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Intraoral Radiographic Anatomy

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Intraoral Radiographic Anatomy

The following slides identify the anatomical
structures that may be seen on intraoral films.
These structures are more likely to be seen
when using the bisecting angle technique
because of the increased vertical angulation
(increased positive in the maxilla and
increased negative in the mandible) commonly
used with this technique. Since some of the
structures may be confused with pathology, it
is important to understand their normal
appearance in order to make a proper
diagnosis.

Maxillary Incisor
Nasal septum
Inferior concha
Nasal fossa
Nasal spine
Incisive foramen
Nose
Median palatine suture

facial view

b
a

palatal view

f
e

a = nasal septum
b = inferior concha
c = nasal fossa
d = anterior nasal spine

e = incisive foramen
f = median palatal
suture

facial view

Nasal septum

facial view

Inferior concha

facial view

Nasal fossa

facial view

Anterior nasal spine

palatal view

Incisive foramen

palatal view

Median palatal suture

Soft tissue of the nose

a: nasal septum; b: inferior concha; d: anterior nasal spine;

e: incisive foramen

a
a

Red arrow points to periapical

lesion (post-endo).

Red arrows = lip line

d: anterior nasal spine; f: median palatal suture

Blue arrow = chronic periapical

periodontitis. Tooth # 9 is nonvital (trauma) and needs endo.

Red arrow = mesiodens

(supernumerary tooth);

Superior foramina of the nasopalatine canals (red

arrows). These foramina lie in the floor of the nasal
fossa. The nasopalatine canals travel downward to join
in the incisive foramen.

a: nasal septum; b: inferior concha; d: anterior nasal spine;

f: median palatal suture

The red arrows point to an

incisive canal cyst; the
orange arrow identifies
the root of tooth # 7.

All the incisors are non-vital and

have periapical lesions. The
purple arrows point to external
resorption; the blue arrow
identifies internal resorption.

The red arrows point to the soft tissue of the nose.

The green arrows identify the lip line.

Maxillary Canine
Floor of nasal fossa
Maxillary sinus
Lateral fossa
Nose

facial view

c
b
b

a = floor of nasal fossa

b = maxillary sinus
c = lateral fossa
(a & b form inverted Y)

facial view

Floor of nasal fossa (red arrows) and anterior border

of maxillary sinus (blue arrows), forming the inverted
(upside down) Y.

facial view

Lateral fossa. The radiolucency results from a

depression above and posterior to the lateral incisor.
To help rule out pathology, look for an intact lamina
dura surrounding the adjacent teeth.

Soft tissue of the nose

Red arrows point to nasolabial fold.
Also note the inverted Y.

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

The red arrow identifies the lateral fossa. The pink

arrow points to CPP (chronic periapical periodontitis =
abscess, granuloma, etc.).

Maxillary Premolar
Sinus recess

Sinus septum

Zygomatic
process

Maxillary sinus

facial view

b
a c

b
c
a

a = malar process
b = sinus recess
c = sinus septum
d = maxillary sinus

facial view

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

Sinus septum. This septum is composed of folds of

cortical bone that arise from the floor and walls of the
maxillary sinus, extending several millimeters into the
sinus. In rare cases, the septum completely divides the
sinus into separate compartments.

facial view

Sinus recess. Increased area of radiolucency caused

by outpocketing (localized expansion) of sinus wall. If
superimposed over roots, may mimic pathology.

facial view

Maxillary Sinus. An air-filled cavity lined with

mucous membrane. Communicates with nasal cavity
through 3-6 mm opening below middle concha. Red
arrows point to neurovascular canal containing
superior alveolar vessels and nerves.

Blue arrows identify

radiopacity which is a
mucous retention cyst.
Note relatively recent
premolar extraction sites.
Green arrow points to
neurovascular canal.

The red arrows point to

the nasolabial fold. The
thicker cheek tissue
makes the area more
radiopaque posterior to
the line.

Pneumatization. Expansion of sinus wall into

surrounding bone, usually in areas where teeth
have been lost prematurely. Increases with age.

Maxillary Molar
Zygoma

Maxillary sinus

Sinus recess

Pterygoid plate

Hamular
process

Coronoid process

Maxillary tuberosity

facial view

e
g

d
f

c
a
b

d
c a
b

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

facial view

Maxillary Tuberosity. The rounded elevation

located at the posterior aspect of both sides of
the maxilla. Aids in the retention of dentures.

facial view

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).

facial view

Hamular process (white 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

Zygomatic (malar) bone/process/arch. The zygomatic

bone (white/black arrows) starts in the anterior
aspect with the zygomatic process (blue arrow),
which has a U-shape. The zygomatic bone extends
posteriorly into the zygomatic arch (green arrow).

facial view

Maxillary sinus. As seen in the above film, the floor of the

maxillary sinus flows around the roots of the maxillary molars
and premolars. The walls of the sinus may become very thin.
As a result, sinusitis may put pressure on the superior alveolar
nerves resulting in apparent tooth pain, even though the tooth
is perfectly healthy. Note coronoid process (green arrow),
zygomatic bone (blue arrow), sinus septum (yellow arrow) and
neurovascular canal (orange arrows).

The maxillary sinus is evident

anterior to the second molar
(black arrows) but it
disappears posteriorly due to
the superimposition of the
zygomatic bone. The orange
arrows identify a mucous
retention cyst (retention
pseudocyst) within the sinus.

This film shows the coronoid

process (green arrow) and a
distomolar (blue arrow) that
has erupted ahead of the
third molar (red arrow). A
distomolar is a
supernumerary tooth that
erupts distal (posterior) to
the other molars.

The zygomatic process (green arrows) is a prominent Ushaped radiopacity. 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.

This film shows the expansion of the borders of the

maxillary sinus through pneumatization (red arrows). This
expansion increases with age and it may be accelerated as
a result of chronic sinus infections. It is most commonly
seen when the first molar is extracted prematurely, as in
the film at right (the second and third molars have
migrated anteriorly to close the space). The coronoid
process is seen in the lower left-hand corner of each film.
The green arrow identifies a sinus recess. Note the two
distomolars in film at right (blue arrows).

Mandibular Incisor

Mental ridge

Genial tubercles

Mental fossa

Lingual foramen

lingual view

facial view

d
b

a = lingual foramen

c = mental ridge

b = genial tubercles

d = mental fossa

lingual view

Lingual foramen. Radiolucent hole in center of

genial tubercles. Lingual nutrient vessels pass
through this foramen.

lingual view

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).

facial view

Mental ridge. These represent the raised portions of the

mental protuberance on either side of the midline. More
commonly seen when using the bisecting angle
technique, when the x-ray beam is directed at an
upward angle through the ridges.

facial view

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.

The radiolucent area above

corresponds to the location
of the mental fossa. However,
this slide represents chronic
periapical periodontitis; these
teeth are non-vital, due to
trauma.

The orange arrows above

identify nutrient canals.
They are most often seen in
older persons with thin
bone, and in those with high
blood pressure or advanced
periodontitis.

Mandibular Canine

Mental ridge
Lingual foramen
Mental foramen

Genial tubercles
Cortical bone

facial view

lingual view

b
db22
d
a
d
c
a = mental ridge
c = mental foramen

d
b1
b1 = genial tubercles
b2 = lingual foramen

facial view

Mental ridge. The raised portions of the mental

protuberance, sloping downward and backward
from the midline.

lingual view

Lingual foramen/genial tubercles. (See

description under mandibular incisor).

facial view

The red arrows identify the mandibular canal;

the blue arrow points to the mental foramen;
the green arrows identify the cortical bone at
the lower border of the mandible.

Mandibular Premolar

Mylohyoid ridge

Submandibular
gland fossa
Mental foramen
Mandibular canal

facial view

lingual view

a
c

b = mandibular canal
d = mental foramen

a = mylohyoid ridge
(internal oblique)
c = submandibular gland
fossa

lingual view

Mylohyoid (internal oblique) ridge. This radiopaque

ridge is the attachment for the mylohyoid muscle. The
ridge runs downward and forward from the third molar
region to the area of the premolars.

facial view

Mandibular (inferior alveolar) canal. Runs downward

from the mandibular foramen to the mental foramen,
passing close to the roots of the molars. More easily
seen in the molar periapical. Contains the inferior
alveolar nerve and vessels.

lingual view

Submandibular gland fossa. The depression below the

mylohyoid ridge where the submandibular gland is
located. More obvious in the molar periapical film.

facial view

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.
The mental vessels and nerve pass through this
foramen.

The mental foramen (blue

arrow) is adjacent to a
periapical lesion associated
with tooth # 21 (red arrow).
There is slight external
resorption on # 21.

The green arrow points to the

mental foramen. The yellow
arrow identifies a periapical
lesion on # 30. Note the
overextension of the silver point
in the distal root, the perforation
of the mesial root and the
amalgam protruding through
the perforation from the pulp
chamber.

Mandibular Molar
External oblique
ridge
Mylohyoid ridge
(internal oblique)

Mandibular canal

Submandibular
gland fossa

facial view

lingual view

a
b
c
a = external oblique ridge
c = mandibular canal

d
b = mylohyoid ridge
d = submandibular gland
fossa

d
c
a = external oblique ridge
b = mylohyoid ridge
c = mandibular canal
d = submandibular gland fossa

facial view

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
distinct 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).

lingual view

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.

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.

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 trabecular
pattern of the bone is very sparse and results in the
area being very radiolucent. The fact that it occurs
bilaterally helps to differentiate it from pathology.

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.

The mandibular canal (red arrows identify inferior border

of canal) usually runs very close to the roots of the
molars, especially the third molar. This can be a problem
when extracting these teeth. Note the extreme dilaceration
(curving) of the roots of the third molar (green arrow) in
the film at left. The film at right shows kissing
impactions located at the superior border of the canal.

Identify the anatomical structures

on the following eight slides.

Slide # 1

A. The red arrows identify the ?

Floor of the nasal fossa

Slide # 2

A. The red arrow points to the ?

B. The white arrows identify the ?

Coronoid process
Maxillary sinus*

C. The blue arrow points to the ?

Sinus septum

D. The yellow arrow identifies the ? Zygomatic process

*(pneumatized into maxillary tuberosity)

Slide # 3

A. The small radioluceny identified by

the green arrow is the ?
Lingual foramen

Slide # 4

A. The radiopacity identified by the Mylohyoid ridge

blue arrows is the ?
B. The orange arrow identifies the ? Submandibular
gland fossa

Slide # 5

A. The yellow arrows point to the ? Zygomatic process

B. The red arrows identify the ?

Maxillary sinus

Slide # 6

A. The red arrow points to the ?

Inferior concha

B. The orange arrow points to the ? Nasal septum

C. The blue arrows point to the
radiolucent line known as the ?

Median palatal suture

Slide # 7

A. The red arrows point to the ?

Mental ridge

Slide # 8

A. The red arrows identify the ?

Mandibular canal

B. What is the name of the radiolucent Submandibular

gland fossa
area surrounding this structure?

This concludes the section on Intraoral

Radiographic Anatomy. If you have any
questions, you may e-mail me at
jaynes.1@osu.edu.