NORMAL RADIOGRAPHIC

ANATOMY AND PRINCIPLES OF

RADIOGRAPHIC INTERPRETATION

Moderated By:
•Dr Sunita Gupta
•Dr Shalini Gupta
•Dr Deepmala
•Dr. Vikram
NEHA AGGARWAL
FINAL YEAR
 NORMAL RADIOGRAPHIC
ANATOMY

IMPORTANCE
TEETH
SUPPORTING STRUCTURES
MAXILLA
MANDILBLE
RESTORATIVE MATERIALS
TEETH
 ENAMEL
 DEJ DENTIN
 APICAL FORAMEN

 PULP CHAMBER
 PULP CANAL
DEVELOPING TOOTH

CERVICAL BURNOUT
SUPPORTING
STRUCTURES
 The alveolar bone is the bone of the
maxilla and the mandible that supports
and encases the roots.
 LAMINA DURA
 ALVEOLAR CREST
 PERIODONTAL LIGAMENT SPACE
 SURROUNDING BONE
 ALVEOLAR CREST
PDL SPACE

LAMINA DURA

ALVEOLAR CREST
TYPES OF BONE
 CORTICAL BONE
outer layer of compact bone. Appears
radioopaque.

 CANCELLOUS BONE –
Also called as spongy or trabecular bone.
Lies within the cortical plates in both jaws.
Thin radioopaque plates(trabeculae)
surrounding small radiolucent marrow spaces.
THIN AND
NUMEROUS
TRABECULAE
WITH SMALL
MARROW LARGE MARROW
SPACES SPACES

THICK
TRABECULAE
HORIZONTALL
Y ARRANGED
WITH LARGE
MARROW
SPACES
LARGER TRABECULAE AND
MARROW SPACES
GENERAL TERMS
 Bony prominences – process, ridge,
spine, tubercle, tuberosity.

 Spaces and depressions – canal, fossa.

sinus, foramen.

 Other terms – septum, suture

MAXILLA
 Intermaxillary suture
 Anterior nasal spine
 Nasal aperture
 Incisive foramen
 Superior foramina of the nasopalatine canal
 Lateral fossa
 Nose
 Nasolacrimal canal
 Maxillary sinus
 Zygomatic process and zygomatic bone
 Nasolabial fold
 Pterygoid plates
Intermaxillary suture (median palatal
suture)
Anterior nasal spine and nasal septum
Nasal aperture (nasal fossa) and inferior
nasal conchae
Inverted “Y” of
Ennis
Incisive foramen ( nasopalatine or
anterior palatine foramen)
Nasopalatine canal
Superior foramina of the nasopalatine
canal
Nose
Cheek
mass
Nasolabial
fold

Soft
tissue tip
Nasolacrimal canal
Lateral fossa (incisive fossa or canine
fossa)
MAXILLARY SINUS
Relation of the floor to the root apices
and the alveolar ridge
 neurovascular
canals and grooves

Septa of the
maxillary sinus
Clinical importance
 Proximity of sinus and teeth

 Distinguish a healthy sinus from a cyst

by the presence of nuerovascular canals

 Distinguish bony nodules from root tips.

Zygomatic process and zygomatic bone
Pterygoid plates and hamulus

Maxillary tuberosity
The coronoid process
MANDIBLE
 Symphysis
 Genial tubercles
 lingual foramen
 Menatl ridge
 Mental fossa
 Mental foramen
 Mandibular canal
 Nutrient canals
 Mylohyoid ridge
 Submandibular gland fossa
 External oblique ridge
 Inferior border of the mandible
Genial tubercles
( mental spine)
Lingual foramen Mental ridge
Mental foramen Mental fossa
Mandibular canal
Relationship of the root apex to the
mandibular canal
Nutrient canals
Mylohyoid ridge
Submandibular gland fossa
External oblique ridge
Inferior border of the mandible
Restorative materials
RADIOOPAQUE RADIOLUCENT

•SILVER AMALGAM •SILICATE CEMENTS

•GOLD- CAST CROWN OR INLAY •COMPOSITE BUILD UPS
OR CONDENSED AS GOLD
FOIL.
•STAINLESS STEEL PINS
•CALCIUM HYDROXIDE BASE
•GUTTA-PERCHA
•SILVER POINTS
•STAINLESS STEEL CROWNS
AND ORTHODONTIC
APPLIANCES
•PORCELAIN FUSED TO A
METAL COPING.
PRINCIPLES OF RADIOGRAPHIC
INTERPRETATION
 Clinical examination

It should be performed only when a

historical, or clinical sign or symptom
identifies an abnormality that cannot be
evaluated in any less invasive manner.
Acquiring appropriate diagnostic images

 The scope of the imaging study is

usually made on the basis of the size,
location, perceived nature and
accessibility of the abnormality.
 An insufficient number or inadequate
quality of radiographs limits the
information available from diagnostic
imaging.
Quality of the Diagnostic image
 Check for distortion. Eg. elongation may
lead to errors in working length.
 Panoramic imaging – inherent frequency
of image distortion. Eg. Magnifiaction of
condyle
 Check for degradation by over or
underexposure. Eg. Its difficult to
diagnose osteoporosis in an
overexposed image.
Number and type of available images
 The ALARA principle

 Use of supplemental films eg. Recurrent

caries, condylar neck fracture

 Imaging should be complete before a

biopsy procedure or treatment is
provided.
 Other techniques
Viewing conditions

 Ambient light
 Mounted radiographs
 Light of the viewbox
 Size
 Intense light source for evaluating dark
regions of the film
 Use of a magnifying glass
Image analysis

Systematic
Examine all aspects
Specific sequence
approach of analysis
Intraoral images

BONE IS EXAMINED

BONE OF THE ALVEOLAR PROCESS

DENTITION AND ASSOCIATED STRUCTURES

Analysis of intraosseous lesions

Picture matching
or the “ Aunt
Minnie ’’ method Step –by-step
analysis
STEP 1 : Localizing the abnormality
 Localized or generalized
 Anatomic location
 Unilateral or bilateral
 Single or multifocal
 Size
Eg. Dentigerous cyst end dental follicle
Locations of various lesions
Locations of Locations of
radiolucent lesions radiopaque lesions
Periapical Cyst, granuloma, PCD, benign
abcess, incisive cyst cementoblastoma
Edentulous zones Cyst, granuloma Complex odontoma
Pericoronal Dentigerous cyst, Ameloblastic
AOT, CEOT fibroodontoma
interradicular Lateral periodontal
cyst, botryoid
odontogenic cyst
No specific location Multiple myeloma, Osteosarcoma,
cherubism, myxoma, chondrosracoma
osteomyelitis,osteosar
coma, lymphomas.
multifocal Multiple myeloma Fibrous dysplasia
osteopetrosis
Alveolar bone loss Peridontitis, cyclic
neutropenia, luekemia
 Periapical cemental
dysplasia

Central giant cell granuloma

Ameloblastoma
Position in the jaws
EPICENTER – indicate the tissue type. Eg.
odontogenic epithelium - Coronal to the
tooth
Above, below or within - Relation with IAC
Cartiaginous lesions - Condylar region
Maxillary antrum

 Specific location.eg. CGCG,

osteomyelitis, PCD
Follicular cyst ameloblastoma

Salivary gland defect lesion within the iac

Step 2 :assess the periphery and shape

Well-defined

ILL-defined
 Well - defined

Corticated margin

punched out/moth eaten

Sclerotic
margin target lesion
Ill-defined borders
Sqaumous cell
Carcinoma

fibrous dysplasia
SHAPE OF THE LESION
 CIRCULAR
 SCALLOPED
 IRREGULAR
 Periapical cyst odontogenic keratocyst
STEP 3: analyze the internal structure
 Totally radiolucent
 Totally radiopaque
 Mixed radiolucent and radiopaque
 Internal structure – air, fat , gas
fluid
soft tissue
bone marrow
trabecular bone
cortical bone
enamel and metal
Few possibilities
 Pattern of trabeculae

 Presence of septa

 Dystrophic calcification
 Cementum
 Tooth structure
 Multifocal confluent radiopacities
 Ill-defined opacities
 Ground-glass appearance
 Soft-tissue opacity - silaoliths
STEP 4 : analyze the effects of the
lesion on surrounding structures
Effect on teeth, lamina dura
and pdl space
 Surrounding bone density and trabecular
pattern – presence of a sclerotic margin
 Inferior alveolar canal and mental
foramen-
superior displacement
widening with intact cortex
widening with cortical
destruction
 Outer cortical bone and periosteal
reactions
 Radiographic
analysis

abnormal Normal variation

developmental acquired
ACQUIRED ABNORMALITIES:

 Cyst
 Benign neoplasia
 Malignancy
 Inflammatory lesion
 Bone dysplasia
 Vascular anomaly
 Metabolic disease
 Trauma
Step 5 : formulating a radiographic
interpretation

 Decision 1 : normal or abnormal

 Decision 2 : developmental or acquired
 Decision 3 : classification
 Decision 4: ways to proceed
Radiographic report
 Patient and general information
 Imaging procedure
 Clinical information
 Observations
 Rdaiographic interpretation
BIBLIOGRAPHY
 White and Pharoah
 Haring and Howerton
 Karjodkar’s dental radiography
 Web search
THANKYOU