Radiographic Anatomy

First lectureThe upper jaw

(maxillae)

Leif KullmanAssoc. Prof.

OMF Radiology

The radiographic recognition of disease requires a sound knowledge of the radiographic appearance of normal structuresThat’s why we will start already now with anatomy

As you know is x-rays an important tool to diagnose different diseases

First some definitions

Radio-opaque =White or gray areas Metal – enamel – dentin - bone

Radiolucency =Black areas Less grey than neighboring area

white

Findings in radiographs Hard tissues, such as bones and teeth

=radiopaque view Anatomic landmarks

foramens, cavities are radiolucentand bone ridges radiopaque

Cysts bone lesion visible as cavity = radiolucency

Fillings amalgam as white areas composites as grey areas, less radio-opaque than teeth root canal filling as grey, more radio-opaque than tooth

Prosthodontic appliances crowns =radiopaque

Facial bones and some landmarks visible in dental radiographs of the upper jaw. We willconcentrate on the upper jaw today

Upper jaw region----some basic structures to start with Maxilla Zygomatic bone Nasal cavity Maxillary Sinus Orbit

Different dental radiographs Periapical x-ray Bite wing

small x-ray showing crowns of teeth Occlusal x-ray

showing teeth from above, along the axis of teeth Panoramic view

OPG showing all teeth, jaws and surroundings Lateral view Posterior-anterior view Tomographic methodsespecially

CT= computed tomography, based on radiation

MRI= magnetic resonance imaging, based on magnetic fieldsAll these extraoral x-rays…..what’s that?

All these intraoral x-rays

Extra-oral Radiography Include all views made of the orofacial region with the

film positioned extra-orally. Used to visualize the skull and facial structures, for

detection of disease or injury or to evaluate skeletal growth.

All extra oral radiograph require screen film and intensifying screen, that’s why

they will only give us a low radiation doseeven if they are quite big

(the screen will enhance the ‘small’ radiation coming)

Occlusal view but nor normal anatomy!

Periapical x-ray (intraoral ones)

A FMS or CMS can be taken

9 in the upper and 7 in the lower jawand 4 bitewings

Normal findings in x-rays Teeth

dentin and enamel have different shades due to variation in mineralization

radiopacity: enamel – dentin – pulp cemento-enamel junction should be recognized

Periodontium lamina dura

thin layer of dense bone surrounding the root periodontal ligament space

thin radiolucent area between root and lamina dura alveolar crest

bone that extens between the teeth normal level no more than 1,5 mm from cemento-enamel junction

Normal bone findings in x-rays Bone

cortical bone superficial layer of all bones better visible in mandible than in maxilla dense and hard bone

cancellous bone s.c. trabecular bone trabeculation varies net-like appearance

Today the upper jaw!!

Normal findings in x-rays, upper jaw

Intermaxillary suture visible in occlusal radiographs

Anterior nasal spine visible in periapical radiograph

Incisive foramen visible in periapical or occlusal

radiograph Maxillary sinus

in OPG and periapical x-rays Zygomatic process

in opg and periapical x-rays

a

bd

c

fe

g

h

i

j

kL

A1Name the following structures

a enamelb dentinc enamel-dentin junctiond pulp horne pulp chamberf root canalg furcation areah cancellous bone between the rootsi furcation area…..enamel pearl?j lamina durak PDL spacel lamina dura (approximal)

a b

c

d

• •Name the structures:•a floor of nasal fossa

•b inverted Y (crossing sinus max-nasal cavity)

•c floor of sinus max

•d soft tissue of the nose

•Identify the teeth: 21, 22, 23 (24, 25) •Locate the radiographic apices of these teeth

The lateral fossabetween the lateraland the canine

Upper anterior

cb

d

a

e

f

g

h

•12, 11; 21 22• •a nasal septum•b nasal mucosa•c nasal fossa•d floor of the nasal fossa•e anterior nasal spine•f intermaxillary suture•g incisive foramen•h soft tissue of the nose

Identify the teeth and name thestructures

a

b

cd

e

f

•Identify the teeth: 14, 13, 12• •a floor nasal cavity•b floor sinus max•c filling, plastic•d filling in plastic•e PDL of the second root•f Lateral fossa

•Identify the teeth andname the structures

Canine view/x-ray

c

ba

d•Identify the teeth: •21, 22, 23, 24, 25, 63, 64, 65

•Estimate the age: 8-9 y• •a floor nasal fossa•b bony crypt (developing tooth)•c follicular space•d not fully formed root .

•Identify the teeth:and name the structures

Premolar andmolar view

Locate the radiographic apexes of these teeth.Name the structures

a

b cd

B1

 a zygomatic archbZygomatic bone inferior borderc tooth budd follicular space

a

b

c

d

Locate the radiographic apexes of these teeth.Name the following structures

B2

 a lateral part of floor of nasal fossab sinus max inferior borderc septum in sinus maxd posterior wall of SM

a

b

c

d

•Identify the teeth: 17 to 27 (55 to 53, 63 to 65)Name the following structures•a Nasal septum, intermaxillary suture•b superior foramina of the nasopalatine canal•c sinus max•d nasolacrimal duct

Identify the teethand name the strucures

abc

d

B4

a Proc. Coronoideusb tuberosityc pterygoid platesd proc. Zygomaticus

Locate the radiographic apices of these teethName the following structures

d

a

b

c

d

e

Identify the area:upper anterior (midline), edentulous patient  Name the following structuresa nasal fossab mucosa of nasal fossac floor of nasal cavityd nosee nose openingf anterior nasal spine

f

B5Identify the areaand name structures

Thanks for today….now answer this question!!