Intraoral Radiographic Anatomy

The following slides identify the anatomical

structures that may be seen on intraoral films.
These structures are more likely to be seen when
using the bisecting angle technique because of the
increased vertical angulation (increased positive in
the maxilla and increased negative in the mandible)
commonly used with this technique. Since some of
the structures may be confused with pathology, it
is important to understand their normal appearance
in order to make a proper diagnosis.
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Maxillary Incisor
Nasal septum
Inferior concha
Nasal fossa
Nasal spine
Incisive foramen
Nose
Median palatine suture
e
f
a = nasal septum
b = inferior concha
c = nasal fossa
d = anterior nasal spine
e = incisive foramen
f = median palatal
suture
b
a
d
c
facial view
palatal view
Nasal septum
facial view
a
Inferior concha
facial view
Nasal fossa
facial view
Anterior nasal spine
facial view
Incisive foramen
palatal view
Median palatal suture
palatal view
Soft tissue of the nose
Red arrow points to
periapical lesion
(post-endo).
a
b
e
a
d
b
Red arrows = lip line
g
Red arrow = mesiodens
(supernumerary tooth)

d
f
Blue arrow = chronic
periapical periodontitis.
Tooth # 9 is non-vital
(trauma) and needs endo.
Superior foramina of the nasopalatine canals (red
arrows). These foramina lie in the floor of the nasal
fossa. The nasopalatine canals travel downward to join
in the incisive foramen.
d
b
a
The red arrows point to an
incisive canal cyst; the
orange arrow identifies
the root of tooth # 7.
All the incisors are non-vital
and have periapical lesions. The
purple arrows point to external
resorption; the blue arrow
identifies internal resorption.
f
The red arrows point to the soft tissue of the nose.
The green arrows identify the lip line.
Maxillary Canine
Floor of nasal fossa
Maxillary sinus
Lateral fossa
Nose
a = floor of nasal fossa
b = maxillary sinus
c = lateral fossa
(a & b form inverted Y)
a
c
b
a
c
b
facial view
Floor of nasal fossa (red arrows) and anterior
border of maxillary sinus (blue arrows), forming the
inverted (upside down) Y.
facial view
Lateral fossa. The radiolucency results from a
depression above and posterior to the lateral
incisor. To help rule out pathology, look for an
intact lamina dura surrounding the adjacent teeth.
facial view
Soft tissue of the nose
Red arrows point to nasolabial fold.
Also note the inverted Y.
The maxillary sinus
surrounds the root of the
canine, which may be
misinterpreted as
pathology.
The white arrows indicate the
floor of the nasal fossa. The
maxillary sinus (red arrows)
has pneumatized between the
2
nd
premolar and first molar
The red arrow identifies the lateral fossa. The pink
arrow points to CPP (chronic periapical periodontitis =
abscess, granuloma, etc.).
Zygomatic
process
Sinus septum Sinus recess
Maxillary sinus
Maxillary Premolar
a = malar process
b = sinus recess
c = sinus septum
d = maxillary sinus
b
a
c
d
b
d c
a
facial view
Malar (zygomatic) process. U or j-shaped
radiopacity, often superimposed over the roots
of the molars, especially when using the
bisecting-angle technique. The red arrows
define the lower border of the zygomatic bone.
facial view
Sinus septum. This septum is composed of folds
of cortical bone that arise from the floor and walls
of the maxillary sinus, extending several
millimeters into the sinus. In rare cases, the
septum completely divides the sinus into separate
compartments.
facial view
Sinus recess. Increased area of radiolucency
caused by outpocketing (localized expansion)
of sinus wall. If superimposed over roots, may
mimic pathology.
facial view
Maxillary Sinus. An air-filled cavity lined with
mucous membrane. Communicates with nasal
cavity through 3-6 mm opening below middle
concha. Red arrows point to neurovascular
canal containing superior alveolar vessels and
nerves.
facial view
Blue arrows identify
radiopacity which is a
mucous retention cyst.
Note relatively recent
premolar extraction sites.
Green arrow points to
neurovascular canal.
The red arrows point to
the nasolabial fold. The
thicker cheek tissue
makes the area more
radiopaque posterior to
the line.
Pneumatization. Expansion of sinus wall into
surrounding bone, usually in areas where
teeth have been lost prematurely. Increases
with age.
Maxillary Molar
Maxillary sinus
Sinus recess
Zygoma
Pterygoid plate
Hamular
process
Coronoid process Maxillary tuberosity
g
d
a
e
f
a = maxillary tuberosity* e = zygoma (dotted lines)
b = coronoid process f = maxillary sinus
c = hamular process g = sinus recess
d = pterygoid plates

* image of impacted third molar superimposed
c
b
facial view
d
b
a
e
c f
g
Maxillary Tuberosity. The rounded elevation
located at the posterior aspect of both sides of
the maxilla. Aids in the retention of dentures.
facial view
Coronoid process. A mandibular structure
sometimes seen on the maxillary molar periapical
film when using the bisecting angle technique
with finger retention (The mouth is opened wide,
moving the coronoid down and forward). Note the
supernumerary molar.
facial view
Hamular process (white arrows) and pterygoid plates
(purple arrows). The hamular process is an
extension of the medial pterygoid plate of the
sphenoid bone, positioned just posterior to the
maxillary tuberosity.
facial view
Zygomatic (malar) bone/process/arch. The
zygomatic bone (white/black arrows) starts
in the anterior aspect with the zygomatic
process (blue arrow), which has a U-shape.
The zygomatic bone extends posteriorly
into the zygomatic arch (green arrow).
facial view
Maxillary sinus. As seen in the above film, the floor of the
maxillary sinus flows around the roots of the maxillary molars
and premolars. The walls of the sinus may become very thin.
As a result, sinusitis may put pressure on the superior
alveolar nerves resulting in apparent tooth pain, even though
the tooth is perfectly healthy. Note coronoid process (green
arrow), zygomatic bone (blue arrow), sinus septum (yellow
arrow) and neurovascular canal (orange arrows).
facial view
The maxillary sinus is evident
anterior to the second molar
(black arrows) but it
disappears posteriorly due to
the superimposition of the
zygomatic bone. The orange
arrows identify a mucous
retention cyst (retention
pseudocyst) within the sinus.
This film shows the
coronoid process (green
arrow) and a distomolar
(blue arrow) that has erupted
ahead of the third molar (red
arrow). A distomolar is a
supernumerary tooth that
erupts distal (posterior) to
the other molars.
The zygomatic process (green arrows) is a prominent U-
shaped radiopacity. Normally the zygomatic bone
posterior to this is very dense and radiopaque. In this
patient, however, the maxillary sinus has expanded into
the zygomatic bone and makes the area more
radiolucent (red arrows). The coronoid process (orange
arrow), the pterygoid plates (blue arrows) and the
maxillary tuberosity (pink arrows) are also identified.
This film shows the expansion of the borders of the
maxillary sinus through pneumatization (red arrows). This
expansion increases with age and it may be accelerated as
a result of chronic sinus infections. It is most commonly
seen when the first molar is extracted prematurely, as in
the film at right (the second and third molars have
migrated anteriorly to close the space). The coronoid
process is seen in the lower left-hand corner of each film.
The green arrow identifies a sinus recess. Note the two
distomolars in film at right (blue arrows).
Mandibular Incisor
Mental ridge
Genial tubercles Lingual foramen
Mental fossa
b = genial tubercles
a = lingual foramen c = mental ridge
d = mental fossa
a
b
c
d
facial view lingual view
Lingual foramen. Radiolucent hole in center of
genial tubercles. Lingual nutrient vessels pass
through this foramen.
lingual view
Genial tubercles. Radiopaque area in the midline,
midway between the inferior border of the mandible and
the apices of the incisors. Serve as attachments for the
genioglossus and geniohyoid muscles. May have
radiolucent hole in center (lingual foramen), but not on
this film. Note double rooted canine (red arrows).
lingual view
Mental ridge. These represent the raised portions of the
mental protuberance on either side of the midline. More
commonly seen when using the bisecting angle
technique, when the x-ray beam is directed at an upward
angle through the ridges.
facial view
Mental fossa. This represents a depression on the
labial aspect of the mandible overlying the roots of
the incisors. The resulting radiolucency may be
mistaken for pathology.
facial view
The radiolucent area above
corresponds to the location
of the mental fossa. However,
this slide represents chronic
periapical periodontitis; these
teeth are non-vital, due to
trauma.
The orange arrows above
identify nutrient canals.
They are most often seen in
older persons with thin
bone, and in those with high
blood pressure or advanced
periodontitis.
Mandibular Canine
Mental ridge
Genial tubercles
Lingual foramen
Mental foramen
Cortical bone
b
2
a = mental ridge
c = mental foramen
b
2
= lingual foramen

b
1
= genial tubercles

facial view lingual view
d c
d a
d b
1

d b
2

Mental ridge. The raised portions of the mental
protuberance, sloping downward and backward
from the midline.
facial view
Lingual foramen/genial tubercles. (See
description under mandibular incisor
above).

lingual view
The red arrows identify the mandibular canal
and the blue arrow points to the mental
foramen.
facial view
Mandibular Premolar
Mylohyoid ridge
Mandibular canal
Mental foramen
Submandibular
gland fossa
c
b = mandibular canal
d = mental foramen
a = mylohyoid ridge
(internal oblique)
c = submandibular gland
fossa
facial view lingual view
c
a
d d
b
Mylohyoid (internal oblique) ridge. This radiopaque
ridge is the attachment for the mylohyoid muscle.
The ridge runs downward and forward from the
third molar region to the area of the premolars.
lingual view
facial view
Mandibular canal. (Inferior alveolar canal). Runs
downward from the mandibular foramen to the
mental foramen, passing close to the roots of the
molars. More easily seen in the molar periapical.
lingual view
Submandibular gland fossa. The depression below
the mylohyoid ridge where the submandibular gland
is located. More obvious in the molar periapical film.
Mental foramen. Usually located midway between
the upper and lower borders of the body of the
mandible, in the area of the premolars. May mimic
pathology if superimposed over the apex of one of
the premolars.
facial view
The mental foramen (blue
arrow) is adjacent to a
periapical lesion associated
with tooth # 21 (red arrow).
There is slight external
resorption on # 21.
The green arrow points to the
mental foramen. The yellow
arrow identifies a periapical
lesion on # 30. Note the
overextension of the silver point
in the distal root, the perforation
of the mesial root and the
amalgam protruding through
the perforation from the pulp
chamber.
Mandibular Molar
External oblique
ridge
Submandibular
gland fossa
Mandibular canal
Mylohyoid ridge
(internal oblique)
facial view lingual view
b
c
a
b
a = external oblique ridge
c = mandibular canal
b = mylohyoid ridge
d = submandibular gland
fossa
d d
a
b
c
d d
a = external oblique ridge
b = mylohyoid ridge
c = mandibular canal
d = submandibular gland fossa
External oblique ridge. A continuation of the anterior
border of the ramus, passing downward and forward
on the buccal side of the mandible. It appears as a
distinct radiopaque line which usually ends
anteriorly in the area of the first molar. Serves as an
attachment of the buccinator muscle. (The red
arrows point to the mylohyoid ridge).
facial view
Mylohyoid ridge (internal oblique). Located on the
lingual surface of the mandible, extending from the
third molar area to the premolar region. Serves as
the attachment of the mylohyoid muscle.
lingual view
facial view
Mandibular (inferior alveolar) canal. Arises at the
mandibular foramen on the lingual side of the ramus and
passes downward and forward, moving from the lingual
side of the mandible in the third molar region to the
buccal side of the mandible in the premolar region.
Contains the inferior alveolar nerve and vessels.
lingual view
Submandibular gland fossa. A depression on the
lingual side of the mandible below the mylohyoid
ridge. The submandibular gland is located in this
region. Due to the thinness of bone, the trabecular
pattern of the bone is very sparse and results in the
area being very radiolucent. The fact that it occurs
bilaterally helps to differentiate it from pathology.
The external oblique ridge (red arrows) and the
mylohyoid ridge (blue arrows) usually run parallel
with each other, with the external oblique ridge
always being higher on the film.
The mandibular canal (red arrows identify inferior border
of canal) usually runs very close to the roots of the
molars, especially the third molar. This can be a problem
when extracting these teeth. Note the extreme dilaceration
(curving) of the roots of the third molar (green arrow) in
the film at left. The film at right shows kissing
impactions located at the superior border of the canal.
Identify the anatomical structures
on the following eight slides.
Enter answers on the
accompanying answer sheet.
Slide # 1
A. The red arrows identify the ?
Slide # 2
A. The red arrow points to the ?
B. The white arrows identify the ?
C. The blue arrow points to the ?
D. The yellow arrow identifies the ?
Slide # 3
A. The small radioluceny identified by
the green arrow is the ?
Slide # 4
A. The radiopacity identified by the
blue arrows is the ?
B. The orange arrow identifies the ?
Slide # 5
A. The yellow arrows point to the ?
B. The red arrows identify the ?
Slide # 6
A. The red arrow points to the ?
B. The orange arrow points to the ?
C. The blue arrows point to the
radiolucent line known as the ?
Slide # 7
A. The red arrows point to the ?
Slide # 8
A. The red arrows identify the ?
B. What is the name of the radiolucent
area surrounding the canal?