Intraoral Anatomy

By : Rijul Agarwal

Introduction
The radiographic recognition of disease requires
knowledge of the radiographic appearance of
normal structures.

The absence of one or even several such

landmarks in any individual should not
necessarily be considered abnormal.

TEETH
Composed of dentin, enamel cap over the coronal
portion and a thin layer of cementum over root surface.

Enamel appears most dense as it is 90% mineral

causing greatest attenuation of x-ray photons thus
appearing radiopaque.

Dentin is 75% mineralized so its radiographic

appearance is roughly comparable to bone. Appears
smooth & homogeneous on radiographs because of its
uniform morphologic features.

Cementum has mineral content comparable to dentin

so it is not apparent radiographically because the
contrast between it & dentin is low and cementum is so
thin.

 Cervical Burnout:
Diffuse radiolucent
areas with ill-defined
borders on the
mesial or distal
aspects of the teeth
in the cervical
regions between the
edge of the enamel
cap & the crest of the
alveolar ridge caused
by the normal
configuration of the
affected teeth
resulting in
decreased X-ray
absorption in the
areas in question.

 Pulp of normal teeth is

composed of soft tissue and
appears radiolucent. The
chambers and root canals
containing the pulp extend
from the interior of the crown
to the apices of the roots.

In developing tooth root, the

pulp canal diverges and walls
of the root rapidly taper to a
knife edge. In the recess
formed by the root walls and
extending a short distance
beyond is a small, rounded,
radiolucent area in the
trabecular bone, surrounded
by a thin layer of hyperostotic
bone called as the dental
papilla which forms the dentin
& the primordium of the pulp

Supporting Structures
LAMINA DURA:
1. Its a thin radiopaque layer of dense bone which is
continuous with the shadow of the cortical bone at the
alveolar crest. Its radiographic appearance is caused by the
fact that the x-ray beam passes tangentially through many
times the thickness of the thin bony wall resulting in its
observed attenuation(the egg shell affect).

2. When x-ray beam is directed through a relatively long

expanse of structure it appears radiopaque & well defined
whereas if the beam is directed more obliquely it appears
diffuse and is not discernible.

3. Its thickness and density on radiograph vary with amount of

occlusal stress tooth is subjected.

4. Its absence not a sure sign of non-vitality of pulp.

 ALVEOLAR CREST:
1. Gingival margin of the
alveolar process
extending between the
teeth as a radiopaque
line.

2. Normally it is 1.5mm
from the CEJ of the
adjacent teeth. It
recedes apically with age
& show resorption with
periodontal disease.

3. Image of the crest varies

from a dense layer of
cortical bone to a smooth
surface without cortical

 PERIODONTAL LIGAMENT:
1. As it is composed of collagen,
it appears as a radiolucent
space between the tooth root
and lamina dura.

2. The shape of the tooth

creates the appearance of a
double PDL space. When the
x-ray beam is directed so that
two convexities of a root
surface appear on a film, a
double PDL space is seen. Eg.
being on the buccal and
lingual eminences on the
mesial surface of mandibular
first and second molar roots.

 CANCELLOUS BONE:
1. Composed of thin
radiopaque plates and
rods(trabeculae)
surrounding many small
radiolucent pockets of
marrow.

2. Its radiographic pattern

comes from two sources
first being cancellous
bone itself and second
being the endosteal
surface of the outer
cortical bone where the
cancellous bone fuses
with the cortical bone.

MAXILLA
INTERMAXILLARY SUTURE:
1. Appears as a thin radiolucent
line of uniform width in the
midline between the two
portions of the premaxilla.

.ANTERIOR NASAL SPINE:

1. Radiopaque and is v-shaped.
2. Approximately 1.5-2 cm
above the alveolar crest at or
below the junction of the
inferior end of the nasal
septum and the inferior
outline of the nasal aperture.

 NASAL APERTURE:
1. On periapical radiographs of the incisors, the inferior border
of the fossa aperture appears as a radiopaque line extending
bilaterally away from the base of the anterior nasal spine.

2. Nasal cavity contains the opaque shadows of the inferior

conchae extending from the right & left lateral walls for
varying distances toward the septum.

 INCISIVE FORAMEN(Nasopalatine foramen, anterior

palatine foramen):

1. Radiographic image is projected between roots & in the

region of the middle and apical thirds of the central
incisors.

2. It is the potential site for cyst formation. The presence of

cyst is presumed if the width of the foramen exceeds
1cm or if enlargement can be demonstrated on
successive radiographs.

 SUPERIOR FORAMINA OF THE

NASOPALATINE CANAL:

1. The openings are on each

side of the nasal septum,
close to the anteroinferior
border of the nasal cavity,
and each canal passes
downward anteriorly and
medially to unite with canal
from other side forming the
incisive foramen.

.LATERAL FOSSA(incisive
fossa):

1. A gentle depression in the

maxilla near the apex of the
lateral incisor.

2. Appears diffusely radiolucent

on periapical projection.

 NOSE:
1. Seen on the projections of the maxillary central and
lateral incisors, superimposed over the roots of
these teeth as a uniform, slightly opaque
appearance with a sharp border.

.NASOLACRIMAL CANAL:
1. Formed by the nasal and maxillary bones.
2. Occasionally seen on periapical radiographs in the
region above canine apex when steep vertical
angulation is used.

3. Routinely seen on maxillary occlusal projections in

the region of molars.

 MAXILLARY SINUS:
Borders on a periapical
radiograph appears as a
thin, delicate, tenuous
radiopaque line.

It has small interruptions

in its smoothness or
density.

Floor of the sinus and

nasal cavity are
superimposed and are
seen crossing one another
forming an inverted Y in
the area.

 Root apices may project anatomically into the floor of

the sinus, causing small elevations or prominences.

The thin layer of bone covering the root is seen as a

fusion of the lamina dura and floor of the sinus.

The intimate relationship between sinus and teeth leads

to a possibility that clinical symptoms originating in the
sinus may be perceived in the teeth and vice versa.
Frequently, thin radiolucent lines
of uniform width are found within
the image of the maxillary sinus.
These are shadows of
neurovascular canals or grooves
in the lateral sinus walls that
accommodate the posterior
superior alveolar vessels, their
branches, and the accompanying
superior alveolar nerves.

 Presence of several radiopaque lines traversing the

image of the maxillary sinus called septa.

These are thin folds of cortical bone that project a

few millimeters away from the floor and wall of the
antrum, or they may extend across the sinus.

The floor of the maxillary sinus occasionally shows

small radiopaque projections, which are nodules of
bone.

 ZYGOMATIC PROCESS AND ZYGOMA:

1. It is the extension of the lateral maxillary surface
that arises in the region of the apices of the first
and second molars and articulates with the
maxillary process of the zygoma.

2. On periapical radiographs, the zygomatic process

appears as a U-shaped radiopaque line with its
open end directed superiorly. The enclosed rounded
end is projected in the apical region of the 1st and
2nd molars.

3. The inferior border of the zygoma extends

posteriorly from the zygomatic process of the
maxilla to the zygomatic process of the temporal
bone. Seen as a uniform radiopacity over the apices
of the molars.

 NASOLABIAL FOLD:
1. An oblique line demarcating a
region that appears to be
covered by a veil of slight
radiopacity frequently
traverses periapical
radiographs of the premolar
region.

2. Useful in identifying the side

of the maxilla represented by
a film of the area if it is
edentulous.

.PTERYGOID PLATES:
1. Lie immediately posterior to
the tuberosity's.

2. Seen as a single radiopaque

homogeneous shadow without
any trabeculation.

MANDIBLE
SYMPHYSIS:
1. Radiolucent line in the region
of the forming deciduous
central incisors in infants upto
first years of life.

2. Its presence in older

individuals is abnormal and
suggestive of a fracture or a
cleft.

.LINGUAL FORAMEN:
1. Seen as a single round
radiolucent canal with a welldefined opaque border lying in
the midline below the level of
the apices of the incisors.

 GENIAL TUBERCLE:
1. On the mandibular occlusal radiographs as one or
more small projections.

2. On the periapical radiographs they appear as a

radiopaque mass(3-4mm in diameter) in the midline
below the incisor roots.

 MENTAL RIDGE:
1. On periapical
radiographs of the
mandibular central
incisors, the mental
ridge(protuberance) is
seen as two radiopaque
lines sweeping
bilaterally forward and
upward toward the
midline.

.MENTAL FOSSA:
1. Depression on the labial
aspect of the mandible
extending laterally from

 MENTAL FORAMEN:
1. Anterior limit of the inferior
dental canal seen on periapical
radiographs.

2. It may be round, oblong, slitlike,

or very irregular and partially or
completely corticated.

3. It is seen about halfway

between the lower border of
the mandible and crest of the
alveolar process, usually in the
region the apex of the second
premolar.

4. If it is projected over one of the

premolar apices it may mimic
periapical disease.

 MANDIBULAR CANAL:
1. Radiographically seen as a
dark linear shadow with thin
radiopaque superior and
inferior borders cast by the
lamella of bone that bounds
the canal.

.NUTRIENT CANAL:
1. They carry a neurovascular
bundle and appear as
radiolucent lines of fairly
uniform width.

2. Seen running vertically from

the inferior dental canal
directly to the apex of a
tooth or into the interdental
space between the
mandibular incisors.

 MYLOHYOID RIDGE:
1. Slightly irregular crest of bone
on the lingual surface of the
mandibular body.

2. Runs diagonally downward and

forward from the area of 3rd
molars to the premolar region,
at the level of the apices of
posterior teeth.

.SUBMANDIBULAR GLAND
FOSSA:

1. Seen as a depression in the

molar area immediately below
the mylohyoid ridge as a
depression.

2. Appears as a radiolucent area

with sparse trabecular pattern.

 EXTERNAL OBLIQUE
RIDGE:

1. Continuation of the
anterior border of the
mandibular ramus.

2. Follow an anteroinferior
course lateral to the
alveolar process.

.INFERIOR BORDER OF
THE MANDIBLE:

1. Seen on periapical
projection as a
characteristically dense,
broad, radiopaque band
of bone.

 CORONOID PROCESS:
1. Seen in the maxillary molar
region as a triangular
radiopacity, with its apex
directed superiorly and
anteriorly, superimposed on
the region the 3rd molar.

2. Occasionally, especially when

its shadow is dense and
homogeneous, the coronoid
process is mistaken for a root
fragment. The true nature of
the shadow can be easily
demonstrated by obtaining
two radiographs with the
mouth in different positions
and noting the change in
position of suspected shadow.

RESTORATIVE MATERIALS
Vary in their radiographic appearance, depending primarily
on their thickness, density, and atomic number.

Silver amalgam: Radiopaque

Gold used as cast in a crown or inlay or condensed as gold
foil: Radiopaque

Stainless steel pin: Radiopaque

Calcium Hydroxide used as base material: Radiolucent
Gutta-percha: Radiopaque
Composite restorations and porcelain: Partially radiopaque
Stainless steel crowns and orthodontic appliances: Relatively
radiopaque.

BIBLIOGRAPHY
Oral Radiology (Principles and Interpretation) by
White and Pharoah : 1st South Asia edition

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