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SECOND EDITION
ii
SECOND EDITION
Lisa J. Koenig, BChD, DDS, MS

Associate Dean for Academic Affairs
Professor, Oral Medicine and Oral Radiology
Marquette University School of Dentistry
Milwaukee, Wisconsin
Dania Tamimi, C. Grace Petrikowski, Susanne E. Perschbacher,

BDS, DMSc DDS, MSc, FRCD(C) DDS, MSc, FRCD(C)
Oral and Maxillofacial Radiology Consultant Oral and Maxillofacial Radiologist Assistant Professor
Private Practice Huronia Maxillofacial Radiology Oral & Maxillofacial Radiology
Orlando, Florida Toronto, Ontario, Canada University of Toronto, Faculty of Dentistry
Adjunct Assistant Professor Toronto, Ontario, Canada
Department of Comprehensive Dentistry
University of Texas Health Science Center
San Antonio, Texas
Axel Ruprecht, DDS, MScD, David Hatcher, DDS, MSc Brad J. Potter, DDS, MS
FRCD(C) Clinical Professor, Orofacial Sciences Professor and Director of Oral
Professor Emeritus of Oral School of Dentistry and Maxillofacial Radiology
and Maxillofacial Radiology University of California, San Francisco Department of Diagnostic
Professor Emeritus of Radiology San Francisco, California and Biological Sciences
Professor Emeritus of Anatomy Clinical Professor, School of Dentistry University of Colorado
and Cell Biology University of California, Los Angeles School of Dental Medicine
The University of Iowa Los Angeles, California Aurora, Colorado
Adjunct Clinical Professor of Oral Adjunct Professor, School of Dentistry
and Maxillofacial Radiology Department of Orthodontics H. Ric Harnsberger, MD
University of Florida University of the Pacific R.C. Willey Chair in Neuroradiology
Gainesville, Florida San Francisco, California Professor of Radiology and Otolaryngology
Clinical Professor Volunteer, Department of University of Utah School of Medicine
Byron W. Benson, DDS, MS Surgical & Radiological Sciences Salt Lake City, Utah
School of Veterinary Medicine
Regents Professor and Vice Chair
University of California, Davis
Department of Diagnostic Sciences
Davis, California
Texas A&M University
Clinical Professor, School of Dentistry
College of Dentistry
Roseman University of Health Sciences
Dallas, Texas
Henderson, Nevada
Private Practice, Diagnostic Digital Imaging
Sacramento, California
iii
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
DIAGNOSTIC IMAGING: ORAL AND MAXILLOFACIAL, SECOND EDITION ISBN: 978-0-323-47782-6
Copyright © 2017 by Elsevier. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including
photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on
how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as
the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be
noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional practices,
or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described
herein. In using such information or methods they should be mindful of their own safety
and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check
the most current information provided (i) on procedures featured or (ii) by the manufacturer
of each product to be administered, to verify the recommended dose or formula, the
method and duration of administration, and contraindications. It is the responsibility of
practitioners, relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to
take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
editors, assume any liability for any injury and/or damage to persons or property as a matter
of products liability, negligence or otherwise, or from any use or operation of any methods,
products, instructions, or ideas contained in the material herein.
Publisher Cataloging-in-Publication Data
Names: Koenig, Lisa J. | Tamimi, Dania Faisal | Petrikowski, C. Grace | Perschbacher, Susanne E.
Title: Diagnostic imaging. Oral and maxillofacial / [edited by] Lisa J. Koenig, Dania Tamimi,
C. Grace Petrikowski, and Susanne E. Perschbacher.
Other titles: Oral and maxillofacial.
Description: Second edition. | Salt Lake City, UT : Elsevier, Inc., [2017] | Includes
bibliographical references and index.
Identifiers: ISBN 978-0-323-47782-6
Subjects: LCSH: Mouth--Surgery--Handbooks, manuals, etc. | Maxilla--Surgery--Handbooks, manuals, etc. |
Face--Surgery--Handbooks, manuals, etc. | MESH: Radiograophy--Atlases. | Stomatognathic
Diseases--diagnostic images--Atlases. | Imaging, Three-Dimensional--Atlases. | Radiography,
Panoramic--Atlases.
Classification: LCC RK529.D52 2017 | NLM WU 140 | DDC 617.5’22059--dc23
International Standard Book Number: 978-0-323-47782-6

Cover Designer: Tom M. Olson, BA
Cover Art: Richard Coombs, MS
Printed in Canada by Friesens, Altona, Manitoba, Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1
iv
Dedications
To my children, Sophie, Ben, Alex, Jack, and especially Natalie and baby Raphi, who have
kept me grounded; my friend Esme, who made me food; and my students and patients who
inspire me.
LJK
Dedicated to all the incredible teachers I’ve had in my life, most notably my parents and
children. Time management and compassion are the most precious of skills.
DT
Thank you to my parents for encouraging me to pursue a career in dentistry during a

time when women comprised only a small minority in dental school classes. Thanks also
to my teachers and mentors during my oral radiology training, as well as my coauthors,
colleagues, and editors, who so generously shared their knowledge and experience as
this book was being written. My biggest thanks go to my husband and best friend, Eggert
Boehlau, who has so generously supported me, both in my work as a radiologist, which
puts food on the table, and my passion as a musician, which feeds the soul.
CGP
To my teachers: For showing me the path.

To my students: For keeping me on it.
To Mom, Dad, and Kristina: For your enthusiasm.
To Anya and Daphne: For always sleeping while I wrote.
To Mark: For always staying up…I love you.
SEP
v
vi
Additional Contributors
Barton F. Branstetter, IV, MD, FACR
Rebecca S. Cornelius, MD, FACR
Julia Crim, MD
H. Christian Davidson, MD
Joanne Ethier, DMD, MBA, MS
Bronwyn E. Hamilton, MD
Patricia A. Hudgins, MD, FACR
Richard W. Katzberg, MD
Bernadette L. Koch, MD
Nicholas A. Koontz, MD
Luke N. Ledbetter, MD
Daniel E. Meltzer, MD
Michelle A. Michel, MD
Kevin R. Moore, MD
Kristine M. Mosier, DMD, PhD
Cheryl A. Petersilge, MD, MBA
Caroline D. Robson, MBChB
Jeffrey S. Ross, MD
Lubdha M. Shah, MD
Deborah R. Shatzkes, MD
Hilda E. Stambuk, MD
Margot L. Van Dis, DDS, MS
Richard H. Wiggins, III, MD, CIIP, FSIIM
vii
viii
Preface
We are very proud to present the second edition of our Diagnostic Imaging text dedicated
to oral and maxillofacial radiology. As in the first edition, the book is divided into three
parts: Anatomy, Diagnoses, and Differential Diagnoses. The Anatomy part has seen the
addition of a chapter on the posterior skull base that reflects the increasing need for oral
and maxillofacial radiologists to interpret larger fields of view. In this regard, the Diagnoses
part includes 18 new chapters dedicated to the more common findings in the cervical
spine. There are also extended chapters on TMJ and airway evaluation. The Diagnoses part
now contains over 200 chapters.
You will also find in this second edition new graphics from our expert illustrators,
exquisitely detailing the Anatomy and Diagnoses parts and serving to enhance the learning
experience. Each chapter has been meticulously updated with the addition of new
references and images wherever possible.
Purchase of the book comes with an electronic version, Expert Consult, that allows for easy
navigation between chapters and access to many more images, as well as text that was
excluded from the print version due to page constraints.
We trust that this second edition, like the first, will appeal to both the beginning and the
experienced radiologist, as well as the increasing number of general dental practitioners
and specialists who are using CBCT technology in their offices. For medical radiologists,
the book will also serve as a valuable companion text to Diagnostic Imaging: Head and Neck,
third edition.

Associate Dean for Academic Affairs
Professor, Oral Medicine and Oral Radiology
Marquette University School of Dentistry
Milwaukee, Wisconsin
ix
http://ebooksdental.net/oral-maxillofacial-surgery
x
Acknowledgments
Text Editors
Arthur G. Gelsinger, MA
Nina I. Bennett, BA
Terry W. Ferrell, MS
Karen E. Concannon, MA, PhD
Matt W. Hoecherl, BS
Megg Morin, BA
Image Editors
Jeffrey J. Marmorstone, BS
Lisa A. M. Steadman, BS
Illustrations
Lane R. Bennion, MS
Richard Coombs, MS
Laura C. Wissler, MA
Art Direction and Design

Tom M. Olson, BA
Laura C. Wissler, MA
Lead Editor
Lisa A. Gervais, BS
Production Coordinators
Rebecca L. Bluth, BA
Angela M. G. Terry, BA
Emily C. Fassett, BA
xi
xii
Sections
Part I: Anatomy
SECTION 1: Oral Cavity
SECTION 2: Nose and Sinuses
SECTION 3: Temporal Bone
SECTION 4: Base of Skull
SECTION 5: Cranial Nerves
SECTION 6: Cervical Spine
SECTION 7: Suprahyoid Neck
Part II: Diagnoses

SECTION 1: Teeth
SECTION 3: Mandible and Maxilla
SECTION 4: Temporomandibular Joint
SECTION 5: Maxillary Sinus and Nasal Cavity
SECTION 6: Masticator Space
SECTION 7: Parotid Space
SECTION 8: Cervical Spine
Part III: Differential Diagnoses

SECTION 1: Teeth
SECTION 2: Mandible and Maxilla
SECTION 4: Temporomandibular Joint
SECTION 5: Maxillary Sinus and Nasal Cavity
xiii
TABLE OF CONTENTS
Part I: Anatomy SECTION 5: CRANIAL NERVES

124 Cranial Nerve V
SECTION 1: ORAL CAVITY H. Ric Harnsberger, MD and Susanne E. Perschbacher,
4 Teeth DDS, MSc, FRCD(C)
Dania Tamimi, BDS, DMSc 138 Cranial Nerve VII
14 Dental Restorations H. Ric Harnsberger, MD and Susanne E. Perschbacher,
Dania Tamimi, BDS, DMSc DDS, MSc, FRCD(C)
22 Maxilla
Dania Tamimi, BDS, DMSc SECTION 6: CERVICAL SPINE
30 Mandible 150 Craniocervical Junction
Dania Tamimi, BDS, DMSc H. Ric Harnsberger, MD
36 Tongue
H. Ric Harnsberger, MD SECTION 7: SUPRAHYOID NECK
40 Retromolar Trigone 162 Suprahyoid Neck Overview
H. Ric Harnsberger, MD H. Ric Harnsberger, MD
44 Sublingual Space 168 Parapharyngeal Space
H. Ric Harnsberger, MD H. Ric Harnsberger, MD
48 Submandibular Space 172 Nasopharynx and Oropharynx
H. Ric Harnsberger, MD H. Ric Harnsberger, MD and Susanne E. Perschbacher,
52 Oral Mucosal Space/Surface DDS, MSc, FRCD(C)
H. Ric Harnsberger, MD 180 Masticator Space
H. Ric Harnsberger, MD
SECTION 2: NOSE AND SINUSES 184 Parotid Space
56 Sinonasal Overview H. Ric Harnsberger, MD
Susanne E. Perschbacher, DDS, MSc, FRCD(C) 188 Carotid Space
72 Ostiomeatal Complex H. Ric Harnsberger, MD
H. Ric Harnsberger, MD 192 Retropharyngeal Space
76 Pterygopalatine Fossa H. Ric Harnsberger, MD
H. Ric Harnsberger, MD 196 Perivertebral Space
SECTION 3: TEMPORAL BONE 200 Lymph Nodes
82 Temporomandibular Joint H. Ric Harnsberger, MD
Susanne E. Perschbacher, DDS, MSc, FRCD(C) 204 External and Internal Carotid Arteries
90 External, Middle, and Inner Ear Lisa J. Koenig, BChD, DDS, MS
SECTION 4: BASE OF SKULL

Part II: Diagnoses
98 Anterior Skull Base SECTION 1: TEETH
104 Central Skull Base DEVELOPMENTAL ALTERATIONS IN SIZE
H. Ric Harnsberger, MD AND SHAPE OF TEETH
110 Posterior Skull Base
212 Hypodontia
Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS
118 Styloid Process and Stylohyoid Ligament
214 Hyperdontia
Susanne E. Perschbacher, DDS, MSc, FRCD(C)
216 Macrodontia, Gemination, and Fusion
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TABLE OF CONTENTS
218 Microdontia 264 Periapical Rarefying Osteitis
Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS Dania Tamimi, BDS, DMSc
219 Concrescence 268 Periapical Sclerosing Osteitis
220 Talon Cusp 270 Periodontal Disease
221 Dens Invaginatus
Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS MISCELLANEOUS
222 Enamel Pearls 276 Gubernaculum Dentis
Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS Lisa J. Koenig, BChD, DDS, MS
223 Taurodontism
Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS SECTION 2: ORAL CAVITY
224 Dilaceration
Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS CONGENITAL/GENETIC
225 Supernumerary Roots 280 Submandibular Space Accessory Salivary Tissue
Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS Daniel E. Meltzer, MD
282 Lingual Thyroid
DEVELOPMENTAL ALTERATIONS IN Deborah R. Shatzkes, MD
STRUCTURE OF TEETH 284 Dermoid and Epidermoid
226 Amelogenesis Imperfecta Bernadette L. Koch, MD
Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS 288 Submandibular Gland Aplasia-Hypoplasia
230 Dentinogenesis Imperfecta Byron W. Benson, DDS, MS
Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS 290 Foregut Duplication Cyst in Tongue
232 Dentin Dysplasia Byron W. Benson, DDS, MS
233 Regional Odontodysplasia INFECTION
Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS 292 Oral Cavity Soft Tissue Infections
234 Segmental Odontomaxillary Dysplasia Byron W. Benson, DDS, MS and Richard H. Wiggins, III, MD,
Lisa J. Koenig, BChD, DDS, MS CIIP, FSIIM
ACQUIRED ALTERATIONS OF TEETH AND INFLAMMATION
SUPPORTING STRUCTURES
296 Ranula
236 Attrition Richard H. Wiggins, III, MD, CIIP, FSIIM
Dania Tamimi, BDS, DMSc 300 Submandibular Gland Sialadenitis
238 Abrasion Richard H. Wiggins, III, MD, CIIP, FSIIM
Dania Tamimi, BDS, DMSc 302 Oral Cavity Sialocele
239 Erosion Richard H. Wiggins, III, MD, CIIP, FSIIM
Dania Tamimi, BDS, DMSc 304 Submandibular Gland Mucocele
240 Abfraction Byron W. Benson, DDS, MS
Dania Tamimi, BDS, DMSc
241 Turner Dysplasia NEOPLASM, BENIGN
Dania Tamimi, BDS, DMSc 306 Sublingual Gland Benign Mixed Tumor
242 Internal and External Resorption Byron W. Benson, DDS, MS
Dania Tamimi, BDS, DMSc 308 Submandibular Gland Benign Mixed Tumor
248 Hypercementosis Richard H. Wiggins, III, MD, CIIP, FSIIM
Dania Tamimi, BDS, DMSc 310 Palate Benign Mixed Tumor
Byron W. Benson, DDS, MS and Richard H. Wiggins, III, MD,
TRAUMA
CIIP, FSIIM
249 Concussion
Dania Tamimi, BDS, DMSc NEOPLASM, MALIGNANT
250 Luxation 312 Oral Cavity Minor Salivary Gland Malignancy
Dania Tamimi, BDS, DMSc Bronwyn E. Hamilton, MD
254 Dentoalveolar Fractures 314 Sublingual Gland Carcinoma
Dania Tamimi, BDS, DMSc Hilda E. Stambuk, MD
INFECTION/INFLAMMATION 316 Submandibular Gland Carcinoma
Hilda E. Stambuk, MD
260 Dental Caries
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TABLE OF CONTENTS
318 Submandibular Space Nodal Non-Hodgkin
Lymphoma
TRAUMA
Bronwyn E. Hamilton, MD 370 Mandible Fracture
320 Oral Tongue Squamous Cell Carcinoma Byron W. Benson, DDS, MS and Michelle A. Michel, MD
Nicholas A. Koontz, MD 374 Nasoethmoid Complex Fracture
324 Floor of Mouth Squamous Cell Carcinoma Byron W. Benson, DDS, MS and Michelle A. Michel, MD
Nicholas A. Koontz, MD 376 Complex Midfacial Fracture
326 Gingival Squamous Cell Carcinoma Byron W. Benson, DDS, MS and Michelle A. Michel, MD
C. Grace Petrikowski, DDS, MSc, FRCD(C) 378 Zygomaticomaxillary Complex Fracture
328 Retromolar Trigone Squamous Cell Carcinoma Byron W. Benson, DDS, MS and Michelle A. Michel, MD
Nicholas A. Koontz, MD 380 Transfacial Fracture (Le Fort)
330 Submandibular Space Nodal Squamous Cell Byron W. Benson, DDS, MS and Kristine M. Mosier, DMD,
Carcinoma PhD
Bronwyn E. Hamilton, MD
332 Buccal Mucosa Squamous Cell Carcinoma INFECTION/INFLAMMATION
Nicholas A. Koontz, MD 384 Mandible-Maxilla Osteomyelitis
334 Hard Palate Squamous Cell Carcinoma Susanne E. Perschbacher, DDS, MSc, FRCD(C)
Nicholas A. Koontz, MD 388 Mandible-Maxilla Osteoradionecrosis
MISCELLANEOUS/IDIOPATHIC 392 Mandible-Maxilla Osteonecrosis
336 Motor Denervation CNXII Susanne E. Perschbacher, DDS, MSc, FRCD(C)
Richard H. Wiggins, III, MD, CIIP, FSIIM
338 Submandibular Sialoliths CYSTS, ODONTOGENIC
Byron W. Benson, DDS, MS 396 Dentigerous Cyst
SECTION 3: MANDIBLE AND MAXILLA 400 Odontogenic Keratocyst
NORMAL VARIANTS
404 Lateral Periodontal Cyst
342 Buccal and Palatal Exostoses Lisa J. Koenig, BChD, DDS, MS
Lisa J. Koenig, BChD, DDS, MS 406 Residual Cyst
344 Mandibular Torus Lisa J. Koenig, BChD, DDS, MS
Lisa J. Koenig, BChD, DDS, MS 408 Buccal Bifurcation Cyst
346 Palatal Torus Lisa J. Koenig, BChD, DDS, MS
Lisa J. Koenig, BChD, DDS, MS 412 Calcifying Odontogenic Cyst
348 Accessory Mandibular Canal Lisa J. Koenig, BChD, DDS, MS
350 Mandibular Salivary Gland Defect (Stafne) CYSTS, NONODONTOGENIC
Lisa J. Koenig, BChD, DDS, MS 414 Mandible-Maxilla Aneurysmal Bone Cyst
354 Mandible-Maxilla Idiopathic Osteosclerosis Lisa J. Koenig, BChD, DDS, MS
Lisa J. Koenig, BChD, DDS, MS 418 Nasopalatine Duct Cyst
CONGENITAL/GENETIC
422 Nasolabial Cyst
356 Clefts Lisa J. Koenig, BChD, DDS, MS and Kristine M. Mosier,
Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS DMD, PhD
358 Cherubism 424 Mandible-Maxilla Simple (Traumatic) Bone Cyst
C. Grace Petrikowski, DDS, MSc, FRCD(C) Lisa J. Koenig, BChD, DDS, MS
362 Basal Cell Nevus Syndrome
Susanne E. Perschbacher, DDS, MSc, FRCD(C) FIBROOSSEOUS LESIONS
364 Cleidocranial Dysplasia 428 Periapical Osseous Dysplasia
Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS C. Grace Petrikowski, DDS, MSc, FRCD(C)
366 Pierre Robin Sequence 432 Florid Osseous Dysplasia
Caroline D. Robson, MBChB and Dania Tamimi, BDS, C. Grace Petrikowski, DDS, MSc, FRCD(C)
DMSc 436 Ossifying Fibroma
368 Treacher Collins Syndrome C. Grace Petrikowski, DDS, MSc, FRCD(C)
Brad J. Potter, DDS, MS, Margot L. Van Dis, DDS, MS, and 440 Mandible-Maxilla Fibrous Dysplasia
Caroline D. Robson, MBChB C. Grace Petrikowski, DDS, MSc, FRCD(C) and Dania
Tamimi, BDS, DMSc
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TABLE OF CONTENTS
512 Burkitt Lymphoma
METABOLIC/SYSTEMIC C. Grace Petrikowski, DDS, MSc, FRCD(C)
446 Paget Disease 516 Non-Hodgkin Lymphoma of Pharyngeal Mucosal
C. Grace Petrikowski, DDS, MSc, FRCD(C) Space
Patricia A. Hudgins, MD, FACR
NEOPLASM, BENIGN, ODONTOGENIC 520 Multiple Myeloma
450 Odontoma Lisa J. Koenig, BChD, DDS, MS
Dania Tamimi, BDS, DMSc 524 Ewing Sarcoma
454 Adenomatoid Odontogenic Tumor Axel Ruprecht, DDS, MScD, FRCD(C)
Dania Tamimi, BDS, DMSc 528 Leukemia
456 Ameloblastoma Byron W. Benson, DDS, MS
460 Ameloblastic Fibroma TUMOR-LIKE LESIONS
Lisa J. Koenig, BChD, DDS, MS 530 Mandible-Maxilla Central Giant Cell Granuloma
464 Ameloblastic Fibroodontoma Susanne E. Perschbacher, DDS, MSc, FRCD(C)
Dania Tamimi, BDS, DMSc 534 Langerhans Histiocytosis
466 Calcifying Epithelial Odontogenic Tumor Lisa J. Koenig, BChD, DDS, MS
468 Cementoblastoma SECTION 4: TEMPOROMANDIBULAR
Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS JOINT
470 Odontogenic Myxoma
Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS CONGENITAL DISORDERS
472 Central Odontogenic Fibroma 540 Condylar Aplasia
Dania Tamimi, BDS, DMSc David Hatcher, DDS, MSc
542 Hemifacial Microsomia
NEOPLASM, BENIGN, NONODONTOGENIC David Hatcher, DDS, MSc
474 Central Hemangioma
Byron W. Benson, DDS, MS DEVELOPMENTAL ACQUIRED DISORDERS
476 Osteoid Osteoma 546 Condylar Hyperplasia
Lisa J. Koenig, BChD, DDS, MS David Hatcher, DDS, MSc and Lisa J. Koenig, BChD, DDS,
478 Osteoblastoma MS
Lisa J. Koenig, BChD, DDS, MS 552 Coronoid Hyperplasia
480 Mandible-Maxilla Osteoma Lisa J. Koenig, BChD, DDS, MS, David Hatcher, DDS, MSc,
Lisa J. Koenig, BChD, DDS, MS and Dania Tamimi, BDS, DMSc
482 Nerve Sheath Tumor 556 Condylar Hypoplasia
Lisa J. Koenig, BChD, DDS, MS David Hatcher, DDS, MSc, Lisa J. Koenig, BChD, DDS, MS,
486 Neurofibromatosis Type 1 and C. Grace Petrikowski, DDS, MSc, FRCD(C)
Lisa J. Koenig, BChD, DDS, MS 560 Fibrous Ankylosis
490 Desmoplastic Fibroma David Hatcher, DDS, MSc and Lisa J. Koenig, BChD, DDS,
Lisa J. Koenig, BChD, DDS, MS MS
562 Bony Ankylosis
NEOPLASM, MALIGNANT, ODONTOGENIC C. Grace Petrikowski, DDS, MSc, FRCD(C)
492 Malignant Ameloblastoma and Ameloblastic
Carcinoma TRAUMA
Byron W. Benson, DDS, MS 564 TMJ Fractures
David Hatcher, DDS, MSc and C. Grace Petrikowski, DDS,
NEOPLASM, MALIGNANT, MSc, FRCD(C)
NONODONTOGENIC 570 TMJ Dislocation
494 Mandible-Maxilla Metastasis C. Grace Petrikowski, DDS, MSc, FRCD(C)
C. Grace Petrikowski, DDS, MSc, FRCD(C) 572 Bifid Condyle
500 Mandible-Maxilla Osteosarcoma C. Grace Petrikowski, DDS, MSc, FRCD(C)
C. Grace Petrikowski, DDS, MSc, FRCD(C) 576 TMJ Osteochondritis Dissecans
504 Mandible-Maxilla Chondrosarcoma David Hatcher, DDS, MSc
C. Grace Petrikowski, DDS, MSc, FRCD(C)
508 Primary Intraosseous Squamous Cell Carcinoma INFLAMMATION
C. Grace Petrikowski, DDS, MSc, FRCD(C) 578 TMJ Rheumatoid Arthritis
510 Central Mucoepidermoid Carcinoma David Hatcher, DDS, MSc
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TABLE OF CONTENTS
584 TMJ Juvenile Idiopathic Arthritis
Lubdha M. Shah, MD and David Hatcher, DDS, MSc
SECTION 5: MAXILLARY SINUS AND
590 TMJ Pigmented Villonodular Synovitis
NASAL CAVITY
David Hatcher, DDS, MSc and Kristine M. Mosier, DMD, NORMAL VARIANTS
PhD
650 Deviated Nasal Septum
DEGENERATIVE DISORDERS Axel Ruprecht, DDS, MScD, FRCD(C)
652 Concha Bullosa
592 Degenerative Joint Disease
Axel Ruprecht, DDS, MScD, FRCD(C)
David Hatcher, DDS, MSc
656 Accessory Ostia
596 TMJ Synovial Cyst
598 Progressive Condylar Resorption DEVELOPMENTAL
658 Hypoplasia/Aplasia
DISC DERANGEMENT DISORDERS Axel Ruprecht, DDS, MScD, FRCD(C)
604 Disc Displacement With Reduction INFLAMMATION
Richard W. Katzberg, MD, David Hatcher, DDS, MSc, and
Joanne Ethier, DMD, MBA, MS 662 Mucus Retention Pseudocyst
610 Disc Displacement Without Reduction Axel Ruprecht, DDS, MScD, FRCD(C)
Richard W. Katzberg, MD, David Hatcher, DDS, MSc, and 664 Sinonasal Mucocele
Joanne Ethier, DMD, MBA, MS Axel Ruprecht, DDS, MScD, FRCD(C) and Michelle A.
616 Adhesions Michel, MD
David Hatcher, DDS, MSc 668 Sinonasal Granulomatosis With Polyangiitis
(Wegener Granulomatosis)
NEOPLASM, BENIGN Axel Ruprecht, DDS, MScD, FRCD(C) and Michelle A.
Michel, MD
618 TMJ Osteoma
672 Sinonasal Polyposis
Lisa J. Koenig, BChD, DDS, MS and H. Ric Harnsberger, MD
620 TMJ Osteochondroma
676 Acute Rhinosinusitis
David Hatcher, DDS, MSc and C. Grace Petrikowski, DDS,
Axel Ruprecht, DDS, MScD, FRCD(C) and Michelle A.
MSc, FRCD(C)
Michel, MD
TUMOR-LIKE LESIONS 680 Chronic Rhinosinusitis
626 TMJ Calcium Pyrophosphate Dihydrate Deposition Michel, MD
Disease 684 Odontogenic Sinusitis
C. Grace Petrikowski, DDS, MSc, FRCD(C) Axel Ruprecht, DDS, MScD, FRCD(C)
630 TMJ Primary Synovial Chondromatosis 686 Allergic Fungal Sinusitis
C. Grace Petrikowski, DDS, MSc, FRCD(C) and David H. Christian Davidson, MD
Hatcher, DDS, MSc 688 Invasive Fungal Sinusitis
NEOPLASM, MALIGNANT 692 Mycetoma
634 TMJ Osteosarcoma Michelle A. Michel, MD
C. Grace Petrikowski, DDS, MSc, FRCD(C) 694 Invasive Pseudotumor
636 TMJ Chondrosarcoma Axel Ruprecht, DDS, MScD, FRCD(C)
640 TMJ Metastasis NEOPLASM, BENIGN
C. Grace Petrikowski, DDS, MSc, FRCD(C) and Lisa J. 696 Sinonasal Inverted Papilloma
Koenig, BChD, DDS, MS Axel Ruprecht, DDS, MScD, FRCD(C) and Michelle A.
Michel, MD
MISCELLANEOUS 700 Sinonasal Osteoma
642 TMJ Simple (Traumatic) Bone Cyst Axel Ruprecht, DDS, MScD, FRCD(C)
C. Grace Petrikowski, DDS, MSc, FRCD(C) and Lisa J.
Koenig, BChD, DDS, MS NEOPLASM, MALIGNANT
644 Aneurysmal Bone Cyst 704 Sinonasal Squamous Cell Carcinoma
David Hatcher, DDS, MSc Axel Ruprecht, DDS, MScD, FRCD(C)
706 Sinonasal Adenoid Cystic Carcinoma
Michel, MD
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708 Nasopharyngeal Carcinoma 768 Parotid Mucoepidermoid Carcinoma
Luke N. Ledbetter, MD Barton F. Branstetter, IV, MD, FACR
712 Sinonasal Malignant Melanoma 772 Parotid Adenoid Cystic Carcinoma
Axel Ruprecht, DDS, MScD, FRCD(C) Barton F. Branstetter, IV, MD, FACR
774 Parotid Non-Hodgkin Lymphoma
FIBROOSSEOUS LESIONS Barton F. Branstetter, IV, MD, FACR
714 Sinonasal Fibrous Dysplasia 778 Metastatic Disease of Parotid Nodes
Axel Ruprecht, DDS, MScD, FRCD(C) Barton F. Branstetter, IV, MD, FACR
718 Sinonasal Ossifying Fibroma
Axel Ruprecht, DDS, MScD, FRCD(C) and Michelle A. AUTOIMMUNE
Michel, MD 782 Sjögren Syndrome
Byron W. Benson, DDS, MS
SECTION 6: MASTICATOR SPACE
MISCELLANEOUS/IDIOPATHIC
INFECTION
784 Parotid Sialoliths
724 Masticator Space Abscess Byron W. Benson, DDS, MS
SECTION 8: CERVICAL SPINE
DEGENERATIVE
728 Masticator Muscle Atrophy
DEVELOPMENTAL ALTERATIONS
Rebecca S. Cornelius, MD, FACR 788 C2-C3 Fusion
Kevin R. Moore, MD
NEOPLASM, BENIGN 790 C1 Assimilation
732 Masticator Space CNV3 Schwannoma Kevin R. Moore, MD
Rebecca S. Cornelius, MD, FACR 792 Ponticulus Posticus
Kevin R. Moore, MD
NEOPLASM, MALIGNANT 794 Ossiculum Terminale
Kevin R. Moore, MD
734 Masticator Space Chondrosarcoma
796 Split Atlas
Kevin R. Moore, MD
738 Masticator Space Sarcoma
798 Os Odontoideum
Kevin R. Moore, MD
742 Masticator Space CNV3 Perineural Tumor
802 Os Avis (Fused to Clivus)
Kevin R. Moore, MD
MISCELLANEOUS/IDIOPATHIC 804 Odontoid Hypoplasia/Aplasia
Kevin R. Moore, MD
746 Benign Masticator Muscle Hypertrophy 806 Failure of Formation
Rebecca S. Cornelius, MD, FACR Kevin R. Moore, MD
810 Failure of Segmentation
SECTION 7: PAROTID SPACE
Kevin R. Moore, MD
INFLAMMATION
DEGENERATIVE DISORDERS
750 Benign Lymphoepithelial Lesions: HIV
Barton F. Branstetter, IV, MD, FACR 814 Degenerative Joint Disorders of Craniovertebral
754 Parotid Sialadenitis Junction
Byron W. Benson, DDS, MS Cheryl A. Petersilge, MD, MBA
818 Ossification of Posterior Longitudinal Ligament
NEOPLASM, BENIGN Cheryl A. Petersilge, MD, MBA
822 Diffuse Idiopathic Skeletal Hyperostosis
756 Parotid Benign Mixed Tumor Cheryl A. Petersilge, MD, MBA
Barton F. Branstetter, IV, MD, FACR 826 Cervical Facet Arthropathy
760 Warthin Tumor Jeffrey S. Ross, MD
764 Parotid Schwannoma TUMOR AND TUMOR-LIKE LESIONS
830 Hemangioma, Cervical Spine
NEOPLASM, MALIGNANT Cheryl A. Petersilge, MD, MBA
834 Lytic and Blastic Metastases
766 Parotid Malignant Mixed Tumor Cheryl A. Petersilge, MD, MBA
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TABLE OF CONTENTS
896 Ground-Glass and Granular Radiopacities
FIBROOSSEOUS Dania Tamimi, BDS, DMSc
838 Fibrous Dysplasia, Cervical Spine 902 Generalized Radiopacities
Cheryl A. Petersilge, MD, MBA and Julia Crim, MD Dania Tamimi, BDS, DMSc
MISCELLANEOUS PERIOSTEAL REACTIONS

840 Tumoral Calcinosis 906 Periosteal Reactions
Jeffrey S. Ross, MD and Lubdha M. Shah, MD Dania Tamimi, BDS, DMSc
Part III: Differential Diagnoses SECTION 3: ORAL CAVITY

ANATOMICALLY BASED LESIONS
SECTION 1: TEETH 914 Submandibular Space Lesions
ALTERATIONS IN TOOTH NUMBER Byron W. Benson, DDS, MS
918 Parotid Space Lesions
844 Extra Teeth Byron W. Benson, DDS, MS
Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS 922 Sublingual Space Lesions
846 Missing Teeth Byron W. Benson, DDS, MS
Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS 926 Oral Mucosal Space/Surface Lesions
ALTERATIONS IN TOOTH 930 Root of Tongue Lesions
MORPHOLOGY/SHAPE Byron W. Benson, DDS, MS
848 Crown Changes
Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS MISCELLANEOUS
850 Root Changes 934 Soft Tissue Calcifications
Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS Brad J. Potter, DDS, MS and Margot L. Van Dis, DDS, MS
SECTION 2: MANDIBLE AND MAXILLA SECTION 4: TEMPOROMANDIBULAR
JOINT
ALTERATIONS IN SUPPORTING STRUCTURES
OF TEETH CHANGES IN CONDYLAR SIZE AND
856 Periapical Radiolucencies FUNCTION
Dania Tamimi, BDS, DMSc 940 Small Condyle
860 Periapical Radiopacities and Mixed Lesions C. Grace Petrikowski, DDS, MSc, FRCD(C) and Dania
Dania Tamimi, BDS, DMSc Tamimi, BDS, DMSc
862 Floating Teeth 946 Large Condyle
Lisa J. Koenig, BChD, DDS, MS C. Grace Petrikowski, DDS, MSc, FRCD(C) and Dania
864 Widened Periodontal Ligament Space Tamimi, BDS, DMSc
Lisa J. Koenig, BChD, DDS, MS 950 Limited Condylar Translation
866 Lamina Dura Changes C. Grace Petrikowski, DDS, MSc, FRCD(C)
MASS LESIONS
RADIOLUCENCIES
954 TMJ Radiolucencies
870 Well-Defined Unilocular Radiolucencies C. Grace Petrikowski, DDS, MSc, FRCD(C)
Lisa J. Koenig, BChD, DDS, MS 956 TMJ Radiopacities
874 Pericoronal Radiolucencies Without Radiopacities C. Grace Petrikowski, DDS, MSc, FRCD(C) and Dania
Lisa J. Koenig, BChD, DDS, MS Tamimi, BDS, DMSc
876 Pericoronal Radiolucencies With Radiopacities
Lisa J. Koenig, BChD, DDS, MS MISCELLANEOUS
878 Multilocular Radiolucencies
960 TMJ Articular Loose Bodies
C. Grace Petrikowski, DDS, MSc, FRCD(C) and Dania
882 Ill-Defined Radiolucencies
Tamimi, BDS, DMSc
888 Generalized Rarefaction
RADIOPACITIES
892 Well-Defined Radiopacities
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SECTION 5: MAXILLARY SINUS AND
NASAL CAVITY
NASAL LESIONS
964 Perforated Nasal Septum
966 Nasal Lesion Without Bony Destruction
970 Nasal Lesion With Bony Destruction
974 Sinonasal Fibroosseous and Cartilaginous Lesions
SINUS LESIONS
976 Paranasal Sinus Lesions Without Bony Destruction
980 Paranasal Sinus Lesions With Bony Destruction
MISCELLANEOUS
984 Displaced Dental Structures Into Antrum
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SECOND EDITION
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PART I
SECTION 1
Oral Cavity
Teeth 4
Dental Restorations 14
Maxilla 22
Mandible 30
Tongue 36
Retromolar Trigone 40
Sublingual Space 44
Submandibular Space 48
Oral Mucosal Space/Surface 52
Teeth
Anatomy: Oral Cavity
• Position is described in relation to

TERMINOLOGY
○ Midline of arch (i.e., line between central Incs), not
Abbreviations anatomical midline
• Incisor (Inc), canine (C), premolar (PM), molar (M) – All surfaces of teeth that are in direction of midline
of arch are "mesial"
Synonyms – All surfaces of teeth away from midline of arch are
• Cuspid = canine "distal"
• Bicuspid = premolar ○ Inside or outside of arch
– Surfaces toward face are facial (can use buccal if
IMAGING ANATOMY posterior, labial if anterior)
Overview – Surfaces toward tongue are lingual (can use palatal if
maxillary)
• Humans have 2 dentitions: Primary and permanent
○ Anatomic tooth
• Teeth are divided into maxillary (upper) and mandibular
(lower) – If above crown of tooth, use "coronal to"
• Each jaw is divided into 2 quadrants: Right and left – If below apices of tooth, use "apical to"
separated by midline Eruption Patterns
• Each quadrant has 5 primary and 8 permanent teeth • 3 phases of eruption: Primary, mixed, and permanent
○ Primary: 2 Incs (central and lateral), 1 C, 2 Ms (1st and dentitions
2nd) • Primary dentition
○ Permanent: 2 Incs (central and lateral), 1 C, 2 PMs (1st ○ Starts to erupt between 6-12 months
and 2nd), 3 Ms (1st, 2nd, and 3rd) ○ 1st teeth are usually lower central Incs; last teeth are 2nd
• Teeth can be named or numbered Ms
• Naming teeth should follow this sequence: Dentition → jaw • Mixed dentition
→ side → tooth name ○ Combination of primary and permanent teeth have
○ Example: Primary maxillary right 1st M; permanent erupted
mandibular left C ○ 1st permanent teeth are permanent 1st Ms at 6 years
○ Exceptions are PMs and 3rd Ms: Only present in ○ Exfoliation of primary Incs followed by eruption of
permanent dentition, so no need to use "permanent" permanent Incs (6-9 years)
○ If only permanent teeth are present (all primary teeth ○ Exfoliation of primary mandibular Cs followed by
have been exfoliated), no need to use "permanent" eruption of permanent mandibular Cs (9-10 years)
• Numbering teeth depends on country ○ Exfoliation of primary Ms followed by eruption of PMs
○ Most countries use FDI (Federation Dentaire (10-12 years)
International) system for numbering ○ Exfoliation of primary maxillary Cs followed by eruption
– Quadrants are numbered of permanent Cs (11-12 years)
– Permanent: Upper right (UR) = 1, upper left (UL) = 2, – May get crowded out of arch, either impacted or
lower left (LL) = 3, lower right (LR) = 4 malerupted
– Primary: UR = 5, UL = 6, LL = 7, LR = 8 – High incidence of dentigerous cyst formation with
– Teeth are numbered impaction of these teeth
– Permanent: Central Inc = 1, lateral Inc = 2, C = 3, 1st • Permanent dentition
PM = 4, 2nd PM = 5, 1st M = 6, 2nd M = 7, 3rd M = 8 ○ No more primary teeth in jaws
– Primary: Central Inc = 1, lateral Inc = 2, C = 3, 1st M = 4, ○ Eruption of permanent 2nd Ms (11-13 years)
2nd M = 5 ○ Eruption of 3rd Ms (17-21 years)
– Example: Permanent mandibular right 1st M = tooth – Impactions are common; dentigerous cysts may
#46 (pronounced four six) occur around crown of impacted tooth
○ United States uses universal system
– Only teeth are numbered Tooth Anatomy
– Permanent teeth start with #1 (maxillary right 3rd M) • Teeth are made up of 4 basic anatomic structures: Enamel,
and go to #16 (maxillary left 3rd M) pronounced dentin, cementum, and pulp
sixteen ○ Enamel
– Mandibular left 3rd M is #17 (seventeen) and goes to – Hardest substance in body = most mineralized (95%
mandibular right 3rd M #32 (thirty two) calcified) = highest radiographic density
– Primary teeth are labeled with letters A → T starting – Covers crown of tooth; contacts dentin at
with last M on UR: UR → UL→ LL → LR dentinoenamel junction
○ Other tooth numbering systems exist; check with local – Contacts cementum at cementoenamel junction
dental organization (CEJ)
○ When in doubt, describe teeth by name – Develops from ameloblasts
Anatomy Relationships ○ Dentin
– Makes up majority of tooth; provides resiliency to hard
• When describing teeth or objects in relation to teeth, overlying enamel; 75% calcified
conventional anatomic positions (inferior, posterior,
medial, lateral, anterior, posterior) are not used
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Teeth

– Contains dentinoblastic processes: Tooth becomes Tooth Development and Tumorigenesis
sensitive when dentin is exposed • Potential sources for development of tumors
○ Cementum ○ Prefunctional dental lamina (odontogenic epithelium
– Thin layer of calcified material covering root of tooth with ability to produce tooth); more abundant distal to
and providing attachment for periodontal ligament lower 3rd Ms
(PDL) ○ Postfunctional dental lamina: Epithelial remnants, such
– Not visible radiographically unless hypercementosis as rests of Serres, in fibrous gingival tissue; epithelial cell
occurs rests of Malassez in PDL and reduced enamel organ
○ Pulp (a.k.a. "nerve") epithelium (covers enamel surface until tooth eruption)
– Vital portion of tooth (tooth "dies" when pulp dies) ○ Basal cell layer of gingival epithelium (source of dental
– Contains nerves and vessels that enter and emerge lamina)
through apical foramen of tooth ○ Dental papilla (origin of dental pulp); can be induced to
– Most radiolucent portion of tooth produce odontoblasts and synthesize dentin &/or
– Crown portion called pulp chamber with pointy pulp dentinoid material
horns; root portion called pulp canal ○ Dental follicle
• Teeth are made up of crown and root ○ PDL: Can induce production of fibrous and cemento-
○ Crown: Everything above CEJ osseous mineralized material
– Further subdivided into occlusal/incisal, middle, and
cervical 1/3rds ANATOMY IMAGING ISSUES
– Incs have incisal edges as functional component; all Imaging Recommendations
other teeth have cusps
○ Root: Everything below CEJ • For imaging of teeth for caries, periapical or periodontal
disease, intraoral radiography is recommended
– Further subdivided into cervical, middle, and apical
1/3rds ○ Horizontal bitewings for caries and early periodontal
disease detection
– Teeth can have single root or be multirooted; area
between roots of tooth is called furcation area ○ Vertical bitewings for moderate to severe periodontal
disease
– Roots are named according to location in alveolar
process: Buccal, lingual, mesial, distal, mesiobuccal, ○ Periapical radiographs if periapical pathology is
distobuccal suspected
○ Pros: High-resolution images showing fine changes in
Periodontium demineralization; low radiation dose, especially if F-
• Primary function is to support teeth; when teeth are lost, speed film or digital radiography is used
periodontal bone recedes ○ Cons: Limited to dimensions of intraoral film, cannot see
• Made up of periodontal bone, PDLs, and gingiva lesions or impacted teeth if they extend beyond
○ Periodontal bone • For general overview of teeth in jaws: Panoramic
– Portion of alveolar processes of maxilla and mandible radiography
that come in direct contact with teeth ○ Shows eruption pattern and impactions of teeth;
– Most cervical aspect called crest; corticated when presence of intraosseous pathology
healthy ○ Pros: Cost effective; lower radiation dose when
– If tooth is lost, most cervical aspect of bone is called compared to CBCT
residual ridge ○ Cons: Distortion, magnification, and blurring can impede
– Bone at apex of tooth called periapical bone evaluation
– Bone in furcation area called furcal bone • For relationship of impacted teeth with vital anatomic
– Thin radiopaque line seen radiographically lining tooth structures: CBCT
socket is called lamina dura ○ Can show inferior alveolar nerve canals in relation to 3rd
○ PDL Ms if extraction is planned
– Multidirectional fibers that attach tooth to socket; ○ Can show relationship of impacted Cs to anterior
offer resilience to tooth during function superior alveolar canal, nasopalatine canal, and floor of
– Radiographically seen as uniform radiolucent line on nasal cavity
inside of lamina dura ○ Pros: 3D representation of 3D structures; 3D
– If loses uniformity, suspect pathology reformations can be obtained to give exact visualization
of anatomy
– Houses epithelial rests of Malassez, which may
contribute to formation of cyst lining for odontogenic ○ Cons: Expensive imaging modality, generally not covered
cysts by insurance; higher radiation dose
– Position in relation to tooth can determine if lesion is ○ If unable to obtain CBCT or CT, use intraoral radiography
attached to tooth structure (inside PDL) or not and SLOB (same lingual, opposite buccal) rule and 2
(outside PDL) images at right angles to one another
○ Gingiva (a.k.a. gums)
– Soft tissue component covering periodontal bone
– Attaches to root to form small gingival sulcus with
crown; cannot be visualized radiographically
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Teeth
TOOTH DEVELOPMENT
Oral epithelium arising from

ectoderm
Ectomesenchyme
Dental sac
Dental lamina
Dental papilla
Developing bone
Erupting tooth
Permanent tooth bud

Ameloblasts secreting enamel
matrix
Enamel matrix
Enamel organ Dentin matrix
Odontoblasts secreting dentin
matrix
Developing bone
Dental papilla
Cervical loop
Enamel matrix
Hertwig root sheath

Ameloblasts
Stratum intermedium
Stellate reticulum Epithelial rests of Malassez
Outer enamel epithelium

Future cementoenamel
Dental papilla junction
Disintegration of Hertwig root
Odontoblasts sheath
Dentin matrix Forming periodontal ligaments
Developing bone
Cementum
Epithelial rests of Malassez
(Top) Graphic shows stages of tooth development: (A) Initiation: Ectoderm develops oral epithelium and dental lamina, (B) bud stage:
Dental lamina grows into bud penetrating the ectomesenchyme, (C) cap stage: Enamel organ forms cap surrounding dental papilla and
surrounded by dental sac, (D) bell stage: Differentiation of enamel organ and dental papilla into different cells types, (E) apposition
stage: Secretion of dental tissue matrix, and (F) maturation: Full mineralization of dental tissues. (Bottom) Graphic shows stages of root
development: (A) Apposition stage, (B) enamel deposition completion at the cervical loop and formation of Hertwig epithelial root
sheath from inner and outer enamel epithelium cells, (C) root sheath disintegration and fragmentation of some of its cells into
epithelial rests of Malassez, and (D) formation of cementum and periodontal ligaments with persistence of these epithelial remnants,
which may be the source of the epithelial component of some odontogenic cysts and tumors.
Teeth

TOOTH ERUPTION
Fusion of reduced enamel

Oral epithelium epithelium to oral epithelium
Connective tissue
Reduced enamel epithelium
Bone
Enamel
Dentin
Tissue disintegration Erupting tooth cusp
Initial junctional epithelium
Developing maxillary canine

with incomplete root
formation
Ankylosed tooth
Developing mandibular canine

with incomplete root
formation
(Top) Graphic shows process of tooth eruption: (A) Enamel organ reduces to thin layers covering enamel and secretes enzymes, (B)
fusion of the reduced enamel epithelium with the oral epithelium, (C) disintegration of the central fused tissues, leaving a canal for
tooth movement, and (D) peripheral-fused tissues peel back from the crown as the tooth erupts and form initial junctional epithelium
that migrate cervically to cementoenamel junction. (Bottom) The age of the patient can be determined by examining the eruption of
the teeth. This CBCT 3D reformation shows that the permanent incisors and 1st molars have erupted, but the premolars have not. This
puts the patient's age at between 8-10 years. 3D reformations can be helpful in evaluation of erupting teeth if malocclusion and
malalignment are present. Note that the maxillary right central incisor has not fully erupted, although the apical foramen is almost
closed. This may be due to ankylosis (loss of periodontal ligament) of the tooth. (Courtesy 3D Diagnostix, Inc.)
Teeth
TEETH NOMENCLATURE AND ERUPTION AGES
Maxillary central incisor (7-8

years)
Maxillary lateral incisor (8-9 Maxillary 1st premolar (10-12
years) years)
Maxillary canine (11-12 years)
Maxillary 2nd premolar (10-12
years)
Maxillary 1st molar (6 years)
Maxillary 2nd molar (12 years)
Maxillary 3rd molar (17-21

years)
Mandibular 3rd molar (17-21

years)
Mandibular 2nd molar (12

years)
Mandibular 1st molar (6 years)
Mandibular canine (9-10 years)
Mandibular lateral incisor (7-8 Mandibular 2nd premolar (10-

years) 12 years)
Mandibular 1st premolar (10-
Mandibular central incisor (6-7 12 years)
years)
(Top) The maxilla has 16 permanent teeth arranged in 2 quadrants: The upper right quadrant, also known as quadrant 1, and the upper
left quadrant, also known as quadrant 2. Eruption ages are in parenthesis. The functional cusps on the maxillary posterior teeth are
lingual (palatal) cusps. (Bottom) The mandible has 16 permanent teeth arranged in 2 quadrants: The lower left quadrant, also known as
quadrant 3, and the lower right quadrant, also known as quadrant 4. Eruption ages are noted in parenthesis. The functional cusps on
the mandibular posterior teeth are the buccal (facial) cusps. The permanent maxillary and mandibular incisors and canines have
similarly named deciduous predecessors. The predecessors of the 1st and 2nd premolar teeth are the 1st and 2nd deciduous molars,
respectively. The deciduous incisors and canines have a single root, the mandibular deciduous molars have 2 roots, and the maxillary
deciduous molars have 3 roots.
Teeth

HUMAN DENTITIONS
Permanent 1st molar

Primary central incisor
Permanent central incisor
Primary 1st molar
Permanent incisors
Premolars
Permanent 1st molars Permanent 1st molars
Premolars
Permanent incisors
3rd molar follicles 3rd molar follicles
(Top) Panoramic reformat of CBCT data shows a patient at the primary dentition stage. All 20 primary teeth have erupted into the oral
cavity and are in occlusion, but all permanent teeth are still unerupted. Examination of the follicles of the permanent teeth for any
displacement or expansion is recommended when evaluating images for the primary dentition phase. It is also important to note any
missing permanent teeth to aid in future orthodontic treatment planning. (Middle) Panoramic radiograph shows a patient at the mixed
dentition stage. The upper and lower permanent 1st molars have erupted as well as the upper and lower incisors. As the premolars have
not erupted yet, it means the patient's age is between 8-10 years. (Bottom) CBCT panoramic reformat shows a patient in the
permanent dentition/late adolescence stage. All erupted teeth are permanent. The developing 3rd molars are present but unerupted.
The stage of 3rd molar development indicates that the patient's age is between 17-20 years.
Teeth
DENTAL ANATOMY
Enamel
Dentin Dentinoenamel junction
Pulp horn
Cementoenamel junction Pulp chamber
Periodontal ligament space
Buccal plate Lingual plate
Pulp canal Alveolar bone adjacent to

periodontal ligament space,
appears as thin radiopaque
line (lamina dura)
Nutrient canal radiographically
Inferior alveolar canal

containing inferior alveolar
neurovascular bundle
Crown
Crest of alveolar bone (crestal

lamina dura)
Tooth furcation
Cementum
Root
Periodontal ligament space
Lateral canal
Nutrient canal Apical foramen
(Top) Graphic representation shows a mandibular 1st molar in coronal cross section through the mesial root. Identification of the
location of pathology in relation to the DEJ and CEJ helps in classifying caries and periodontal disease. Cross sections of the teeth are
the most common reformation for dental applications, such as implant and impaction analysis, as they allow for evaluation of alveolar
bone width and height and accurate localization of the inferior alveolar nerve canal. (Bottom) Graphic representation shows sagittal
cross section of a mandibular 1st molar. The tooth is attached to the socket through the periodontal ligaments. The crest of the healthy
alveolar bone is located about 1-2 mm apical to the CEJ of a tooth. Innervation and vasculature exit through the apical foramen, but on
occasion, lateral canals may exit through the lateral aspects of the root. If pulpal death occurs, bacteria can seep through the lateral
canals, causing lateral radicular abscesses and cysts, and through the apical foramina, causing periapical inflammation.
Teeth

DENTAL RADIOGRAPHIC ANATOMY
Enamel Dentinoenamel junction
Dentin
Cementoenamel junction
Pulp horn
Pulp chamber
Crest of alveolar bone (crestal
lamina dura)
Tooth furcation Alveolar interdental bone
Pulp (root) canal

Furcal bone
Lamina dura
Periapical periodontal Periodontal ligament space

ligament space
Nutrient canal
Mental foramen
Anterior nasal spine
Shadow of nose
Pulp canal
Intermaxillary suture
Gingival embrasure
Pulp chamber
Interproximal contact
Incisal embrasure Incisal edge
(Top) Periapical radiograph shows normal dental and periodontal anatomy. The periodontal ligament space is a thin radiolucent line
that surrounds the root of the tooth. The lamina dura is a thin radiopaque line that surrounds the tooth socket radiographically.
Healthy alveolar bone crests (crestal laminae dura) are corticated. Nutrient canals may appear as small corticated canals within the
bone connected to the apical foramen. (Courtesy M. Kroona, DXT.) (Bottom) Periapical radiograph of the central incisors shows the
normal anatomic landmarks in this area. It is important to realize that soft and hard tissue superimpositions may occur when imaging
teeth, and their recognition is necessary to determine normal from abnormal. Evaluation of the interproximal contact point and crown
contours is important as caries tends to occur cervical to the contact point, and incomplete contact or improper crown contour may
lead to plaque accumulation and resulting caries and periodontal disease. (Courtesy M. Kroona, DXT.)
Teeth
TOOTH IMPACTIONS
Inferior alveolar nerve seen in 3D

reformation running between roots of
Cross sections showing inferior alveolar distoangularly impacted mandibular left
nerve canals highlighted 3rd molar
Panoramic reformat with inferior

alveolar nerve canals highlighted
Horizontally impacted 3rd molar
Supernumerary impacted tooth

Horizontally impacted 3rd molar
Panoramic reformat with inferior

alveolar nerve canals highlighted
Mesioangularly impacted 3rd molar
Inferior alveolar nerve running through

mesial root
(Top) Cross sections, panoramic, 3D reformations using Simplant software show the inferior alveolar nerve canal traveling between the
roots of the distoangularly impacted mandibular left 3rd molar. (Courtesy 3D Diagnostix, Inc.) (Middle) Panoramic and 3D reformations
show a horizontally impacted left 3rd molar with its crown oriented distally and an impacted supernumerary tooth (4th molar) with its
crown oriented mesially, both lying on top of the left inferior alveolar nerve canal. The right 3rd molar is horizontally impacted with its
crown oriented mesially. CBCT imaging can aid in predicting and preventing nerve damage when removing 3rd molars surgically.
(Courtesy 3D Diagnostix, Inc.) (Bottom) 3D reformation shows the left inferior alveolar nerve going through the mesial root of the
mesioangularly impacted mandibular left 3rd molar. This occurs during tooth development due to proximity of the tooth follicle to the
inferior alveolar nerve, which is engulfed by the root as it develops and calcifies. (Courtesy 3D Diagnostix, Inc.)
Teeth

TOOTH IMPACTIONS
Root apex in nasal cavity

Impacted canine with crown located Impacted canine with crown located
lingual to primary maxillary lateral incisor lingual to permanent maxillary left
and permanent maxillary central incisor lateral incisor
Primary lateral incisor crown Primary canine crown
Horizontally oriented permanent canines

Developing root of 2nd molar
2nd premolar
1st premolar
Impacted canine
Inferior alveolar nerve
(Top) CBCT 3D reformation with transparent bone shows the vertical impaction of the permanent canines with lingual placement of the
crowns and slight facial tipping of the roots. Knowledge of this orientation aids the surgeon in deciding on the entry point for either
extraction or exposure of the crowns for placement of an orthodontic bracket. (Courtesy 3D Diagnostix, Inc.) (Middle) The bone can also
be made transparent on CBCT 3D reformations and segmentations to further visualize the relationship of the teeth with one another.
This image shows unerupted maxillary canines with the crowns oriented facially. The roots are not completely formed. (Courtesy 3D
Diagnostix, Inc.) (Bottom) CBCT 3D reformation and segmentation using Simplant software shows an impacted mandibular canine. The
position of the impacted tooth in relation to the erupted dentition can easily be determined with 3D reformation. Virtual extractions
(digital removal of teeth) can also be performed. (Courtesy 3D Diagnostix, Inc.)
Dental Restorations
• Sealer cement
TERMINOLOGY
○ Viscous radiopaque material that seals gaps between
Definitions gutta percha cones
• Materials used to restore form and function of teeth or to ○ May extend beyond apex of tooth and cause rarefaction
enhance dental aesthetics of bone; most are biocompatible
Orthodontics
IMAGING ANATOMY
• Brackets
Restorative Materials ○ Traditionally fixed to facial aspect of teeth with resin;
• Amalgam lingual brackets available
○ Traditional silver filling material; metallic in density • Bands
○ Combination of silver, mercury, tin, and copper and ○ Placed on posterior teeth as anchors for appliance
sometimes zinc, indium, and palladium • Archwire
• Composite ○ Stainless steel wires that follow outline of arch fixed to
○ Tooth-colored restoration that binds to enamel through brackets and bands with elastic &/or ligature wire
acid-etching bonding • Other fixed appliances
○ Historically radiolucent, now mixed with radiopaque ○ Anchored to posterior teeth through bands
fillers ○ May have several metallic spring and loop components
○ More radiodense than enamel, but less than metal as well as acrylic components
• Glass ionomer
Pediatrics
○ Tooth-colored restoration that binds to dentin
chemically • Stainless steel crown
○ Used on root lesions where there is no enamel present ○ Prefabricated crown
for acid etching ○ Used when tooth structure cannot be restored by
○ Also used as base under other large restorations amalgam alone or when tooth is root canal-treated
(pulpotomy or pulpectomy)
Prosthetic • Space maintainer
• Crowns ○ Teeth will drift mesially when adjacent mesial tooth is
○ Full or partial tooth coverage extracted
○ Full cast metal, full porcelain, or porcelain fused to ○ To ensure enough space for permanent successor tooth,
metal space maintainer is placed on tooth adjacent to
○ Tooth must be prepped: Ground down to specific edentulous space
dimensions to create space for crown material ○ Many different types: Fixed and removable; unilateral
• Bridges and bilateral
○ Replace missing teeth by crowning at least 2 adjacent ○ Band and loop space maintainer: Made of band soldered
teeth (abutments) to thick wire formed to abut with tooth mesial to
○ Portion that replaces missing tooth called pontic edentulous space, thus preventing drift
○ Bridge can be supported by implants
• Post and core ANATOMY IMAGING ISSUES
○ Post: Metal rod affixed to, or cast with, core to anchor it Imaging Recommendations
to root canal • MR for orthodontic patients
○ Core: Cast metal replacement of tooth structure to ○ If MR of head and neck
mimic crown prep; crown placed on top of it
– Temporary removal of orthodontic appliances to
• Implants prevent signal void artifact
○ Osseointegrated root form replacement of teeth ○ If MR of other body structures
restored with crown
– Stainless steel archwire is magnetic and should be
• Complete and partial dentures removed
○ Removable dentures used when several or all teeth are – All orthodontic brackets and bands should be
missing secured
○ Should be removed from mouth prior to imaging to
prevent metal artifact unless scan with denture is Imaging Pitfalls
requested • Dental restorations can cause metal streaking and beam-
Endodontics hardening artifact on CT and signal voids on MR, thus
marring evaluation of adjacent bone and soft tissue
• Gutta percha ○ 2D imaging radiographic and clinical examination is
○ Cone-shaped flexible radiopaque material that can be recommended for evaluation of bone and dental lesions
condensed to fill tapering prepared root canal if artifact is excessive on CBCT or CT
○ Should be ≤ 1 mm from apex within root ○ To reduce artifact when examining oral cavity soft
– 0.5 mm is ideal tissues on CT and MR, obtain scans without teeth crowns
○ If it extends beyond apex, called overfill in field of view (modified axial)
– If it is 1 mm from apex (within root canal), called
underfilled or short
Dental Restorations

PERIAPICALS AND AXIAL CBCT
Mesio-occluso-distal Amalgam build-up

Amalgam (class I)
Posterior composite restoration

(radiolucent) Posterior composite restoration
(radiopaque)
Amalgam restoration (class I) Posterior composite restoration
Amalgam restoration (class II) Temporary filling
Cotton roll
Root canal filling (gutta percha)
Anterior composite restorations
(Top) Bitewing radiograph shows several posterior restorations. Amalgam is metallic and, therefore, appears completely radiopaque
(image void). Posterior composite restorations can be used for more aesthetic results if clinically indicated and appear radiolucent (if of
1st-generation composites), posing a diagnostic challenge if evaluating for recurrent caries. Composites with radiopaque fillers appear
moderately radiopaque. (Courtesy B. Friedland, BDS.) (Middle) Bitewing radiograph shows 2 types of amalgam restorations that are
named according to surfaces replaced [occlusal (class I), mesio- or disto-occlusal (class II), amalgam build-up, etc.]. If treatment of a
tooth has not been completed or if a period of pulpal healing is required after deep caries excavation, a temporary (interim) filling may
be placed. If a root canal-treated tooth is awaiting a crown, a cotton ball is placed to separate the gutta percha from the sticky
temporary filling. (Courtesy B. Friedland, BDS.) (Bottom) Axial CBCT shows several anterior composite restorations.
Dental Restorations
AXIAL CBCT AND PERIAPICALS
Anterior composite restorations

(radiolucent)
Full metal crown
Gutta percha
Root canal filling short of apex
Abutment tooth
Pontic
Crown on abutment tooth
Ceramic on PFM bridge
Root canal filling
(Top) Axial CBCT shows multiple rounded well-defined radiolucencies on the proximal surfaces of the teeth, representing radiolucent
old-generation composite restorations. (Middle) A periapical radiograph shows a full metal coverage crown on the mandibular left 1st
molar. The contours of the crown should follow the original contours of the tooth with no overhangs or open margins. This tooth is root
canal treated, and the filling material in the mesial root is short, which may mean that a portion of the root canal was not instrumented
to remove debris, presenting a risk for periapical rarefying osteitis. (Courtesy B. Friedland, BDS.) (Bottom) A periapical radiograph
shows a porcelain fused to metal (PFM) bridge. The teeth onto which the bridge is fixed are called abutments and are covered with
crowns. The portion that replaces the missing tooth is called a pontic. According to the number of teeth involved and replaced, the
bridge is called a 3-unit, 4-unit, 5-unit, etc. bridge. (Courtesy B. Friedland, BDS.)
Dental Restorations

CBCT REFORMATS
Mucus retention pseudocyst
Periapical rarefying osteitis
Posts
Post and core

Porcelain fused to metal crown
Root canal overfill

Root apex
Post angled lingual to pulp canal
Porcelain crown
Cement
(Top) CBCT cropped panoramic reformat shows multiple root canal-treated teeth that have been restored with post and core
restorations followed by crowns. A core recreates proper crown preparation outline when tooth structure is inadequate to support
seating of the crown restoration. A post anchors the core to the root and should not extend more than 2/3 of the root length. Note
large mucus retention pseudocyst in left maxillary sinus. (Middle) CBCT sagittal section shows root canal overfill of the central incisor
with post and core not in line with the pulp canal. Perforation of the tooth structure with the post can occur during preparation of the
tooth. Root canal filling in the periapical tissues may be attached to the apex or may be dissociated from it. This foreign body may illicit
an inflammatory reaction with symptoms of pain, or it may be asymptomatic. (Bottom) CBCT panoramic reformat shows full porcelain
coverage crowns in the maxillary and mandibular 1st molars. These are cemented to the tooth with radiopaque cement.
Dental Restorations
CBCT REFORMATS
Glass ionomer cement

Cementoenamel junction
Split palatal suture
Rapid palatal expander
Orthodontic spacers
Orthodontic spacers
(Top) CBCT sagittal reformat shows a restoration of glass ionomer cement (GIC) in the buccal cervical region of this anterior tooth. GICs
are used to restore carious or tooth wear lesions that occur on the root surface of the tooth, or partially in enamel and partially in
dentin. (Middle) Coronal CBCT shows a rapid palatal expander, which is a type of fixed appliance that is used to quickly increase the
width of the maxillary arch by splitting the intermaxillary suture before puberty. It is cemented onto the posterior teeth of the patient.
(Bottom) Axial CBCT shows orthodontic separators (spacers) that are placed between the molars before fixed appliances, such as a
palatal expander or orthodontic bands, are applied. Spacers are circular rubber bands about a centimeter in diameter placed between
adjacent molars. There may be 1-12 spacers applied. The spacers stay between the teeth for 1-2 weeks and move the teeth apart slowly
until they are far apart enough so that the dentist can fit an orthodontic band in between them.
Dental Restorations

CBCT REFORMATS
Orthodontic brackets
Orthodontic archwire
Orthodontic band
Caries
Orthodontic band
Widening of lingual periodontal ligament

space
Orthodontic bracket
(Top) Axial CBCT shows a traditional fixed orthodontic appliance, which consists of brackets fixed to the facial surfaces of teeth, bands
that are cemented to 1 posterior tooth bilaterally, and archwire that is fixed to the brackets with elastic bands. Stainless steel archwire
is ferromagnetic, and metal hardware may cause degradation of image quality on MR. (Middle) Axial CBCT shows caries in a tooth with
an orthodontic band and bracket. Meticulous oral hygiene should be maintained for the duration of the orthodontic treatment to
prevent plaque accumulation and the development of caries. (Bottom) Orthodontic brackets are placed on the crown of the tooth, and
force is applied through the tightening of the orthodontic wire attached to them. With the movement of the teeth, widening of the
periodontal ligament (PDL) space along the surface of the tooth away from the direction of the movement of the root is commonly
seen. In this cross-sectional CBCT, the widening is noted on the lingual surface of the root due to the facial torquing of the root.
Dental Restorations
CBCT REFORMATS
Simulated implant
2 mm of facial alveolar bone thickness
1 mm of lingual alveolar bone thickness

Simulated crown
Facial aspect of implant not covered with

bone
Crown in contact with opposing crown
Implant centered in alveolar process
Crown on tilted abutment
(Top) CBCT 3D surface rendering shows implant planning for an edentulous maxillary anterior alveolar process. The simulated implant
is positioned in the alveolar process following several rules: The crown restoration should function against the opposing dentition, there
should be at least 2 mm of facial alveolar bone and 1 mm of lingual alveolar bone, and there should be 1.5- to 2.0-mm between the
implant and the adjacent teeth. The anatomy should be evaluated to prevent violation of vital anatomical structures. (Courtesy D.
Chenin, DDS.) (Middle) CBCT cross section of a central incisor implant that was positioned to bring the crown into contact with the
opposing teeth, but no ridge augmentation, was performed, resulting in no bone coverage on the facial aspect of the implant. (Bottom)
Sagittal CBCT shows an implant that was centered in the alveolar process but without considering the position of the final restoration.
A tilted abutment was used to bring the crown into occlusion (in this case, not biomechanically ideal for load distribution).
Dental Restorations

PERIAPICAL RADIOGRAPH AND CBCT REFORMATS
Bone level
Shadow of nose
Image of threads shows no blurring or

superimposition
Implant apex
Inferior alveolar canal
Implant apices in nasal cavity
(Top) Periapical radiograph of an implant replacing the left lateral incisor shows severe peri-implant bone loss, extending to the apical
portion of the implant. Vertical bitewings or periapical radiographs in which the central x-ray beams pass through the threads (resulting
in a crisp image of the threads) are ideal for evaluation of peri-implant bone loss, as metal artifact does not obscure evaluation on these
intraoral 2D imaging. (Middle) CBCT panoramic reformat shows the apex of an implant passing through the right inferior alveolar
canal. Cross-sectional reformations of the alveolar process are the gold standard during implant treatment planning to avoid violating
important anatomy. (Bottom) CBCT panoramic reformation shows maxillary anterior implants placed in the right and left nasal cavities.
Evaluation of the amount of bone present and its angulation in relation to the opposing dentition is necessary prior to placement of
implants to determine the need for alveolar process augmentation. (Courtesy T. Sawisch, DDS.)
Maxilla
– Alveolar bone is resorbed when tooth is lost

TERMINOLOGY
– Bone overlying tooth roots forms wave-like
Abbreviations eminences
• Maxilla (Mx) – Bulky part surrounding facial aspect of canine called
canine eminence
IMAGING ANATOMY – Concavity noted on facial surface mesial to canine
called incisive fossa (a.k.a. lateral fossa)
Overview
– Concavity noted on facial surface distal to canine
• Forms majority of midface skeleton and upper jaw called canine fossa
• Contains maxillary sinuses – Most posterior aspect called maxillary tuberosity
• There are 2 maxillae that fuse in midline (intermaxillary – Site of extracted tooth called tooth or extraction
suture) socket
• Presence of "premaxilla" in humans widely contested – Early tooth extractions may cause localized
○ Exists in early embryonic human development developmental hypoplasia
○ Disappears early by fusing to anterior aspect of maxillary • Innervation
bones ○ Infraorbital nerve
○ Has implications for cleft palate development – Continuation of V2
Anatomy Relationships – Passes anteriorly through infraorbital groove and
infraorbital canal and exits onto face via infraorbital
• Articulates with
foramen
○ Opposite Mx
– Gives rise to 2 alveolar branches: Middle superior and
○ Frontal, sphenoid, nasal, vomer, and ethmoid bones
anterior superior
○ Inferior nasal concha
○ Middle superior alveolar nerve
○ Palatine, lacrimal, and zygomatic bones
– May or may not be present
○ Septal and nasal cartilages
– As it descends to form superior dental plexus,
Internal Contents innervates part of maxillary sinus, premolars, and
• Maxillary bone mesiobuccal root of 1st molar, and gingiva and
mucosa of same teeth
○ Body
– Not usually visualized radiographically
– Major part of bone
○ Anterior superior alveolar nerve
– Pyramid-like shape
– As it descends to form superior dental plexus,
– Gives borders to 4 different regions: Orbit, nasal
innervates part of maxillary sinus, maxillary anterior
cavity, infratemporal fossa, middle 1/3 of face
teeth, and gingiva and mucosa of these teeth
– Infraorbital canal and foramen pass from orbit region
– Vertical component may be seen on coronals and
to face region
cross sections lateral to lateral wall of nasal cavity in
– Anterior nasal spine: Pointed prominence in midline
canine/premolar region
– Nasal notch: Concave rims lateral to anterior nasal
– Horizontal component may be seen on axials
spine that form floor of piriform aperture
extending from inferior aspect of vertical component
○ Frontal process
to midline
– Articulates superiorly with nasal, frontal, ethmoid, and
○ Posterior superior alveolar nerve
lacrimal bones
– Branch of V2
– Forms posterior boundary of lacrimal fossa and
– In infratemporal fossa: Passes on posterior surface of
houses lacrimal canal
Mx along region of maxillary tuberosity
○ Zygomatic process
– Gives rise to gingival branch that innervates buccal
– Articulates laterally with maxillary process of
gingiva alongside maxillary molars
zygomatic bone
– Enters posterior surface of Mx and supplies maxillary
○ Palatine process
sinus and maxillary molars, except mesiobuccal root of
– Extends medially to form majority of hard palate 1st molar
– Articulates with palatine process of opposite Mx in ○ Nasopalatine nerve (V2 sensory branch) travels from
midline superior portion of nasal cavity to nasal septum, then
– Articulates with horizontal plate of palatine bone travels anteroinferiorly to go through incisive
posteriorly (nasopalatine) canal and exit through incisive foramen
– Incisive foramen located anteriorly and may be in (foramen of Stenson)
midline or slightly shifted – Supplies sensory fibers to gingiva and mucosa of
– In axial plane, palate may be U shaped or V shaped anterior hard palate from central incisor to canine
(high palatal vault) – May be single, fused, paired, or have multiple canals ±
○ Alveolar process single large incisive canal
– Supports maxillary teeth – Canals located lateral to incisive foramen are called
– Extends inferiorly from Mx foramina of Scarpa
– Each maxillary bone normally contains 5 primary and ○ Greater palatine nerve descends palatine canal in
8 permanent teeth palatine bone
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CHAPTER XXI.
The pinnace and the cracker.
From the time of discovering the pinnace, my desire of returning

to the vessel grew every moment more and more irresistible: but one
thing I saw was absolutely necessary, which was to collect all my
hands and go provided with sufficient strength to enable me to get
her out from the situation where we had found her the day before. I
therefore thought of taking with me the three boys: I even wished
that my wife should accompany us; but she had been seized with
such an horror of the perfidious element as she called it, the sea,
that she assured me the very attempt would make her ill, and thus
occasion her to be an additional trouble rather than of use. I had
some difficulty to prevail upon her to let so many as three of the
children go: she made me promise to return the same evening, and
on no account to pass another night on-board the wreck: and to this I
was, though with regret, obliged to consent.
After breakfast then, we prepared for setting out, but not without
some sighing and mournful looks from my amiable partner. The
boys, on the contrary, were gay and on the alert, in the expectation
of the pleasure that awaited them; particularly Ernest, who had not
yet made a single voyage with us to the vessel. We took with us an
ample provision of boiled potatoes and cassave; and in addition,
arms and weapons of every kind. We embarked and reached Safety
Bay without the occurrence of any remarkable event: here we
thought it prudent to put on our cork jackets; we then scattered some
food for the geese and ducks which had taken up their abode there,
and soon after stepped gaily into our tub-raft, at the same time
fastening the new boat by a rope to her stern, so that she could be
drawn along. We put out for the current, though not without
considerable fear of finding that the wreck had entirely disappeared.
We soon, however, perceived that she still remained firm between
the rocks. Having got on-board, our first care was to load our craft
with different stores, that we might not return without some
acquisition of comfort for our establishment; and then all on the
wings of curiosity and ardour we repaired to that part of the vessel
called the bulk-head, which contained the enviable prize, the
pinnace. On further observation, it appeared to me that the plan we
had formed was subject to at least two alarming and perhaps
insurmountable difficulties: the one was the situation of the pinnace
in the ship; and the other was the size and weight it would
necessarily acquire when put together. The inclosure in which she
lay in pieces was far back in the interior of the ship, and close upon
the side which was in the water, immediately under the officers’
cabin. Several inner timbers of prodigious bulk and weight separated
this inclosure from the breach at which only we had been able to get
on-board, and in this part of the deck there was not sufficient space
for us to work at putting the pinnace together, or to give her room
should we succeed in completing our business. The breach also was
too narrow and too irregular to admit of her being launched from this
place, as we had done with our tub-raft. In short, the separate pieces
of the pinnace were too heavy for the possibility of our removing
them even with the assistance of our united strength. What therefore
was to be done? and how could we meet so formidable a difficulty? I
stood on the spot absorbed in deep reflection, while the boys were
running from place to place, conveying every thing portable they
could find, on-board the raft.
The cabinet which contained the pinnace was lighted by several
small fissures in the timbers, which after standing in the place a few
minutes to accustom the eye, enabled one to see sufficiently to
distinguish objects.
I discovered with pleasure that all the pieces of which she was
composed were so accurately arranged and numbered, that without
too much presumption, I might flatter myself with the hope of being
able effectually to collect and put them together, if I could be allowed
the necessary time, and could procure a convenient place. I
therefore, in spite of every disadvantage, decided on the
undertaking; and we immediately set about it. We proceeded, it must
be confessed, at first so slowly as to produce discouragement, if the
desire of possessing so admirable a little vessel, quite new, perfectly
safe, easy to conduct, and which might at some future day be the
means of our deliverance, had not at every moment inspired us with
new strength and ardour.
Evening, however, was fast approaching, and we had made but
small progress; we were obliged to think of our promise to my wife;
and though with reluctance, we left our occupation and re-embarked.
On reaching Safety Bay, we had the satisfaction of finding there our
kind steward and little Francis; they had been, during the day,
employed in some necessary arrangements for our living at Tent-
House as long as we should have occasion to continue the
excursions to the vessel: this she did to shorten the length of the
voyage, and that we might be always in sight of each other. This new
proof of her kind attention affected me in a lively manner, and I could
not sufficiently express the gratitude which I felt, particularly as I
knew the dislike she had conceived to living in this spot. I presented
her with the valuable cargo we brought, which I knew would give her
pleasure, and regretted that I had no better recompense to offer for
the voluntary sacrifice she had made to my accommodation. I made
the best display I could of two casks of salted butter, three of flour,
some small bags of millet-seed and of rice, and a multitude of other
articles of utility and comfort for our establishment. My wife rewarded
me by the expression of her perfect satisfaction, and the whole was
removed to our storehouse at the rocks.
We passed an entire week in this arduous undertaking of the
pinnace. I embarked regularly every morning with my three sons,
and returned every evening, and never without some small addition
to our stores. We were now so accustomed to this manner of
proceeding, that my wife bade us good bye without concern, and we,
on our parts, left Tent-House without anxiety; she even had the
courage to go several times, with no companion but her little Francis,
to Falcon’s Stream, to feed and take care of the poultry, and to bring
back potatoes for our use. As night successively returned, we had a
thousand interesting things to tell each other, and the pleasure of
being together was much increased by these short separations: we
even enjoyed with a better appetite the excellent supper our kind
hostess at all times took care to prepare for us.
At length the pinnace was completed, and in a condition to be
launched: the question now was, how to manage this remaining
difficulty. She was an elegant little vessel, perfect in every part: she
had a small neat deck; and her mast and sails were no less exact
and perfect than those of a little brig. It was probable she would sail
well, from the lightness of her construction, and in consequence,
drawing but little water. We had pitched and towed all the seams,
that nothing might be wanting for her complete appearance: we had
even taken the superfluous pains of further embellishing by mounting
her with two small cannon of about a pound weight; and, in imitation
of larger vessels, had fastened them to the deck with chains. But in
spite of the delight we felt in contemplating a commodious little
vessel, formed for usefulness in all its parts, and the work, as it were,
of our own industry, yet the great difficulty still remained: the said
commodious, charming little vessel still stood fast, inclosed within
four walls; nor could I conceive of a means of getting her out. To
support the idea of so much time and labour bestowed for no end or
advantage, was absolutely impossible; to effect a passage through
the outer side of the vessel, by means of our united industry in the
use of all the utensils we had secured, seemed to present a prospect
of exertions beyond the reach of man, even if not attended with
dangers the most threatening and alarming. We now examined if it
might be practicable to cut away all intervening timbers, to which,
from the nature of the breach, we had easier access; but should we
even succeed in this attempt, the upper timbers being, in
consequence of the inclined position of the ship, on a level with the
water, our labour would be unavailing: besides, we had neither
strength nor time for such a proceeding; from one moment to
another, a storm might arise and engulf the ship, timber, pinnace,
ourselves, and all. Despairing, then, of being able to find a means
consistent with the sober rules of art, my impatient fancy inspired the
thought of a project, which, if subjected to the experiment, must
necessarily be attended with hazards and dangers of a tremendous
nature.
I had found on-board, a strong iron mortar, such as is used in
kitchens. I took a thick oak plank, and nailed to a certain part of it
some large iron hooks: with a knife I cut a groove along the middle of
the plank. I sent the boys to fetch some match-wood from the hold,
and I cut a piece sufficiently long to continue burning at least two
hours. I placed this train in the groove of my plank: I filled the mortar
with gun-powder, and then laid the plank, thus furnished, upon it,
having previously pitched the mortar all round; and, lastly, I made the
whole fast to the spot with strong chains crossed by means of the
hooks in every direction. Thus I accomplished a sort of cracker, from
which I expected to effect a happy conclusion. I hung this infernally-
contrived machine against the side of the bulk-head next the sea,
having taken previous care to choose a spot in which its action could
not affect the pinnace. When the whole was arranged, I set fire to the
match, the end of which projected far enough beyond the plank to
allow us sufficient time to escape. I now hurried on-board the raft,
into which I had previously sent the boys before applying a light to
the match; and who, though they had assisted in forming the cracker,
had no suspicion of the use for which it was intended, and believing
all the while it concealed some subject of amusement for their next
trip to the vessel. I confess I had purposely avoided giving them the
true explanation, from the fear of the entire failure of my project, or
that the vessel, pinnace, and all that it contained, might in
consequence be blown up in a moment. I had naturally, therefore,
some reluctance to announce myself before the time, as the author
of so many disasters.
On our arrival at Tent-House, I immediately put the raft in a certain
order, that she might be in readiness to return speedily to the wreck,
when the noise produced by the cracker should have informed me
that my scheme had taken effect. We set busily to work in emptying
her; and during the occupation, our ears were assailed with the noise
of an explosion of such violence, that my wife and the boys, who
were ignorant of the cause, were so dreadfully alarmed as instantly
to abandon their employment. What can it be?—what is the matter?
—what can have happened? cried all at once. It must be cannon. It
is perhaps the captain and the ship’s company who have found their
way hither! Or can it be some vessel in distress? Can we go to its
relief?
Mother.—The sound appeared to come in the direction of the
wreck; perhaps she has blown up. Were you careful of not leaving
any light which could communicate with gun-powder?—From the
bottom of her heart she made this last suggestion, for she desired
nothing more earnestly than that the vessel should be annihilated,
and thus an end be put to our repeated visits.
Father.—If this is the case, said I, we had better return
immediately, and convince ourselves of the fact.—Who will be of the
party?
I, I, I, cried the boys; and the three young rogues lost not a
moment in jumping into their tubs, whither I soon followed them, after
having whispered a few words to my wife, somewhat tending to
explain, but still more to tranquillise her mind during the trip we had
now to engage in.
We rowed out of the bay with more rapidity than on any former
occasion; curiosity gave strength to our arms. When the vessel was
in sight, I observed with pleasure that no change had taken place in
the part of her which faced Tent-House; and that no sign of smoke
appeared: we advanced, therefore, in excellent spirits; but instead of
rowing, as usual, straight to the breach, we proceeded round to the
side, on the inside of which we had placed the cracker. The horrible
scene of devastation we had caused now broke upon our sight. The
greater part of the ship’s side was shivered to pieces; innumerable
splinters covered the surface of the water; the whole exhibited a
scene of terrible destruction, in the midst of which presented itself
our elegant pinnace, entirely free from injury! I could not refrain from
the liveliest exclamations of joy, which excited the surprise of the
boys, who had felt the disposition such a spectacle naturally
inspired, of being dejected at the sight of so melancholy an event.
They fixed their eyes upon me with the utmost astonishment.—Now
then she is ours, cried I—the elegant little pinnace is ours! for
nothing is now more easy than to launch her. Come, boys, jump
upon her deck, and let us see how quickly we can get her down
upon the water.
Fritz.—Ah! now I understand you, father, you have yourself blown
up the side of the ship with that machine you contrived in our last
visit, that we might be able to get out the pinnace; but how does it
happen that so much of the ship is blown away?
Father.—I will explain all this to you when I have convinced myself
that the pinnace is not injured, and that there is no danger of any of
the fire remaining on-board: let us well examine. We entered by the
new breach, and had soon reason to be satisfied that the pinnace
had wholly escaped from injury, and that the fire was entirely
extinguished. The mortar, however, and pieces of the chain, had
been driven forcibly into the opposite side of the inclosure. Having
now every reason to be satisfied and tranquil, I explained to the boys
the nature of a cracker, the manner of its operation, and the
important service for which I was indebted to the old mortar.
I now attentively examined the breach we had thus effected, and
next the pinnace. I perceived that it would be easy, with the help of
the crow and the lever, to lower her into the water. In putting her
together, I had used the precaution of placing the keel on rollers, that
we might not experience the same difficulty as we had formerly done
in launching our tub-raft. Before letting her go, however, I fastened
the end of a long thick rope to her head, and the other end to the
most solid part of the wreck, for fear of her being carried out too far.
We put our whole ingenuity and strength to this undertaking, and
soon enjoyed the pleasure of seeing our pretty pinnace descend
gracefully into the sea; the rope keeping her sufficiently near, and
enabling us to draw her close to the spot where I was loading the
tub-boat, and where for that purpose I had lodged a pulley on a
projecting beam, from which I was enabled also to advance with the
completing of the necessary masts and sails for our new barge. I
endeavoured to recollect minutely all the information I had ever
possessed on the art of equipping a vessel; and our pinnace was
shortly in a condition to set sail.
On this occasion a spirit of military affairs was awakened in the
minds of my young flock, which was never after extinguished. We
were masters of a vessel mounted with two cannon, and furnished
amply with guns and pistols! This was at once to be invincible, and in
a condition for resisting and destroying the largest fleet the savages
could bring upon us! In the height of exultation it was even almost
wished they might assail us! For my own part, I answered their
young enthusiasm with pious prayers that we might ever escape
such a calamity as the being compelled to use our fire arms. Night
surprised us before we had finished our work, and we accordingly
prepared for our return to Tent-House, after drawing the pinnace
close under the vessel’s side. We arrived in safety, and took great
care, as had been previously agreed on, not to mention our new and
invaluable booty to the good mother, till we could surprise her with
the sight of it in a state of entire completeness. In answer, therefore,
to her inquiries as to the noise she heard, we told her that a barrel of
gun-powder had taken fire, and had shivered to pieces a small part
of the ship. We relied that no suspicion of the secret would occur to
her mind, should she even have the fancy of looking at the vessel
through the glass, as she sometimes did; for the pinnace lay so as to
be concealed by the immense bulk of the ship’s body.
Two whole days more were spent in completely equipping and
loading the beautiful little barge we had now secured. When she was
ready for sailing, I found it impossible to resist the earnest
importunity of the boys, who, as a recompense for the industry and
discretion they had employed, claimed my permission to salute their
mother, on their approach to Tent House, with two discharges of
cannon. These accordingly were loaded, and the two youngest
placed themselves, with a lighted match in hand, close to the touch-
holes, to be in readiness. Fritz stood at the mast to manage the
ropes and cables, while I took my station at the rudder. These
matters being adjusted, we put off with sensations of lively joy, which
was demonstrated by loud huzzas and suitable gesticulation. The
wind was favourable; and so brisk, that we glided with the rapidity of
a bird along the mirror of the waters: and while my young ones were
transported with pleasure by the velocity of the motion, I could not
myself refrain from shuddering at the thought of some possible
disaster.
Our old friend the tub-raft had been deeply loaded and fastened to
the pinnace, and it now followed as an accompanying boat to a
superior vessel. We took down our large sail as soon as we found
ourselves at the entrance of the Bay of Safety, to have the greater
command in directing the barge; and soon, the smaller ones were
lowered one by one, that we might the more securely avoid being
thrown with violence upon the rocks so prevalent along the coast:
thus, proceeding at a slower rate, we had greater facilities for
managing the important affair of the discharge of the cannon. Arrived
within a certain distance—“Fire”—cried commander Fritz. The rocks
behind Tent-House returned the sound.—“Fire”—said Fritz again.—
Ernest and Jack obeyed, and the echoes again majestically replied.
Fritz at the same moment had discharged his two pistols, and all
joined instantly in three loud huzzas.
Welcome! welcome! dear ones, was the answer from the anxious
mother, almost breathless with astonishment and joy! Welcome,
cried also little Francis with his feeble voice, as he stood clinging to
her side, and not well knowing whether he was to be sad or merry!
We now tried to push to shore with our oars in a particular direction,
that we might have the protection of a projecting mass of rocks, and
my wife and little Francis hastened to the spot to receive us: Ah,
dear deceitful ones! cried she, throwing herself upon my neck and
heartily embracing me, what a fright have you, and your cannon, and
your little ship thrown me into! I saw it advancing rapidly towards us,
and was unable to conceive from whence it could come, or what it
might have on board: I stole with Francis behind the rocks, and when
I heard the firing, I was near sinking to the ground with terror; if I had
not the moment after heard your voices, God knows where we
should have run to—but come, the cruel moment is now over, and
thanks to Heaven I have you once again in safety! But tell me where
you got so unhoped-for a prize as this neat charming little vessel? In
good truth it would really almost tempt me to venture once more on a
sea voyage, especially if she would promise to convey us back to
our dear country! I foresee of what use she will be to us, and for her
sake I think that I must try to forgive the many sins of absence you
have committed against me.
Fritz now invited his mother to get on-board, and gave her his
assistance. When they had all stepped upon the deck, they
entreated for permission to salute, by again discharging the cannon,
and at the same moment to confer on the pinnace the name of their
mother—The Elizabeth.
My wife was particularly gratified by these our late adventures; she
applauded our skill and perseverance: but do not, said she, imagine
that I bestow so much commendation without the hope of some
return in kind: on the contrary, it is now my turn to claim from you, for
myself and little Francis, the same sort of agreeable recompense; for
we have not, I assure you, remained idle while the rest were so
actively employed for the common benefit.—No, not so; little Francis
and his mother found means to be doing something also, though not
at this moment prepared to furnish such unquestionable proofs as
you, by your salutations of cannon, &c.: but wait a little, good friends,
and our proofs shall hereafter be apparent in some dishes of
excellent vegetables which we shall be able to regale you with.—It
depends, to say the truth, only on yourselves, dear ones, to go with
me and see what we have done.
We did not hesitate to comply, and jumped briskly out of the
pinnace for the purpose. Taking her little coadjutor Francis by the
hand, she led the way, and we followed in the gayest mood
imaginable. She conducted us up an ascent of one of our rocks, and
stopping at the spot where the cascade is formed from Jackal’s river,
she displayed to our astonished eyes a handsome and commodious
kitchen garden, laid out properly in beds and walks, and, as she told
us, every where sowed with the seed of useful plants.
This, said she, is the pretty exploit we have been engaged in, if
you will kindly think so of it. In this spot the earth is so light, being
principally composed of decayed leaves, that Francis and I had no
difficulty in working it, and then dividing it into different
compartments; one for potatoes, one for manioc, and other smaller
shares for lettuces of various kinds, not forgetting to leave a due
proportion to receive some plants of the sugar-cane. You, dear
husband, and Fritz, will easily find means to conduct sufficient water
hither from the cascade, by means of pipes of bamboo, to keep the
whole in health and vigour; and we shall have a double source of
pleasure from the general prosperity, for both the eyes and the
palate will be gratified. But you have not yet seen all: there, on the
slope of the rock, I have transplanted some plants of the ananas.
Between these, I have sowed some melon seeds, which cannot fail
to succeed, thus securely sheltered and in so warm a soil: here is a
plot allotted to pease and beans, and this other for all sorts of
cabbage. Round each bed or plot I have sowed seeds of maize, on
account of its tall and bushy form, to serve as a border, which at the
same time will protect my young plants from the scorching heat of
the sun.
I stood transported in the midst of so perfect an exhibition of the
kind zeal and persevering industry of this most amiable of women! I
could only exclaim, that I should never have believed in the
possibility of such a labour in so short a time, and particularly with so
much privacy as to leave me wholly unsuspicious of the existence of
such a project.
Mother.—To confess the truth, I did not myself at first expect to
succeed, for which reason I resolved to say nothing of the matter to
any one, that I might not be put to the blush for my presumption. But
as I found my little calculations answer better than I expected, I was
encouraged, and the hope of surprising you so agreeably, gave me
new strength and activity. I, on my part, however, had my suspicions
that your daily visits to the wreck were connected with some great
mystery, which at a certain time you would be prepared to unfold—
So, mystery for mystery, thought I; and thus, my love, it has turned
out. Though acting in different directions, one only object has been
our mutual aim—the substantial good of our beloved companions of
the desert!
After a few jocose remarks with which we closed this conversation,
we moved towards Tent-House. This was one of our happiest days,
for we were all satisfied with ourselves and with each other; we had
conferred and received benefits, and I led my children to observe the
goodness of Providence, who renders even labour a source of
enjoyment, and makes our own happiness result from that of the
objects of our affection, and our pride to arise from the
commendations of which those objects may be deserving.
I had almost forgot though, said my wife, after a short pause, one
little reproach I had to make you: your trips to the vessel have made
you neglect the bundle of valuable fruit saplings we laid together in
mould at Falcon’s Stream; I fear they by this time must be dying for
want of being planted, though I took care to water and cover them
with branches. Let us go, my love, and see about them.
I readily consented to so reasonable a proposal. I should have
been no less grieved than my wife, to see this charming acquisition
perish for want of care. We had reason on many accounts to return
quickly to Falcon’s Stream, where different matters required our
presence. We had now in possession the greater part of the cargo of
the vessel; but almost the whole of these treasures were at present
in the open air, and liable to injury from both sun and rain.
My wife prepared with alertness for our walk; and the rather from
the aversion she had ever entertained, on account of the intense
heat, for Tent-House. We hastened to unload the boat, and to place
the cargo safely under shelter along with our other stores.
The pinnace was anchored on the shore, and fastened with a
rope, by her head, to a stake. When all our stores were thus
disposed of, we began our journey to Falcon’s Stream, but not
empty-handed; we took with us every thing that seemed to be
absolutely wanted for comfort; and when brought together, it was
really so much, that both ourselves and our beasts of burthen had no
easy task to perform.
CHAPTER XXII.
Gymnastic exercises;—various discoveries; singular
animals, &c.
Neither our voyages to the wreck, nor the laboriousness of our

occupations at Tent House had made us forget the regular
observance of our duties on the sabbath-day, which now again
occurred the day after our return to Falcon’s Stream; and we
accordingly distinguished it by consecrating the forenoon to reading
the church prayers, some chapters in the Bible, singing psalms, and
lastly, the recital of a new parable I had invented, and which I had
named the Arabian Travellers. I reminded my children in it, by the
help of imagery and fictitious names, of all the aid and all the
benefits bestowed upon us by an all-beneficent Providence, from the
moment of our being cast upon our present abode;—that it was his
compassion for our station which had endued us with sagacity and
perseverance in the discovery of so many things necessary for our
existence; and one treasure, valuable above all the rest—a talisman,
bestowed by the good genius who watched over poor defenceless
wanderers. This talisman was such as to inspire them on every
occasion with the knowledge of what was best for their happiness,
and that by listening to these inspirations, they might be sure of
always keeping in the right path, and finding every want supplied. I
need not explain that by the good genius I alluded to the ever-
watchful care of the exemplary wife and mother; and by the talisman,
the sacred volume she had so miraculously preserved and
concealed in her enchanted bag. I was well understood by my
hearers; and as I finished my discourse, the children all ran
spontaneously at once to embrace their mother, addressing her by
the term Good Genius, and thanking her for having been the means
of securing the Bible, to which we might all resort for consolation and
instruction.
After dinner I again addressed my family with a short moral
discourse, and then allowed them to use whatever kind of recreation
they pleased; one feature of my system being, not to tire them with
the subjects I wished them to feel an attachment for. I recommended
to them, for the sake of uniting usefulness with their amusement, to
resume the exercise we began upon the first Sunday of our abode in
these regions, the shooting of arrows; for I had an extreme solicitude
about their preserving and increasing their bodily strength and agility,
which in a situation like ours, might prove of such critical importance.
Nothing tends more to the extinction of personal courage in a human
being, than the consciousness of wanting that strength of limb, or
that address, which may be necessary to aid us in defending
ourselves, or in escaping from dangers. On this occasion, I added
the exercises of running, jumping, getting up trees, both by means of
climbing by the trunk, or by a suspended rope, as sailors are obliged
to do to get to the mast-head. We began at first by making knots in
the rope at a foot distance from each other; then we reduced the
number of knots, and before we left off, we contrived to succeed
without any. I next taught them an exercise of a different nature, with
which they were unacquainted, and which was to be effected by
means of two balls made of lead, fastened one to each end of a
string about a fathom in length. While I was preparing this
machinery, all eyes were fixed upon me.—What can it be intended
for? cried one: How can we use it? asked another: Will it soon be
ready? continued a third.
Father.—Have a little patience, boys, if it be not quite impossible
for you to practise this precious virtue; for though the thing I am
endeavouring to make for you may turn out extremely useful, yet this
said virtue of patience is much more likely to be a constant, steady,
and efficient friend.—But now for the object of your curiosity. It is
nothing less than an imitation of the arms used by a valiant nation
remarkable for their skill in the chase, and whom you all must have
heard of: I mean the Patagonians, inhabitants of the most southern
point of America; but instead of balls, which they are not able to
procure, they tie two heavy stones, one at each end of a cord, but
considerably longer than the one I am working with: every
Patagonian is armed with this simple instrument, which they use with
singular dexterity. If they desire to kill or wound an enemy or an
animal, they fling one of the ends of this cord at him, and begin
instantly to draw it back by the other, which they keep carefully in
their hand, to be ready for another throw if necessary: but if they
wish to take an animal alive, and without hurting it, they possess the
singular art of throwing it in such a way as to make it run several
times round the neck of the prey, occasioning a perplexing tightness;
they then throw the second stone, and with so certain an aim, that
they scarcely ever miss their object: the operation of the second is,
the so twisting itself about the animal as to impede his progress,
even though he were at a full gallop. The stones continue turning,
and carrying with them the cord: the poor animal is at length so
entangled, that he can neither advance nor retire, and thus falls a
prey to the enemy.
This description of the field sports of the Patagonians was heard
with much interest by the boys, who now all entreated I would that
instant try the effect of my own instrument upon a small trunk of a
tree which we saw at a certain distance. My throws entirely
succeeded; and the string with the balls at the ends so completely
surrounded the tree that the skill of the Patagonian huntsmen
required no further illustration. Each of the boys must then needs
have a similar instrument; and in a short time Fritz became quite
expert in the art, as indeed he was in every kind of exercise that
required strength or address: he was not only the most alert of my
children, but being the eldest, his muscles were more formed, and
his intelligence was more developed, than could yet be expected in
the other three.
The next morning, as I was dressing, I remarked from my window
in the tree that the sea was violently agitated, and the waves swelled
with the wind. I rejoiced to find myself in safety in my home, and that
the day had not been destined for out-of-door occupation. Though
such a wind was in reality quite harmless for skilful sailors, for us it
might be truly dangerous, from our ignorance in these matters. I
observed then to my wife that I should not leave her the whole day,
and should therefore hold myself ready to execute any little concerns
she found wanting in our domestic arrangement. We now fell to a
more minute examination than I had hitherto had time for, of all our
various possessions at Falcon’s Stream. She showed me many
things she had herself found means to add to them during my
repeated absences from home: among these was a large barrel filled
with small birds half-roasted and stowed away in butter to preserve
them fresh: this she called her game, which she had found means to
ensnare with birdlime in the branches of the neighbouring bushes.
Next she showed me a pair of young pigeons which had been lately
hatched, and were already beginning to try their wings, while their
mother was again sitting on her eggs. From these we passed to the
fruit-trees we had laid in earth to be planted, and which were in real
need of our assistance, being almost in a decaying state. I
immediately set myself to prevent so important an injury. I had
promised the boys the evening before, to go all together to the wood
of gourds, for the purpose of providing ourselves with vessels of
different sizes to keep our provisions in: they were enchanted with
the idea, but I bargained that they must first assist me to plant all the
young trees; which was no sooner said than executed, excited as we
were by our eager desire for the promised excursion.
When we had finished, a little disappointment however occurred;
the evening, I thought, seemed too far advanced for so long a walk,
especially as my wife and little Francis were to be of the party. By the
time that all were ready, it was too late to think of setting out, and we
accordingly postponed the expected pleasure till the following day,
when we made the necessary preparations for leaving Falcon’s
Stream very early in the morning. By sun-rise all were on foot; for
nothing can exceed the alertness of young persons who act in
expectation of a pleasurable change of scene. The ass, harnessed
to the sledge, played on this occasion the principal character; his
office was to be the drawing home the empty gourds for the service
of our kitchen and the table, and in addition, little Francis, if he
should be tired: in the journey out, he carried our dinner, a bottle of
the Canary wine, and some powder and shot. Turk, according to
custom, led the way as our advanced guard; next followed the three
eldest boys, equipped for sporting; after them, their amiable mother,
leading the little one; and Ponto brought up the rear with the monkey
on his back, to which the boys had given the name of Knips. On this
occasion I took with me a double-barreled gun, loaded on one side
with shot for game, and on the other with ball, in case of meeting
with an enemy.
In this manner we set out, full of good humour and high spirits,
from Falcon’s Stream. Turning round Flamingo Marsh, we soon
reached the pleasant spot which before had so delighted us. My
wife, who now beheld for the first time its various beauties, was
never tired of praising and admiring it. Fritz, who longed to be
engaged in some sporting adventure, took a direction a little further
from the sea-shore; and sending Turk into the tall grass, he followed
himself, and both disappeared. Soon, however, we heard Turk
barking loud, a large bird sprang up, and almost at the same
moment a shot from Fritz brought it down: but the bird though
wounded was not killed; it raised itself and got off with incredible
swiftness, not by flying, but by running. Turk pursued with the
eagerness of an animal enraged; Fritz, bawling out like a mad
creature, followed; and Ponto, seeing what was going on, threw the
monkey off his back, and fell speedily into the same track. It was
Ponto that seized the bird, and held it fast till Fritz came up. But now
a different sort of scene succeeded from that which took place at the
capture of the flamingo. The legs of that bird are long and weak, and
it was able to make but a poor resistance. The present captive was
large in size, and proportionately strong; it struck the dogs, or
whoever came near, with its legs, with so much force, that Fritz, who
had received a blow or two, retired from the field of battle, and dared
not again approach this feathered antagonist. Turk, who had
gallantly assailed the bird, was also discouraged by some severities
applied to his head by the sturdy combatant, and yielded the contest.
The brave Ponto alone withstood the animal’s attacks; he seized one
of its wings, and did not let it go till I reached the spot, which I was
long in doing on account of the height of the grass and the great
weight of my gun; but when I was near enough to distinguish the bird
as it lay on the ground, I was overjoyed to see that it was a female
bustard of the largest size2. I had long wished to possess and to
tame a bird of this species for our poultry-yard, though I foresaw that
it would be somewhat difficult.
To effect the complete capture of the bird without injuring it, I took
out my pocket-handkerchief, and seizing a favourable moment, I
threw it over the head of the bustard; it could not disengage itself,
and its efforts only served to entangle it the more. As in this situation
it could not see me, I got sufficiently near to pass a string with a
running knot over its legs, which, for the present, I drew tight, to
prevent further mischief from such powerful weapons. I gently
released its wing, which was still in the possession of Ponto, and tied
that and its fellow close to the bird’s body. In short, the bustard was
at length vanquished, though not till each and all of us had felt the
powerful blows it was capable of inflicting.—But it was our own, and
that in a condition to promise its preservation when we should once
have conveyed it to Falcon’s Stream, and could administer
abundance of care and kindness to compensate for the rough
treatment it had experienced at our hands.
Without further delay we removed the prisoner to the spot on the
shore where some of our companions had been waiting our return.
On seeing us, Ernest and Jack ran briskly forward, bawling out, Oh
what a handsome bird! And what a size! What beautiful feathers!—I
will lay a wager that it is a female bustard, said Ernest, the instant he
had cast his eyes upon it. And you would win, my boy, answered I; it
is a female bustard; its flesh is excellent, having somewhat of the
flavour of the turkey, to which it also in some other respects has a
resemblance. The male spreads its tail in the form of a wheel, as is
said, to please its female. Let us endeavour to tame and preserve it
by all means.
Mother.—If I had the choice, I would give it back its liberty: most
likely it has young ones which stand in need of its assistance.
Father.—For this once, my dear, the kindness of your heart
misleads you; the poor bird, being wounded, would perish if set at
liberty, for want of care. If, when I have examined its wound, I find it
too serious to admit of cure, I shall kill it, and thus secure an
excellent dish. But if the wound is slight, we shall have gained for our
poultry yard a bird of rare value on account of its size, and which will,
it may be hoped, attract its mate, and thus furnish us with a brood of
its species: should it even happen that it has at this time a young
brood, it is not improbable that they will find the way to take care of
themselves, for no doubt, like chickens, they were able to run as
soon as they came out of the egg.
While conversing on this subject I had been fixing the bustard on
the sledge, taking care to place it in such a posture as to be the least
painful, and to avoid exciting it to struggle against its fetters. We then
pursued our way towards the wood where Fritz and I had seen such
troops of monkeys, who in their spite thought to beat us from the
field by assailing us with showers of cocoa-nuts. Fritz now again
repeated the adventure with much humour to his mother. During this
recital, Ernest was employed in going a little from us in every
direction, in admiration of the height and beauty of the trees: he
stopped in ecstasy at the sight of one in particular which stood alone,
gazing with rapturous wonder at the prodigious distance from the
root to the nearest bunches of cocoa-nuts, which he saw hanging in
clusters under their crown of leaves, and which excited an eager
desire to possess some of them. I glided behind him without his
perceiving me, and was highly amused with the expression of his
features: at length he drew a deep sigh and uttered these words:—
Heavens! What a height!
Father.—Yes, my Ernest, they are indeed at a most
unaccommodating height, and not a monkey in the way to throw
them down to you! Even were I to set Knips at liberty, besides that
he is not in the habit of giving away what he might keep for himself,
he would perhaps take it into his head to stay in the tree when once
there, so fond is every creature that lives of liberty! It is really a pity,
and I am sure you are of my opinion, that those fine cocoa-nuts
cannot find a way to drop down into your mouth.
Ernest.—No indeed, father, this is not the case; I have no great
mind to them, I assure you; they are too hard, and would fall from too
great a height: I should expect to have a tooth or two knocked out at
least.
Scarcely had he ended his sentence, when a nut of the very
largest size fell down. Ernest, alarmed, stepped aside, and looked up

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Diagnostic Imaging : Oral And

Maxillofacial. 2nd Edition Lisa J. Koenig

Contemporary Oral and Maxillofacial Surgery 7th Edition

Oxford Handbook of Oral and Maxillofacial Surgery 2nd

Diagnostic Imaging: Obstetrics 4th Edition Paula J.

Diagnostic Imaging Oncology 2nd Edition Akram M.

Advances in Oral and Maxillofacial Surgery 1st Edition

Imaging Anatomy. Ultrasound 2nd Edition Paula J.

Orthodontics for the Oral and Maxillofacial Surgery

Diagnostic Imaging Genitourinary 4th Edition Ganeh

Lisa J. Koenig, BChD, DDS, MS

Dania Tamimi, C. Grace Petrikowski, Susanne E. Perschbacher,

DIAGNOSTIC IMAGING: ORAL AND MAXILLOFACIAL, SECOND EDITION ISBN: 978-0-323-47782-6

Copyright © 2017 by Elsevier. All rights reserved.

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International Standard Book Number: 978-0-323-47782-6

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Thank you to my parents for encouraging me to pursue a career in dentistry during a

To my teachers: For showing me the path.

Lisa J. Koenig, BChD, DDS, MS

Art Direction and Design

Part II: Diagnoses

Part III: Differential Diagnoses

Part I: Anatomy SECTION 5: CRANIAL NERVES

SECTION 4: BASE OF SKULL

MISCELLANEOUS PERIOSTEAL REACTIONS

Part III: Differential Diagnoses SECTION 3: ORAL CAVITY

• Position is described in relation to

Anatomy: Oral Cavity

Oral epithelium arising from

Permanent tooth bud

Hertwig root sheath

Outer enamel epithelium

Dentin matrix Forming periodontal ligaments

Epithelial rests of Malassez

Anatomy: Oral Cavity

Fusion of reduced enamel

Tissue disintegration Erupting tooth cusp

Initial junctional epithelium

Developing maxillary canine

Developing mandibular canine

TEETH NOMENCLATURE AND ERUPTION AGES

Maxillary central incisor (7-8

Maxillary 2nd molar (12 years)

Maxillary 3rd molar (17-21

Mandibular 3rd molar (17-21

Mandibular 2nd molar (12

Mandibular lateral incisor (7-8 Mandibular 2nd premolar (10-

Anatomy: Oral Cavity

Permanent 1st molar

Permanent central incisor

Primary 1st molar

Permanent 1st molars Permanent 1st molars

3rd molar follicles 3rd molar follicles

Dentin Dentinoenamel junction

Cementoenamel junction Pulp chamber

Periodontal ligament space

Buccal plate Lingual plate

Pulp canal Alveolar bone adjacent to

Inferior alveolar canal

Crest of alveolar bone (crestal

Nutrient canal Apical foramen

Anatomy: Oral Cavity