The document discusses dental radiographic anatomy and interpretation. It begins by outlining the basic principles of radiographic interpretation, including localization, observation, general considerations, interpretation, and correlation. It then describes in detail how to analyze teeth and bone on a radiograph, noting changes in density, margins, internal structure, and effects on surrounding tissues. The document concludes by listing common anatomical landmarks seen on dental radiographs, such as the median palatine suture, nasal fossa, and maxillary sinus.
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3 radio. anatomy.&interpert i
1. 05/19/1605/19/16 OelshallOelshall 11
Dental RadiographicDental Radiographic anatomy
& interpretation
Part I
Dr. Ossama EL-Shall
Professor & Chairman, Faculty of DentalProfessor & Chairman, Faculty of Dental
Medicine for girls, Al-Azhar University,Medicine for girls, Al-Azhar University,
Cairo Egypt.Cairo Egypt.
E.mail address: oelshall@hotmail.comE.mail address: oelshall@hotmail.com
3. 05/19/1605/19/16 OelshallOelshall 33
Dental radiographic interpretationDental radiographic interpretation
Radiographic interpretation, is a
reading of a radiograph and
commenting on it to draw a diagnosis
Reading a radiograph includes
recording any deviation from the
normal appearance.
4. 05/19/1605/19/16 OelshallOelshall 44
Rules of radiographic interpretationRules of radiographic interpretation
1-1- The area to be examined must be completelyThe area to be examined must be completely
shown at optimal angulationsshown at optimal angulations
2-2- All the boundaries of the area of interest must beAll the boundaries of the area of interest must be
shown with normal structures around it.shown with normal structures around it.
3-3- Knowing and familiarity with all normalKnowing and familiarity with all normal
anatomical landmarks as well as all variousanatomical landmarks as well as all various
pathological conditions that may affect the area ofpathological conditions that may affect the area of
interest.interest.
5. 05/19/1605/19/16 OelshallOelshall 55
Principles of radiographicPrinciples of radiographic
interpretationinterpretation
Interpretation of a radiograph is not aInterpretation of a radiograph is not a
diagnosis by itself, but it is an diagnostic aiddiagnosis by itself, but it is an diagnostic aid
or mean help to reach a final diagnosis.or mean help to reach a final diagnosis.
Final diagnosis can be reached byFinal diagnosis can be reached by
performing a full case history, clinicalperforming a full case history, clinical
examination, special investigations andexamination, special investigations and
differential diagnosis.differential diagnosis.
6. 05/19/1605/19/16 OelshallOelshall 66
Methods of interpretationMethods of interpretation
LLocalization.ocalization.
OObservation.bservation.
GGeneral consideration.eneral consideration.
IInterpretation.nterpretation.
CCorrelation.orrelation.
7. 05/19/1605/19/16 OelshallOelshall 77
LocalizationLocalization
It is the identification and recognitionIt is the identification and recognition
of the area which the view shows, forof the area which the view shows, for
example: Upper anterior area, TMJexample: Upper anterior area, TMJ
area, Lower molar area………………..area, Lower molar area………………..
8. 05/19/1605/19/16 OelshallOelshall 88
ObservationObservation
All shadows, other than the localizedAll shadows, other than the localized
shadows of the normal landmarks must beshadows of the normal landmarks must be
observed.observed.
For example: shadows in crowns, cervicalFor example: shadows in crowns, cervical
area, roots, restorations, size of rootarea, roots, restorations, size of root
canals, periodontal membrane space,canals, periodontal membrane space,
periapical area, alveolar crest, foreignperiapical area, alveolar crest, foreign
bodies, integrity of bone …………bodies, integrity of bone …………
9. 05/19/1605/19/16 OelshallOelshall 99
General considerationGeneral consideration
A radiograph shows only 2 dimensions of a 3A radiograph shows only 2 dimensions of a 3
dimensional object (width and height but notdimensional object (width and height but not
the depth)the depth)
Cervical burnout: usually appears as cervicalCervical burnout: usually appears as cervical
RL and misinterpreted by caries; this occursRL and misinterpreted by caries; this occurs
due to less density and more penetration ofdue to less density and more penetration of
rays.rays.
Pulp exposure never to be determined fromPulp exposure never to be determined from
radiograph but only the proximity to the pulp.radiograph but only the proximity to the pulp.
10. 05/19/1605/19/16 OelshallOelshall 1010
InterpretationInterpretation
Studying the features ofStudying the features of teethteeth andand bonebone
TeethTeeth
Study the whole tooth, (crown, rootStudy the whole tooth, (crown, root
enamel, pulp….), number of teeth andenamel, pulp….), number of teeth and
finally supporting structures,finally supporting structures,
(Periodontal membrane space, lamina(Periodontal membrane space, lamina
dura, alveolar crest)dura, alveolar crest)
11. 05/19/1605/19/16 OelshallOelshall 1111
BoneBone
Changes in bone may include:Changes in bone may include:
1- Changes in density.1- Changes in density.
2- Changes in the margin2- Changes in the margin
3- Changes inside the lesion.3- Changes inside the lesion.
4- Effect on surrounding tissues.4- Effect on surrounding tissues.
5- Changes in structure5- Changes in structure
12. 05/19/1605/19/16 OelshallOelshall 1212
1- Changes in density.1- Changes in density.
Three bone density pattern may found:Three bone density pattern may found:
1-decrease in density resulting in RL1-decrease in density resulting in RL
2-Increase in density resulting in RO2-Increase in density resulting in RO
3- Combination of above.3- Combination of above.
13. 05/19/1605/19/16 OelshallOelshall 1313
2-Changes in the lesion margin2-Changes in the lesion margin
1- Well-defined margin with or without1- Well-defined margin with or without
sclerotic border denoting a slowlysclerotic border denoting a slowly
growing or chronic condition such asgrowing or chronic condition such as
cyst and granuloma.cyst and granuloma.
2- ill-defined margin, denoting acute2- ill-defined margin, denoting acute
active condition destroying bone in allactive condition destroying bone in all
directions, such as abscess, ordirections, such as abscess, or
malignancy.malignancy.
14. 05/19/1605/19/16 OelshallOelshall 1414
3- Changes inside the lesion.3- Changes inside the lesion.
1- Unilocular.1- Unilocular.
2-Multilocular.2-Multilocular.
3-Multiple and separate.3-Multiple and separate.
16. 05/19/1605/19/16 OelshallOelshall 1616
4-Effects on surrounding tissues.4-Effects on surrounding tissues.
1-May cause expansion, resorption,1-May cause expansion, resorption,
destruction or thinning of bone.destruction or thinning of bone.
2-Compressed adjacent tissues as max.2-Compressed adjacent tissues as max.
sinus or nasal cavitysinus or nasal cavity
3-Displacement of teeth, divergence or3-Displacement of teeth, divergence or
resorption.resorption.
4-Affection of lamina dura.4-Affection of lamina dura.
17. 05/19/1605/19/16 OelshallOelshall 1717
5- Changes in structure5- Changes in structure
1-Ground glass appearance; fine granules1-Ground glass appearance; fine granules
of bony trabeculation.of bony trabeculation.
2-Cotton wool appearance; irregular ill-2-Cotton wool appearance; irregular ill-
defined RO areas within area of moredefined RO areas within area of more
RLRL
3-Honeycomb; multilocular lesion with3-Honeycomb; multilocular lesion with
small compartments.small compartments.
4-Granular appearance: homogenous due4-Granular appearance: homogenous due
to loss of contrast between RL & ROto loss of contrast between RL & RO
18. 05/19/1605/19/16 OelshallOelshall 1818
CorrelationCorrelation
The final step is to correlate all ofThe final step is to correlate all of
the radiographic features to reach athe radiographic features to reach a
radiographic differential diagnosis.radiographic differential diagnosis.
Then to draw a final diagnosis, weThen to draw a final diagnosis, we
have to correlate other data as casehave to correlate other data as case
history, clinical examination, andhistory, clinical examination, and
other diagnostic aids with theother diagnostic aids with the
radiographic differential diagnosis.radiographic differential diagnosis.
25. 05/19/1605/19/16 OelshallOelshall 2525
Median palatine suture
Appears as a vertically
oriented radiolucent line
in true image projections
through the midline.
Usually prominent
between the two central
incisor roots at young
individuals.
28. 05/19/1605/19/16 OelshallOelshall 2828
Nasal septum: (17)Appear as a
radio-opaque line separates
the two nasal fossa in the
midline.
Anterior nasal spine(16)
Appears as a v-shaped
radio-opaque structure in
the midline above the
incisive foramen.
Incisive foramen:(12) or the
anterior palatine fossa, it
usually appears as a
prominent radiolucent area
above/or between the roots
of two central incisors. It
usually appears as a
rounded or oval in shape not
exceeds 6mm in diameter.
30. 05/19/1605/19/16 OelshallOelshall 3030
e
f
a = nasal septum
b = inferior choncha
c = nasal fossa
d = anterior nasal spine
e = incisive foramen
f = median palatal
suture
a
d
c
facial view palatal view
b
36. 05/19/1605/19/16 OelshallOelshall 3636
Floor of nasal fossa (red arrows) and anterior border
of maxillary sinus (blue arrows), forming the inverted
(upside down) Y.Y
facial view
37. 05/19/1605/19/16 OelshallOelshall 3737
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 2nd
premolar and
first molar
40. 05/19/1605/19/16 OelshallOelshall 4040
5-Maxillary sinus:5-Maxillary sinus:
The maxillary sinus withThe maxillary sinus with
its thin bony walls, itsits thin bony walls, its
thin mucosa, and its vastthin mucosa, and its vast
air space, produce anair space, produce an
extremely dark imageextremely dark image
(10)(10) deep to the maxillarydeep to the maxillary
teeth.teeth.
Its outlines, particularly itsIts outlines, particularly its
floor, are clearlyfloor, are clearly
delineated by delicatedelineated by delicate
radiopaque linesradiopaque lines (11).(11).
41. 05/19/1605/19/16 OelshallOelshall 4141
1-Body of zygoma1-Body of zygoma
6-Apices of roots6-Apices of roots
7-floor of the sinus7-floor of the sinus
8-Septum of the sinus8-Septum of the sinus
Notice the well-demarcated RL area related to 5 toothNotice the well-demarcated RL area related to 5 tooth
42. 05/19/1605/19/16 OelshallOelshall 4242
In general the floor of theIn general the floor of the
sinus is approximatelysinus is approximately
coincidental with thecoincidental with the
location of the apices oflocation of the apices of
the roots of the upperthe roots of the upper
teeth,(bicuspids and firstteeth,(bicuspids and first
two molars).two molars).
But there is often as muchBut there is often as much
as 2 or even 3 millimetersas 2 or even 3 millimeters
of maxillary boneof maxillary bone
between the root ends andbetween the root ends and
sinus floor.sinus floor.
43. 05/19/1605/19/16 OelshallOelshall 4343
In other cases the sinus floor dips so deeplyIn other cases the sinus floor dips so deeply
between the roots of the maxillary teeth thatbetween the roots of the maxillary teeth that
the latter appear to project into it for as muchthe latter appear to project into it for as much
as one half of their length.as one half of their length.
45. 05/19/1605/19/16 OelshallOelshall 4545
Malar bone:
Or the zygomatic process.
The inferior portion of the
malar bone appears as a
Radiopaque u-shaped
structure related to the
roots of the first maxillary
molar.
It represents the attachment
of the zygomatic bone to the
maxilla.
46. 05/19/1605/19/16 OelshallOelshall 4646
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
49. 05/19/1605/19/16 OelshallOelshall 4949
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
facial view
d
b
a
e
c f
g
50. 05/19/1605/19/16 OelshallOelshall 5050
Maxillary Tuberosity:
Appears as a Radiopaque structure that
extends distally and upward from
posterior to maxillary sinus. It represents
the end of maxilla.
52. 05/19/1605/19/16 OelshallOelshall 5252
Coronoid process of the mandible:
Appears as a triangular Radiopaque
structure projected into the same general
area of maxillary Periapical film projections
distally to the maxillary teeth.
53. 05/19/1605/19/16 OelshallOelshall 5353
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
54. 05/19/1605/19/16 OelshallOelshall 5454
Hamular process:
It is a bony spine (5) projecting from the
pterygoid process of the sphenoid bone. It
appears as a Radiopaque spine that recorded
on radiographs distal to the tuberosity of the
maxilla and extends downward.
55. 05/19/1605/19/16 OelshallOelshall 5555
Hamular process (blue 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
56. 05/19/1605/19/16 OelshallOelshall 5656
The zygomatic process (green arrows) is a prominent
U-shaped rationality. 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.
60. 05/19/1605/19/16 OelshallOelshall 6060
Lingual foramen:
It set in the midline
deep to the root apices
of the anterior teeth.
It appears as a small
radiolucent dot at the
symphysis area. It
usually surrounded with
a Radiopaque structure.
62. 05/19/1605/19/16 OelshallOelshall 6262
Genial Tubercles: Or the
superior and inferior mental
spines.
They are four in number located
toward the inferiolingual
border of the mandible and are
mostly 2 on each side of the
midline, although in some
instances they coalesce as a
single radiopaque outcrop of
the mandible.
They appear as a radiopaque
circle that surrounds the
lingual foramen, just below the
apices of the incisors.
Anatomically genyoglossal muscle
attached to the superior two
while the genyohyoid muscle
attached to the inferior two.
63. 05/19/1605/19/16 OelshallOelshall 6363
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
64. 05/19/1605/19/16 OelshallOelshall 6464
Mental ridge:Mental ridge: It is a bony prominence found on the labialIt is a bony prominence found on the labial
aspect of the mandible near its inferior border and extendedaspect of the mandible near its inferior border and extended
from the premolar region to the symphysis area on which itfrom the premolar region to the symphysis area on which it
takes an upward turn as it approach it. It appears as atakes an upward turn as it approach it. It appears as a
radiopaque line below the apices of anterior teeth.radiopaque line below the apices of anterior teeth.
66. 05/19/1605/19/16 OelshallOelshall 6666
Mental Fossa (6):Mental Fossa (6):
It is a slight depressionIt is a slight depression
in the bone one thein the bone one the
labial aspect of thelabial aspect of the
mandible. It appearsmandible. It appears
as a faint radiolucentas a faint radiolucent
structure related tostructure related to
anterior area.anterior area. Notice: 7 is cervical burnout
68. 05/19/1605/19/16 OelshallOelshall 6868
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
70. 05/19/1605/19/16 OelshallOelshall 7070
Mental foramen(3)Mental foramen(3)
It appearsIt appears
as a radiolucent ill-as a radiolucent ill-
defined area betweendefined area between
the apices of thethe apices of the
bicuspids. Itbicuspids. It
represent the anteriorrepresent the anterior
terminates of theterminates of the
mandibular canal.mandibular canal.
71. 05/19/1605/19/16 OelshallOelshall 7171
c
b = mandibular canal
d = mental foramen
a = mylohyoid ridge
(internal oblique)
c = submandibular gland
fossa
facial view lingual view
c
a
dd b
72. 05/19/1605/19/16 OelshallOelshall 7272
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
75. 05/19/1605/19/16 OelshallOelshall 7575
External oblique line:(6)
It is a Radiopaque line
extending from anterior
border of the ramus of
the mandible and
descends to the third
molar area.
7-Internal oblique line,
7-Mylohyoid line,
9-Mandibular canal,
76. 05/19/1605/19/16 OelshallOelshall 7676
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 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
77. 05/19/1605/19/16 OelshallOelshall 7777
Internal oblique line(6):
It appears as a Radiopaque
line descends downward
and forward from
Coronoid process; in a
more horizontal position;
stop at the third molar area
or become continuous with
the Mylohyoid line. Its
place below the external
oblique line.
78. 05/19/1605/19/16 OelshallOelshall 7878
Mylohyoid line or ridge(7)
It is a Radiopaque line
below the external oblique
line and it is the anterior
continuity of the internal
oblique line.
It extend downward and
forward from the ramus
of the mandible to the
bicuspid areas.
79. 05/19/1605/19/16 OelshallOelshall 7979
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
80. 05/19/1605/19/16 OelshallOelshall 8080
Inferior dental canal; (9,2),
Mandibular canal, or
inferior alveolar canal.
Its characteristic image is
therefore likely to be a
radiolucent passage along
the mandible just deep to
the roots of the teeth,
terminating at the mental
foramen and bounded by
Radiopaque margins
representing the walls of
thin cortical bone bounding
the canal.
81. 05/19/1605/19/16 OelshallOelshall 8181
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.
82. 05/19/1605/19/16 OelshallOelshall 8282
Submandibular gland
fossa(4):
It is a depression on
the lingual aspect of the
mandible on which
submandibular glands
are present.
It appears as a zone of
radiolucency below the
lower molars.
83. 05/19/1605/19/16 OelshallOelshall 8383
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 area being very radiolucent. The fact
that it occurs bilaterally helps to differentiate it
from pathology.
85. 05/19/1605/19/16 OelshallOelshall 8585
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.
86. 05/19/1605/19/16 OelshallOelshall 8686
The mandibular canal (red arrows identify inferior border
of canal) usually runs very close to the roots of the
molars. Note the extreme dilaceration of the roots of
the third molar (green arrow).
The film at right shows “kissing” impactions located at
the superior border of the canal.
91. 05/19/1605/19/16 OelshallOelshall 9191
Median palatine sutureMedian palatine suture
A Median palatine suture:
-Can misinterpreted for a
fracture line
-To differentiate between them:
-Suture is regular and is
surrounded by 2 radio- opaque
lines
-While Fracture line is irregular
and is just a radiolucent line
without definite borders.
93. 05/19/1605/19/16 OelshallOelshall 9393
Incisive foramen & Mental foramenIncisive foramen & Mental foramen
Both can be misinterpreted for a periapicalBoth can be misinterpreted for a periapical
granuloma or any other periapical pathosis.granuloma or any other periapical pathosis.
94. 05/19/1605/19/16 OelshallOelshall 9494
To differentiate
1- Check the continuity of
lamina dura.
2- Shift technique.
3- Vitality test.
4- Concerning mental
foramen, check the
evidence of continuity
with alveolar canal.
96. 05/19/1605/19/16 OelshallOelshall 9696
Maxillary sinusMaxillary sinus
Can be misinterpreted for a cystCan be misinterpreted for a cyst
To differentiate:To differentiate:
Check the normal radiographic appearanceCheck the normal radiographic appearance
of the sinus with its septae.of the sinus with its septae.
Take a radiograph of the other sinus toTake a radiograph of the other sinus to
compare.compare.
The radiolucency of the sinus (air filled) isThe radiolucency of the sinus (air filled) is
more than that of cyst (fluid filled)more than that of cyst (fluid filled)
Vitality test.Vitality test.
98. 05/19/1605/19/16 OelshallOelshall 9898
The Coronoid processThe Coronoid process
When it superimposed on the maxillaryWhen it superimposed on the maxillary
tubrosity, it can misinterpreted as impactedtubrosity, it can misinterpreted as impacted
tooth.tooth.
To differentiate: shifting tech.To differentiate: shifting tech.
99. 05/19/1605/19/16 OelshallOelshall 9999
Which is a depression on the labial aspectWhich is a depression on the labial aspect
of the mandible above the mentalof the mandible above the mental
protuberance.protuberance.
It can misinterpreted for a PeriapicalIt can misinterpreted for a Periapical
lesion affecting lower incisors.lesion affecting lower incisors.
It can differentiate by shifting tech. orIt can differentiate by shifting tech. or
vitality test.vitality test.
The mental fossaThe mental fossa
