Radiographic appearance of

normal intraoral land marks

Lecture 6
 Radiographic appearance of normal
intraoral land marks
The radiographic recognition of disease requires a sound knowledge of
radiographic appearance of normal structures. So, the good radiologic
diagnosis cannot be attempted without an appreciation of a wide range
of variation on the appearance of normal anatomic structures. Similarly,
it should be recognized that most normal patients demonstrate many of
normal radiographic landmarks, but it is a rare patient who shows all of
them.
• Radiolucent

refers to that portion of a processed radiograph that is dark or black. A structure

that appears radiolucent on a radiograph lacks density and permits the passage of
the X-ray beam with little or no resistance. For example, air space freely permits the
passage of dental X-rays.

• Radiopaque

refers to that portion of a processed radiograph that appears light or white.

Radiopaque structures are dense and absorb or resist the passage of the X-ray beam.
 The density of the structure being radiographed has a profound
influence of the resultant image.
The greater the density of an object, the greater the attenuation of
the X-Ray beam directed through the object or area.
In the oral cavity the relative densities of various natural structures, in
order of decreasing density, are: enamel, dentin, cementum, bone, soft
tissue, fat and air. Metallic objects, such as restorations, are far denser
and hence better absorbers than enamel.
As X- ray beam is differentially attenuated by these absorbers. The
resultant beam caries information that is recorded on the film, the ones
to be light are said to be radiopaque. these objects are good absorbers.
While those which cast a dark area on the film correspond to the
radiolucent objects.
 Normal radiographic anatomy
Normal tooth anatomy
• Enamel: is the most radiopaque.
• Dentin: less radiopaque than enamel,
has the same radiopacity as bone.
• Dentin appears radiopaque and makes
up the majority of the tooth structure.
• Dentino-Enamel Junction (DEJ)appears
as a line where the enamel (very
radiopaque) meets the dentin (less
radiopaque) .
• Pulp Cavity The pulp cavity consists of
a pulp chamber and pulp canals.
Supporting Structures
• The alveolar process, or alveolar bone,
serves as the supporting structure for
teeth.
• Anatomy of Alveolar bone includes the
lamina dura, the alveolar crest, and the
periodontal ligament space .
• Lamina Dura Description : is the wall of
the tooth socket that surrounds the root
of a tooth and is made up of dense
cortical bone.
• On a dental image, the lamina dura
appears as a dense radiopaque line that
surrounds the root of a tooth .
• Alveolar Crest Description. the most coronal
portion of alveolar bone found between
teeth and is made up of dense cortical bone
• On a dental image, the alveolar crest
appears radiopaque and is typically located
1.5 to 2.0 mm below the junction of the
crown and the root surfaces (CEJ).
• Periodontal Ligament Space (PDL space) the
space between the root of the tooth and the
lamina dura.
• On a dental image, the PDL space appears
as a thin radiolucent line around the root of
a tooth.
• In the healthy periodontium, the PDL space
appears as a continuous radiolucent line of
uniform thickness.
 Types of bone
• The bone in the human body can be described as either cortical or
cancellous
• Cortical bone,(compact bone), is the dense outer layer of bone
• Cancellous bone,(trabecular bone), is the soft, spongy bone located
between two layers of dense cortical bone
• the trabeculae in the anterior
maxilla are typically thin and
numerous in the posterior
maxilla the trabecular
pattern is usually quite
similar to that in the anterior
maxilla, although the marrow
spaces may be slightly larger.
• In the anterior mandible the
trabeculae are somewhat
thicker than in the maxilla,
resulting in trabecular plates
are oriented more
horizontally
• In the posterior mandible
the periradicular trabeculae
and marrow spaces may be
comparable to those in the
anterior mandible but are
usually somewhat larger.
 Some terms of dental radiographs
Prominences of Bone : dense cortical bone and appear radiopaque on dental images.
• Process: A marked prominence or projection of bone, the coronoid process of the mandible
• Ridge: A linear prominence or projection of bone, the external oblique ridge of the mandible.
• Spine: A sharp, thorn-like projection of bone, the anterior nasal spine.
• Tuberosity: A rounded prominence of bone, the maxillary tuberosity
• Spaces and Depressions in Bone
Spaces and depressions: don't resist the passage of the x-ray beam and appear radiolucent.
• Canal: A tube like passageway in bone, the mandibular canal
• Foramen: An opening or hole in bone, the mental foramen of the mandible.
• Fossa: A broad, shallow, scooped-out or depressed area of bone, the submandibular fossa of
the mandible.
• Sinus: A hollow space, cavity, or recess in bone, the maxillary sinus
 Landmarks in radiographs of maxilla
• Median suture: On an anterior maxillary PA image, radiolucent line
between central incisors
• Incisive or anterior palatine foramen: On an anterior maxillary PA
image appears as a small, ovoid or round radiolucent area located
between the roots of the maxillary central incisors. .
Lateral fossa.(canine fossa) Bony
depression in the labial cortical
plate of maxillary lateral incisor
area appears as a radiolucent
area between the maxillary canine
and lateral incisor
Zygomatic (malar) process of
maxilla and zygomatic bone: On a
posterior max. PA image, the
zygomatic process of the maxilla
appears as a J-shaped or U-
shaped radiopacity located
superior to the maxillary rst molar
region.
• Nasal cavity: On an ant. max.
PA image, it appears as a
large, radiolucent area
superior to the maxillary
incisors .
• Nasal septum On an ant.
max. PA image, It appears as
a vertical radiopaque
partition that divides the
nasal cavity.
• Anterior nasal spine: appears as
a V-shaped radiopaque area
located at the intersection of
the floor of the nasal cavity and
the nasal septum.
• Maxillary sinus: On a posterior
max. PA image, It appears as a
radiolucent area located
superior to the apices of max.
premolars and molars.
• Septa Within Maxillary Sinus:
On a posterior max. PA image,
the septa appear as
radiopaque lines within the
maxillary sinus.
Inverted Y
The term inverted Y refers to
the intersection of the
maxillary sinus and the nasal
cavity as viewed on a dental
image.
On a max. canine PA image,
the inverted Y appears as a
radiopaque upside-down Y
formed by the intersection of
the lateral wall of the nasal
fossa and the anterior border
of the maxillary sinus.
• Maxillary tuberosity: is a rounded prominence of bone that extends
posterior to the third molar region . On a posterior max. PA image, It
appears as a radiopaque bulge distal to the third molar region.
 Landmarks in radiographs of the
mandible
• Genial Tubercles: they are tiny bumps of bone that serve as attachment sites
for the genioglossus and geniohyoid muscles. On a mandibular PA
image,they appear as a ring-shaped radiopacity inferior to the apices of the
mandibular incisors.
• Mental fossae: is a depressed area of bone on the external surface of the
anterior mandible, on a mand. PA, It appears as a radiolucent area above
the mental ridge
• Mental ridge: linear prominence of cortical bone on the external surface
of the anterior portion of the mandible. on a mand. PA, It appears as a
thick radiopaque band that extends from the premolar region to the
incisor region
Lingual foramen: tiny opening in bone
on the internal surface of the mandible
near the midline. On a mand. PA
image, It appears as a small,
radiolucent dot located inferior to the
apices of the mandibular incisors.
Mental foramen: is an opening in
bone on the external surface of the
mandible in the region of the mand.
premolars. . On a mand. PA, It
appears as a small, ovoid or round
radiolucent area located in the apical
region of the premolars
• Mandibular canal extends from the mandibular foramen to the
mental foramen. On a mandibular periapical image, It appears as a
radiolucent band. Two thin radiopaque lines represent the cortical
walls of the canal outline the canal. It appears below or
superimposed over the apices of the mandibular molar teeth.
External oblique line: is a linear prominence of bone located on the external
surface of the body of the mandible. appears as a radiopaque band extending
downward and forward from the anterior border of the ramus of the mandible.
Internal oblique line (Mylohyoid Ridge) linear prominence of bone on the
internal surface of the mandible and extends from the third molar region down
and forward to the 2nd premolar area. It appears as a dense radiopaque band
Submaxillary (Submandibular) fossa:
depressed area of bone on the internal surface of the mandible inferior to the
mylohyoid ridge. On a mand. PA image, It appears as a radiolucent area in the
molar region below the mylohyoid ridge.
• Coronoid Process: It is not seen on a mand. PA image but on a
max. molar PA image. It appears as a triangular radiopacity
superimposed over, or inferior to, the maxillary tuberosity
region.
 Radiographic appearance of restorative
materials
Radiopaque restorative materials:
Gold, Silver amalgam, Zinc oxide – eugenol, Zinc phosphate cement,
Gutta – percha, Silver points, Metal bands & crowns, & Metal wires.

Radiolucent restorative materials:

Acrylic, Silicates, Calcium hydroxide pastes, & Porcelain.
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