior maxillary
occlusal projections, the openings of the foramina of Stensen at the nasal
floor may be seen.
6. The shape and size of the incisive foramen is best assessed on axial
sections and the size on sagittal sections on CCTV.
Nasopalatine Canal and Incisive Foramen
The foramen varies markedly in its radiographic shape, size, and
sharpness. It may appear smoothly symmetric or very irregular, and its borders may
be well demarcated or ill defined. The position of the foramen's image is also
variable and may be recognized at the apices of the central incisor roots, near the
alveolar crest, anywhere in between, or extending over the entire distance. The great
variability of its radiographic image is primarily the result of (1) the differing angles
at which the x-ray beam is directed for the maxillary central incisors and (2) some
variability in its anatomic size. Often, a large incisive foramen may mimic disease

The superior
foramina of the
nasopalatine canal
(arrows) appear
just lateral to the
nasal septum and
posterior to the
anterior nasal
spine.
Lateral Fossa (incisive fossa)

1. a gentle depression in the maxilla near the

apex of the lateral incisor.
2. may appear diffusely radiolucent on
periapical projections of this region,
superimposed over the root of the lateral
incisor.
3. An intact lamina dura around the root of the
lateral incisor coupled with absence of clinical
symptoms will indicate absence of periapical
disease.
Nose

1. The soft tissue of the tip of the nose is frequently

seen in projections of the maxillary central and
lateral incisors, superimposed over the roots of these
teeth.
2. has a uniform, slightly opaque appearance with a
sharp border
3. Occasionally the radiolucent nares can be
identified, especially when a steep vertical angle is
used.
Nasolacrimal Canal

1. The nasal and maxillary bones form the nasolacrimal

canal.
2. runs from the medial aspect of the anteroinferior
border of the orbit inferiorly to drain under the inferior
concha into the nasal cavity.
3. best evaluated in the axial and coronal planes on
CBCT.
4. it can be visualized on periapical radiographs in the
region above the apex of the canine, especially when a
steep vertical angulation is used.
5. The nasolacrimal canals are usually seen on
maxillary occlusal projections.
 Maxillary Sinus , the largest paranasal sinus with unknown function
1. develops by the invagination of mucous membrane from the
nasal cavity.
2. normally occupies virtually the entire body of the maxilla.
3. considered as a three-sided pyramid, with its base the medial
wall adjacent to the nasal cavity and its apex extending laterally
into the zygomatic process of the maxilla.
4. Its three sides are (1) the superior wall forming the floor of
the orbit, (2) the anterior wall extending above the premolars,
and (3) the posterior wall bulging above the molar teeth and
maxillary tuberosity.
5. communicates with the nasal cavity by the ostium,
approximately 3 to 6 mm in diameter and positioned under the
posterior aspect of the middle concha of the ethmoid bone.
 Maxillary Sinus
1. sinus floor is a thin layer of cortical bone ,thin radiopaque line.
2. In adults, the sinuses are usually seen to extend from the distal
aspect of the canine to the posterior wall of the maxilla above the
tuberosity.
3. on close examination it can be seen to have small interruptions in its
continuity or radiodensity caused by superimposition of small marrow
spaces.
4. They enlarge during childhood, achieving mature size by age 15 to
18 years.
5. right and left are symmetrical
.6. The floors of the maxillary sinus is approximately at the same level
as the nasal cavity on periapical radiographs around the age of
puberty,
but lower in adults and even below the floor of the nasal cavity in
the posterior region of the maxilla.
Maxillary Sinus

Anteriorly, each sinus is restricted The anterior border of

by the canine fossa and is the maxillary sinus (white
usually seen to sweep superiorly, arrows) crosses
crossing the level of the floor of the floor of the nasal
the nasal cavity in fossa (black arrow).
the premolar or canine region.
Consequently, on periapical
radiographs of the
canine, the floors of the sinus and
nasal cavity are superimposed and
seen crossing
one another, forming an inverted
“Y” in the area