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
a
b a = nasal septum
c b = inferior concha
c = nasal fossa
d d = anterior nasal spine
e e = incisive foramen
f = median palatal suture
g = soft tissue of nose
f

g
 facial view palatal view

c f
b
a e
d

a = nasal septum e = incisive foramen

b = inferior concha f = median palatal
c = nasal fossa suture
d = anterior nasal spine
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
a
b b
d
e

Red arrow points to Red arrows = lip line

periapical lesion
(post-endo).
 d

Blue arrow = chronic

Red arrow = mesiodens
periapical periodontitis.
(supernumerary tooth)
Tooth # 9 is non-vital
(trauma) and needs endo.
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.
b a

f
d

All the incisors are non-vital

The red arrows point to an
and have periapical lesions. The
incisive canal cyst; the
purple arrows point to external
orange arrow identifies
resorption; the blue arrow
the root of tooth # 7.
identifies internal resorption.
The red arrows point to the soft tissue of the nose.
The green arrows identify the lip line.
Maxillary Cuspid
a

b a = floor of nasal fossa

b = maxillary sinus
c
c = lateral fossa
d = nose

d
 facial view

a a

c 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 The white arrows indicate the
surrounds the root of the floor of the nasal fossa. The
canine, which may be maxillary sinus (red arrows)
misinterpreted as has pneumatized between the
pathology. 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

a b c
a = malar process

b = sinus septum

c = sinus recess

d = maxillary sinus

d
 facial view

b b
d
a c a c d

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 The red arrows point to
radiopacity which is a the nasolabial fold. The
mucous retention cyst. thicker cheek tissue
Note relatively recent makes the area more
premolar extraction sites. radiopaque posterior to
Green arrow points to the line.
neurovascular canal.
Pneumatization. Expansion of sinus wall into
surrounding bone, usually in areas where
teeth have been lost prematurely. Increases
with age.
 Maxillary Molar

a = maxillary tuberosity e f
b = coronoid process

c = hamular process d
d = pterygoid plates c
e = zygoma b
f = maxillary sinus
a
 facial view
e e
g g

d
d
c f
c a f
a
b
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). Note the
supernumerary molar.
 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 U-
shaped 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

a. lingual foramen
b. genial tubercles
c. mental ridge
d. mental fossa

a b c
 lingual view facial view

d c

a
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

a = mental ridge
c b = genial tubercles/
lingual foramen
c = mental foramen

b
a
 facial view lingual view

db22
b
d
a
d
c
b1
d

a = mental ridge b1 = genial tubercles

c = mental foramen 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
above).
 facial view

The red arrows identify the mandibular canal

and the blue arrow points to the mental
foramen.
Mandibular Premolar

a = mylohyoid ridge
b = mandibular canal
c = submandibular gland fossa
d = mental foramen
 facial view lingual view

b a
d

b = mandibular canal a = mylohyoid ridge

d = mental foramen (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 canal. (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.
 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 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

a = external oblique ridge

b = mylohyoid ridge
c = mandibular canal
d = submandibular gland fossa
 facial view lingual view

a
b

c d

a = external oblique ridge b = mylohyoid ridge

c = mandibular canal d = submandibular gland
fossa
 b a

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. The
answers are on the last slide.
 Slide # 1

A. The red arrows identify the ?

 Slide # 2

A. The red arrow points to the ?

B. The white arrows identify the ?
C. The blue arrow points to the ?
D. The yellow arrow identifies the ?
 Slide # 3

A. The small radioluceny identified by

the green arrow is the ?
 Slide # 4

A. The radiopacity identified by the

blue arrows is the ?
B. The orange arrow identifies the ?
 Slide # 5

A. The yellow arrows point to the ?

B. The red arrows identify the ?
 Slide # 6

A. The red arrow points to the ?

B. The orange arrow points to the ?
C. The blue arrows point to the
radiolucent line known as the ?
 Slide # 7

A. The red arrows point to the ?

 Slide # 8

A. The red arrows identify the ?

B. What is the name of the radiolucent
area surrounding the canal?
 KEY
Slide # 1: A. Floor of the nasal fossa
Slide # 2: A. Coronoid process
B. Maxillary sinus (pneumatized
into maxillary tuberosity)
C. Sinus septum
D. Zygomatic process
Slide # 3: A. Lingual foramen
Slide # 4: A. Mylohyoid ridge
B. Submandibular gland fossa
Slide # 5: A. Zygomatic process
B. Maxillary sinus
Slide # 6: A. Inferior concha
B. Nasal septum
C. Median palatal suture
Slide # 7: A. Mental ridge
Slide # 8: A. Mandibular canal
B. Submandibular gland fossa