dental anatomy on radiographs.pdf

8/14/2019 dental Anatomy on Radiographs.pdf

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Anatomy on Radiographs: Intraoral RadiographsPart IPosted on by Dr. Shawneen Gonzalez

I am starting a new series of posts on anatomy on radiographs. There will be two posts on intraoral radiographs

(Part I anterior and Part II posterior), one on ol!sal radiographs, one on pantomographs and lastly one ons"!ll radiographs (primarily lateral ephalometri s"!ll radiographs).

Anatomical radiographic appearances

Foramina ro!nd to o#oid radiol!ent entities, may or may not ha#e a radiopa$!e%ortiated edge.

Canals radiol!ent line or band, may or may not ha#e radiopa$!e%ortiated edge(s).

&ow on to the anterior portion of intraoral radiographs.

Mandible

The mandible is a nie plae to start as there are fewer anatomial landmar"s identifiable in the anterior region(ompared to the ma'illa). There are fo!r anatomial landmar"s fre$!ently identifiable ling!al foramen,

n!trient anals, mental ridge, and inferior border of the mandible.
http://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/wp-content/uploads/2012/06/canals-appearance-diagram.jpghttp://drgstoothpix.com/wp-content/uploads/2012/06/foramina-radiographic-appearance-diagram.jpghttp://drgstoothpix.com/author/oralradiology/


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The lingual foramenappears as a small radiol!ent irle diretly inferior to the entral inisors. It is notalways #isible on e#ery patient.

Nutrient canals (vascular canals)are anals ontaining blood #essels o!rsing thro!gho!t the ma'illa andmandible. They are #ery small and more ommonly seen in areas of thin bone (hene the anterior mandible).

They appear as a radiol!ent line or band o!rsing in a #ertial diretion.
http://drgstoothpix.com/wp-content/uploads/2012/06/nutrient-canals-radiograph.jpghttp://drgstoothpix.com/wp-content/uploads/2012/06/lingual-foramen-radiograph.jpg


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The mental ridge (mental triangle)appears as two obli$!e thi" radiopa$!e bands that that meet in the midlinegi#ing it the appearane of an in#erted or triangle shape. This is more ommonly seen when an inreased

negati#e #ertial angleis !sed.
http://drgstoothpix.com/2011/08/31/radiographic-technique-vertical-angle/http://drgstoothpix.com/wp-content/uploads/2012/06/mental-triangle-radiograph.jpghttp://drgstoothpix.com/2011/08/31/radiographic-technique-vertical-angle/


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The inferior border of the mandibleappears as a thi" radiopa$!e band.

Maxilla

The ma'illa has $!ite a bit more anatomy e#ident inl!ding a good portion of the nasal a#ity.
http://drgstoothpix.com/wp-content/uploads/2012/06/inferior-border-mandible-radiograph-anterior.jpg


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The intermaxillary suture appears as a thin radiol!ent line between the two ma'illary entral inisors. It maynot be #isible on all patients.
http://drgstoothpix.com/wp-content/uploads/2012/06/incisive-foramen-radiograph.jpghttp://drgstoothpix.com/wp-content/uploads/2012/06/intermaxillary-suture-radiograph.jpg


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The incisive foramenappears as a ro!nd to o#oid radiol!ent area between the roots of the ma'illary entralinisors.

The anterior nasal spine appears as an in#erted radiopa$!e triangle or *shaped. It is on the midline ands!perior to the apies of the ma'illary entral inisors.
http://drgstoothpix.com/wp-content/uploads/2012/06/anterior-nasal-spine-radiograph.jpg


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The incisive fossaappears as a well*loalized radiol!ent area aro!nd the root of the ma'illary lateral inisor.This is d!e to a derease in bone thi"ness in this region.
http://drgstoothpix.com/wp-content/uploads/2012/06/lateral-incisor-fossa.jpg


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The soft tissue of the noseappears as a radiopa$!e area s!perimposed o#er the ma'illary anterior teeth. The tipof the nose is seen o#er the ma'illary entral inisors. The ala of the nose is seen o#er the lateral inisors.
http://drgstoothpix.com/wp-content/uploads/2012/06/floor-of-the-nasal-cavity-radiograph.jpghttp://drgstoothpix.com/wp-content/uploads/2012/06/soft-tissue-of-the-nose-radiograph.jpg


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The floor of the nasal cavity appears as a thin straight radiopa$!e line.

The nasal cavityappears as a radiol!ent area s!perior to the floor of the nasal a#ity.
http://drgstoothpix.com/wp-content/uploads/2012/06/nasal-septum-radiograph.jpghttp://drgstoothpix.com/wp-content/uploads/2012/06/nasal-cavity-radiograph.jpg


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The nasal septumappears as a radiopa$!e band going s!perior from the floor of the nasal a#ity. It is on themidline.

The inferior nasal conchaappears as a ro!nd to o#oid radiopa$!e mass s!perior to the floor of the nasal a#ity.
http://drgstoothpix.com/wp-content/uploads/2012/06/inferior-nasal-concha-radiograph.jpg


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The line of !nnis(inverted ) is not a tr!e anatomial landmar" b!t seen only on radiographs d!e tos!perimposition of the floor of the nasal a#ity (straight radiopa$!e line) and the border of the ma'illary sin!s

(!r#ed radiopa$!e line).

The border of the maxillary sinusappears as a !r#ed, thin radiopa$!e line s!perior to the roots of the anineand posterior teeth. The ma'illary sin!s appears as a radiol!ent area s!perior to the border of the ma'illary

sin!s.
http://drgstoothpix.com/wp-content/uploads/2012/06/y-line-of-ennis-radiographs.jpg


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Anatomy on Radiographs: Intraoral RadiographsPart "Posted on by Dr. Shawneen Gonzalez

This is part + (posterior) of anatomy on intraoral radiographs.

Mandible

The mental foramen appears as a ro!nd to o#al radiol!ent area near the ape' of the seond premolar.

The inferior alveolar nerve canal (mandibular canal)appears as radiol!ent band with two thin radiopa$!e

lines r!nning parallel to eah other (s!perior and inferior). If only one border it #isible, it is more li"ely theinferior border.
http://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/wp-content/uploads/2012/06/mandibular-canal.jpghttp://drgstoothpix.com/wp-content/uploads/2012/06/mental-foramen.jpghttp://drgstoothpix.com/author/oralradiology/


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The external obli#ue ridge (external obli#ue line)appears a thi" radiopa$!e line that r!ns obli$!ely as itdesends and s!perimposes o#er the roots of the molars.

The mylohyoid ridgeappears as a thi" radiopa$!e line fre$!ently seen near the roots%apies of the posteriorteeth.
http://drgstoothpix.com/wp-content/uploads/2012/06/mylohyoid-ridge.jpghttp://drgstoothpix.com/wp-content/uploads/2012/06/external-oblique-ridge-bitewing.jpghttp://drgstoothpix.com/wp-content/uploads/2012/06/external-oblique-ridge-periapical.jpg


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The submandibular salivary gland fossaappears as an area of more radiol!ent bone inferior to the mylohyoidridge.

The inferior border of the mandibleappears as a thi" radiopa$!e band.

The coronoid processis seen on ma'illary molar periapials. It appears as a triang!lar radiopa$!e areas!perimposed o#er the ma'illary molars and t!berosity.
http://drgstoothpix.com/wp-content/uploads/2012/06/coronoid-process.jpghttp://drgstoothpix.com/wp-content/uploads/2012/06/inferior-border-of-the-mandible-posterior.jpghttp://drgstoothpix.com/wp-content/uploads/2012/06/submandibular-salivary-gland-fossa.jpg


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Maxilla

The border of the maxillary sinusappears as a thin radiopa$!e line s!perior%s!perimposed o#er the roots of theposterior teeth. The ma'illary sin!s appears as a radiol!ent area s!perior to the border of the ma'illary sin!s.

The $ygomatic process of the maxillaappears as a , or - shaped radiopa$!e line. It is s!perior to the firstand seond molars.

The $ygomatic bone appears as a radiopa$!e area distal to the zygomati proess of the ma'illa.
http://drgstoothpix.com/wp-content/uploads/2012/06/zygomatic-bone.jpghttp://drgstoothpix.com/wp-content/uploads/2012/06/zygomatic-process-of-the-maxilla.jpghttp://drgstoothpix.com/wp-content/uploads/2012/06/border-of-maxillary-sinus.jpg


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The floor of the nasal cavity appears as a thin straight radiopa$!e line s!perimposed o#er the ma'illary sin!s.

I hope yo! find this seond post on intraoral anatomy informati#e. hile I didn/t o#er all the anatomy #isible,

these are the most ommonly seen entities. If yo! ha#e any $!estions, please let me "now.

Anatomy on Radiographs: Pantomographs Part %Posted on by Dr. Shawneen Gonzalez0&o 1omments 2

3", I am ba" and now onto pantomographs. Sine these images are larger and will ta"e !p m!h more spae I

ha#e deided to brea" them down into + parts. I also will ha#e se#eral anatomy identified on eah radiograph aswell. 4ere we go.

Mandible
http://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/07/13/anatomy-on-radiographs-pantomographs-part-1/#respondhttp://drgstoothpix.com/2012/07/13/anatomy-on-radiographs-pantomographs-part-1/#respondhttp://drgstoothpix.com/2012/07/13/anatomy-on-radiographs-pantomographs-part-1/#respondhttp://drgstoothpix.com/wp-content/uploads/2012/07/mandible-pantomograph-1.jpghttp://drgstoothpix.com/wp-content/uploads/2012/06/floor-of-nose-posterior.jpghttp://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/07/13/anatomy-on-radiographs-pantomographs-part-1/#respond


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5The mandib!lar condyle(two thin arrows pointing down) appears as a ro!nded radiopa$!e area in the glenoidfossa on the lateral aspet of the radiograph. 5new anatomy not #isible on intraoral radiographs.

Thecoronoid process(triangles) appears as a triang!lar radiopa$!e area s!perimposed o#er the ma'illaryt!berosity and posterior ma'illary sin!s.

Thelingual foramen(circle) appears as a small radiol!ent irle diretly inferior to the entral inisors.

Theinferior border of the mandible(multiple thick arrows pointing up) appears as a thi" radiopa$!e band.
http://drgstoothpix.com/wp-content/uploads/2012/07/mandible-pantomograph-2.jpghttp://drgstoothpix.com/wp-content/uploads/2012/07/mandible-pantomograph-1-original.jpg


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Themental foramen(circle) appears as a ro!nd to o#al radiol!ent area seen near the ape' of the seondpremolar.

The inferior alveolar nerve canal & mandibular canal (two !r#ed lines) appears as radiol!ent band with twothin radiopa$!e lines r!nning parallel to eah other (s!perior and inferior).

Maxilla
http://drgstoothpix.com/wp-content/uploads/2012/07/maxilla-pantomograph.jpghttp://drgstoothpix.com/wp-content/uploads/2012/07/mandible-pantomograph-2-original.jpg


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The line of !nnis% inverted (arrow) is not a tr!e anatomial landmar" b!t seen only on radiographs d!e tos!perimposition of the floor of the nasal a#ity (straight radiopa$!e line) and the border of the ma'illary sin!s(!r#ed radiopa$!e line)

The border of the maxillary sinus(curved line on right) appears as a !r#ed, thin radiopa$!e line s!perior tothe roots of the anine and posterior teeth. The maxillary sinusappears as a radiol!ent area s!perior andmedial to the border of the ma'illary sin!s.

The $ygomatic process of the maxilla(J shaped line on left) appears as a , or - shaped radiopa$!e line. It iss!perior to the first and seond molars.

Nasal region
http://drgstoothpix.com/wp-content/uploads/2012/07/nasal-region-pantomograph-1.jpghttp://drgstoothpix.com/wp-content/uploads/2012/07/maxilla-pantomograph.jpg


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The borders of nasal cavity(solid U shaped line) appears as radiopa$!e lines medial to the ma'illary sin!ses.

The soft tissue of the nose(dotted curved line) appears as a radiopa$!e area s!perimposed o#er the ma'illaryanterior teeth. This is more ommonly seen on patients who are edent!lo!s in the anterior ma'illa.
http://drgstoothpix.com/wp-content/uploads/2012/07/nasal-region-pantomograph-2.jpghttp://drgstoothpix.com/wp-content/uploads/2012/07/nasal-region-pantomograph-1-original.jpg


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The nasal septum(orange vertical block) appears as a radiopa$!e band going s!perior from the floor of thenasal a#ity. It is on the midline.

The inferior nasal concha(yellow horizontal mass) appears as a ro!nd to o#oid radiopa$!e mass s!perior to thefloor of the nasal a#ity.

The floor of the nasal cavity (dotted horizontal yellow line) appears as a thin straight radiopa$!e line.

Anatomy on Radiographs: Pantomographs Part "Posted on by Dr. Shawneen Gonzalez06 1omments 2

&ow onto other str!t!res #isible on a pantomograph.

Midface
http://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/07/19/anatomy-on-radiographs-pantomographs-part-2/#commentshttp://drgstoothpix.com/2012/07/19/anatomy-on-radiographs-pantomographs-part-2/#commentshttp://drgstoothpix.com/wp-content/uploads/2012/07/pantomograph-midface-1.jpghttp://drgstoothpix.com/wp-content/uploads/2012/07/nasal-region-pantomograph-2-original.jpghttp://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/07/19/anatomy-on-radiographs-pantomographs-part-2/#comments


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The orbital rim(green dots) appears as a thi" semi ir!lar radiopa$!e band s!perior to the ma'illary sin!ses.The pterygomaxillary fissure(blue area) appears as an in#erted teardrop shaped radiol!ent area with a thinradiopa$!e border. It is diretly lateral to the ma'illary sin!s.

The $ygomatic bone(yellow line)appears as a radiopa$!e area distal to the zygomati proess of the ma'illa. Itis s!perimposed o#er the distal aspet of the ma'illary sin!s and pterygoma'illary fis!re.
http://drgstoothpix.com/wp-content/uploads/2012/07/pantomograph-midface-2.jpghttp://drgstoothpix.com/wp-content/uploads/2012/07/pantomograph-midface-1-original.jpg


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The infraorbital canal(yellow arrows) appears a radiol!ent band with two thin radiopa$!e lines r!nningparallel to eah other as the borders of the anal. It is angled infero*medially and s!perimposed o#er the orbital

rim.

'ther
http://drgstoothpix.com/wp-content/uploads/2012/07/pantomograph-other-1.jpghttp://drgstoothpix.com/wp-content/uploads/2012/07/pantomograph-midface-2-original.jpg


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The ear lobe(double green curved lines) appears as a radiopa$!e area lateral to and%or s!perimposed o#er theram!s of the mandible.

The oropharynx(blue dotted line) appears as a radiol!ent band s!perimposed o#er the roots of the ma'illaryteeth diretly inferior to the floor of the nasal a#ity. This is only seen when the patient does not position theirtong!e to the roof of the mo!th d!ring the e'pos!re.

The soft palate(yellow line) appears as a radiopa$!e mass oming off the floor of the nasal a#ity. This is morereadily seen when the patient does not ha#e their tong!e on the roof of the mo!th d!ring e'pos!re.

Anatomy on Radiographs: !xtraoral Radiographs(ateral ephalometric *+ull)Posted on by Dr. Shawneen Gonzalez0+ 1omments 2

This wee" is e'traoral radiographs, speifially the lateral ephalometri s"!ll radiograph. This will be a short

and sweet post only going o#er basi anatomy. I am not o#ering most of the anatomial landmar"s !sed in

orthodontis, b!t if yo! wo!ld li"e a post on this, please let me "now and I an reate one.
http://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/07/26/anatomy-on-radiographs-extraoral-radiographs-lateral-cephalometric-skull/#commentshttp://drgstoothpix.com/2012/07/26/anatomy-on-radiographs-extraoral-radiographs-lateral-cephalometric-skull/#commentshttp://drgstoothpix.com/wp-content/uploads/2012/07/pantomograph-other-2-original.jpghttp://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/07/26/anatomy-on-radiographs-extraoral-radiographs-lateral-cephalometric-skull/#comments


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ateral ephalometric *+ull
http://drgstoothpix.com/wp-content/uploads/2012/07/lateral-cephalometric-1.jpg


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The right and left sides of the inferior border of the mandible(yellow arrows) are seen s!perimposed o#er eahother.

The right and left maxillary sinuses(green dots) appear as a radiol!ent area s!perior to the apies of thema'illary teeth.

The floor of the nasal cavity(blue line) appears as a horizontal radiopa$!e line at the apies of the ma'illaryteeth.
http://drgstoothpix.com/wp-content/uploads/2012/07/lateral-cephalometric-1-original.jpg


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http://drgstoothpix.com/wp-content/uploads/2012/07/lateral-cephalometric-2.jpg


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The hyoid(green arrow) appears a radiopa$!e entity inferior to the mandible near the angle.

The cervical spine(yellow arrow) is #isible at the lateral aspet of the image posterior to the mandible.

The sella turcica(blue U) appears as a radiopa$!e s!perior to the ondyle and posterior to the sphenoidsin!ses.

The frontal sinuses(orange area) appear as a radiol!ent area at the anterior portion of the s"!ll 7!st s!perior tothe orbits.

Anatomy on Radiographs: 'cclusal RadiographsPosted on by Dr. Shawneen Gonzalez0&o 1omments 2

This is the last post I ha#e planned for anatomy and it will be on ol!sal radiographs.

Mandible

Short and sweet here with only one anatomial landmar" readily #isible.
http://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/08/03/anatomy-on-radiographs-occlusal-radiographs/#respondhttp://drgstoothpix.com/2012/08/03/anatomy-on-radiographs-occlusal-radiographs/#respondhttp://drgstoothpix.com/2012/08/03/anatomy-on-radiographs-occlusal-radiographs/#respondhttp://drgstoothpix.com/wp-content/uploads/2012/07/lateral-cephalometric-1-original.jpghttp://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/08/03/anatomy-on-radiographs-occlusal-radiographs/#respond


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The genial tubercles (yellow arrow) appear as a small radiopa$!e mass(es) e'tending off the ling!al aspet ofthe mandible.
http://drgstoothpix.com/wp-content/uploads/2012/08/mandibular-occlusal-original.jpghttp://drgstoothpix.com/wp-content/uploads/2012/08/mandibular-occlusal.jpg


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Maxilla

The nasal septum(red dotted line) appears as a linear radiopa$!e band on the midline.

The superior foramina of the nasopalatine canal (blue circles) appear as ro!nd to o#oid radiol!ent areass!perior to the ma'illary entral inisor apies and lateral to the nasal sept!m.
http://drgstoothpix.com/wp-content/uploads/2012/08/maxillary-occlusal-1-original.jpghttp://drgstoothpix.com/wp-content/uploads/2012/08/maxillary-occlusal-1.jpg


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The nasolacrimal canal (yellow circles) appear as ro!nd to o#oid radiol!ent areas at the lateral aspet of thenasal a#ity near the le#el of the first molars.

The border of the maxillary sinus & maxillary sinus(green area) appears as a !r#ed radiol!ent area lateral tothe nasolarimal anal and nasal a#ity.
http://drgstoothpix.com/wp-content/uploads/2012/08/maxillary-occlusal-2.jpg


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The $ygomatic process of the maxilla (blue arrow) appears as a radiopa$!e mass e'tending lateral of the teethnear the le#el of the first molars.

The anterior nasal spine (yellow lines) appears as a radiopa$!e . It is on the midline and pro7eted near themidroot portion of the ma'illary entral inisors.

The soft tissue of the nose(green curved dotted line) appears as a radiopa$!e area s!perimposed o#er thema'illary entral inisors.

,o- -as that missed. (Impacted teeth)Posted on by Dr. Shawneen Gonzalez08 1omments 2

I reently had a re$!est to show some missed and%or misdiagnosed ases. I oddly eno!gh ame aross one ofthese ases shortly after that re$!est and deided to start with two ases of missed impated teeth.

ase %

This ase was shown to me of how yo! an miss things if yo! are not loo"ing aref!lly. There is an impated

mandib!lar anine near the inferior border of the mandible slightly to the patients/ left of the midline. I realizethis is not a great radiograph (the 7oys of sanning a print o!t of a digital image sorry) b!t yo! sho!ld note a

horizontal radiopa$!e entity with the rown and follile to the patients left (inferior to the first molar%seondpremolar region). It is #ery s!btle and hene it was missed for +9 years before it was notied.
http://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/08/08/how-was-that-missed-impacted-teeth/#commentshttp://drgstoothpix.com/2012/08/08/how-was-that-missed-impacted-teeth/#commentshttp://drgstoothpix.com/wp-content/uploads/2012/08/maxillary-occlusal-2-original.jpghttp://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/08/08/how-was-that-missed-impacted-teeth/#comments


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ase "

This ase was presented to me as a possible implant ase and trying to determine whether or not the patient

wo!ld re$!ire a one beam 1T. There is an impated tooth (it appears to be a mandib!lar anine) horizontal inthe right mandible. The enamel of the rown is shaped and at the medial aspet of the e'ternal obli$!e ridge.

It again is #ery s!btle and than"f!lly a!ght before any implants were attempted to be plaed in this loation.

hile these are both simple ases of impated teeth that were missed on the radiographs and were not lifethreating, I hope it helps remind yo! to e'amine yo!r radiographs losely. I will be presenting some other ases

in the ne't o!ple of wee"s on entities that were not only missed b!t also misinterpretated as to the final

diagnosis.

,o- -as that missed. (/rauma)Posted on by Dr. Shawneen Gonzalez0&o 1omments 2
http://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/08/16/how-was-that-missed-trauma/#respondhttp://drgstoothpix.com/2012/08/16/how-was-that-missed-trauma/#respondhttp://drgstoothpix.com/2012/08/16/how-was-that-missed-trauma/#respondhttp://drgstoothpix.com/wp-content/uploads/2012/08/missed-interpretation-2.jpghttp://drgstoothpix.com/wp-content/uploads/2012/08/missed-interpretation-1.jpghttp://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/08/16/how-was-that-missed-trauma/#respond


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This wee" I ha#e a ase of tra!ma to the mandible and its radiographi appearane on +D images #ers!s 6D

images.

This is a pantomograph of a patient presenting after tra!ma to the mandible (an/t remember e'at type of tra!ma fight, aident, et.). Ta"e a loo" below to see what/s going on.

:ost li"ely, the left mandib!lar frat!re starting near the mandib!lar left premolar to the inferior border of the

mandible is $!ite e#ident to yo!. This ase presented in a hospital so a 1T san was performed. 1he" o!t theso!t #iew below (#iewed as if loo"ing at the patient yo!r right is patients left and #ie #ersa).

&otie something a miss on the patient/s ride side; < #ertial radiol!ent line with separation of the body of the

mandible from the ram!s.

&ow ta"e a loo" ba" at the pantomograph in the right antegonial region. There is a shaped radiopaitye#ident. This is an e'ample of two frat!re segments o#erlapping eah other reating an area of inreased
http://drgstoothpix.com/wp-content/uploads/2012/08/mandibular-fracture-ct-scout-view.jpghttp://drgstoothpix.com/wp-content/uploads/2012/08/mandibular-fracture-pantomo.jpg


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radiopaity. =or more on the the > radiographi appearanes of frat!res he" it o!t here.

4ere is an a'ial #iew showing the frat!re of the right angle of the mandible with the two segments o#erlapping

eah other. If yo! loo" in the patients left premolar region, yo! an see the disontin!ity of the more readily#isible frat!re on the pantomograph.

This ase is 7!st to remind yo! that there are a few ways that frat!res appear on radiographs and to e#al!ate theentire radiograph aref!lly.

Radiographic /echni#ue: Maxillary 'cclusalRadiographsPosted on by Dr. Shawneen Gonzalez0+ 1omments 2

This is the first of two posts on ol!sal tehni$!e. ?elow are images I ha#e ta"en with a #ery ooperati#e

patient D@TTA. The only problem for some of the images is he has no ne" so I did the best I o!ld.

'cclusal /echni#ue (general)

3l!sal radiographs are made !sing an e'treme biseting angle tehni$!e. The film%sensor is plaed on the

ol!sal s!rfaes of the teeth. sing the long a'is of the tooth and the long a'is of the film%sensor an angle isreated between the two. To determine the diretion of the ' ray beam, the angle m!st be biseted first and then

orient the ' ray beam perpendi!lar (at BC degrees) to the biseted angle. This tehni$!e res!lts in more

distortion and shortening of the teeth.


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is positioned with its long axis laterally. The entral ray (PID) is aimed with a #ertial angle of 354 to 386degrees7 a horizontal angle of 6 degrees andcentered on the bridge of the nose.

Eong*a'is of filmplaed horizontally.

PID positioned (entered on bridge of nose) with a #ertial angle of 98F to 9HC degrees and a horizontal angle ofC degrees.
http://drgstoothpix.com/wp-content/uploads/2012/09/maxillary-standard-occlusal-pid-position-dxttr.jpg


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'ample ma'illary standard ol!sal radiograph.

Maxillary $ateral

The ma'illary lateral ol!sal radiograph is made !sing a si$e 0film%phosphor plate with the long axis parallel

to the facial surfaces of the posterior teeth . The entral ray (PID) is aimed with a #ertial angle of 356 to 386degrees andcentered slightly inferior to the corner of the eye.

Diagram showing long*a'is of film parallel with faial s!rfaes ofposterior teeth (pin" arrows).

Eong*a'is of film parallel with faial s!rfaes of posterior teeth.
http://drgstoothpix.com/wp-content/uploads/2012/09/maxillary-lateral-occlusal-film-position-dxttr.jpghttp://drgstoothpix.com/wp-content/uploads/2012/09/maxillary-lateral-film-positioning-diagram.jpghttp://drgstoothpix.com/wp-content/uploads/2012/09/maxillary-standard-occlusal-radiograph.jpg


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PID positioned (entered on 7!st inferior to the orner of eye) with a #ertial angle of 98C to 9HC degrees and a

horizontal angle of BC degrees.

'ample ma'illary lateral ol!sal radiograph.

ase of the -ee+: Normal pantomograph imagingmimic+ing diseasePosted on by Dr. Shawneen Gonzalez0&o 1omments 2

This wee" I wanted to show an area on pantomographs that I am fre$!ently as"ed abo!t. The area I am tal"ing

abo!t is the radiol!ent area as noted by the yellow areas inferior to the mandib!lar posterior teeth.
http://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/09/28/case-of-the-week-normal-pantomograph-imaging-mimicking-disease/#respondhttp://drgstoothpix.com/2012/09/28/case-of-the-week-normal-pantomograph-imaging-mimicking-disease/#respondhttp://drgstoothpix.com/2012/09/28/case-of-the-week-normal-pantomograph-imaging-mimicking-disease/#respondhttp://drgstoothpix.com/wp-content/uploads/2012/09/maxillary-lateral-occlusal-example.jpghttp://drgstoothpix.com/wp-content/uploads/2012/09/maxillary-lateral-pid-position-dxttr.jpghttp://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/09/28/case-of-the-week-normal-pantomograph-imaging-mimicking-disease/#respond


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This area is typially where an obser#ers eye are drawn d!e to the ontrast of how radiol!ent it appearsompared to ad7aent str!t!res. This area is a normal pro7etion of pantomographs and reated by the

s!perimposition of two entities and normal anatomy. The first entity that is s!perimposed is the er#ial spine

(#ertial yellow dotted lines). This reates an inreased radiopa$!e area in the mid*line of the radiograph.

The seond s!perimposition is a ghost image of the opposite ram!s (green dotted line). This reates an inreasedradiopa$!e area s!perior to the mid*root and apial portions of the mandib!lar posterior teeth.
http://drgstoothpix.com/wp-content/uploads/2012/09/pantomograph-imaging-mimicking-disease-cervical-spine.jpghttp://drgstoothpix.com/wp-content/uploads/2012/09/pantomograph-imaging-mimicking-disease-with-arrows.jpg


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The last thing that is ma"ing this area appear more radiol!ent is the normal anatomy of the s!bmandib!larsali#ary gland fossa where the mandible is thinner in this region reating an appearane of more radiol!ent bone

ompared to the rest of the al#eolar ridge.

hen loo"ing at a pantomograph in the f!t!re, if yo! find yo!r eyes drawn to this area ma"e s!re to as" yo!rself

some $!estions before possibly e'posing yo!r patient to e'ess radiation. Sho!ld yo! ha#e any $!estions on thisspeifi area on a pantomograph, please let me "now. Than"s and en7oyJ

Radiographic /echni#ue: Mandibular 'cclusalRadiographsPosted on by Dr. Shawneen Gonzalez0&o 1omments 2

This is the seond and last post on ol!sal tehni$!e. =or a refresher on basi ol!sal tehni$!e gohere.
http://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/10/01/radiographic-technique-mandibular-occlusal-radiographs/#respondhttp://drgstoothpix.com/2012/10/01/radiographic-technique-mandibular-occlusal-radiographs/#respondhttp://drgstoothpix.com/2012/10/01/radiographic-technique-mandibular-occlusal-radiographs/#respondhttp://drgstoothpix.com/2012/09/26/radiographic-technique-maxillary-occlusal-radiographs/http://drgstoothpix.com/2012/09/26/radiographic-technique-maxillary-occlusal-radiographs/http://drgstoothpix.com/wp-content/uploads/2012/09/pantomograph-imaging-mimicking-disease.jpghttp://drgstoothpix.com/wp-content/uploads/2012/09/pantomograph-imaging-mimicking-disease-ghost-image-ramus.jpghttp://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/10/01/radiographic-technique-mandibular-occlusal-radiographs/#respondhttp://drgstoothpix.com/2012/09/26/radiographic-technique-maxillary-occlusal-radiographs/


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Mandibular 'cclusal Radiographs

Mandibular Anterior

The mandib!lar anterior ol!sal radiograph is fre$!ently made on both ad!lts and hildren. 3n ad!lts, it ismade with a si$e 0film%phosphor plate with the long axis antero1posteriorly or hori$ontally. It is important toha#e a minim!m of m of film%phosphor plate anterior to the mandib!lar entral inisors. The entral ray

(PID) is aimed with a #ertial angle of 144 to 156 degrees7a horizontal angle of6 degreesand centered on thechin. =or a hild, a size + film%phosphor plate is !sed with the long a'is laterally. The entral ray is positionedthe same as for an ad!lt.

Eong*a'is of film plaed antero*posteriorly with a minim!m of m of film anterior to entral inisors.

PID positioned (entered on hin) with a #ertial angle of FF to *8F degrees and a horizontal angle of C degrees.
http://drgstoothpix.com/wp-content/uploads/2012/09/mandibular-anterior-occlusal-pid-position-dxttr.jpghttp://drgstoothpix.com/wp-content/uploads/2012/09/mandibular-anterior-occlusal-film-position-dxttr.jpg


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'ample ad!lt mandib!lar anterior ol!sal radiograph.

'ample hild mandib!lar anterior ol!sal radiograph.

Mandibular %rue !Mandibular Cross"sectional#

The mandib!lar tr!e ol!sal radiograph is one of the most ommonly made ol!sal radiographs. It is made!sing a si$e 0film%phosphor plate with the long axis laterally. The entral ray (PID) is aimed with a #ertialangle of 196 degrees7 a horizontal angle of 6 degrees and centered on the midline of the patient near the

middle of the film&phosphor plate. The film%phosphor plate an be entered in the oral a#ity or positioned to aside depending on what yo! want to #iew.
http://drgstoothpix.com/wp-content/uploads/2012/09/mandibular-anterior-occlusal-child.jpghttp://drgstoothpix.com/wp-content/uploads/2012/09/mandibular-anterior-occlusal-adult.jpg


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Eong*a'is of film plaed horizontally.

PID positioned (entered on midline of patient in enter of film) with a #ertial angle of *BC degrees and ahorizontal angle of C degrees. %his is where &'%%( having no neck made it difficult to show a true ) *+ degree

vertical angle,

'ample mandib!lar tr!e ol!sal radiograph.
http://drgstoothpix.com/wp-content/uploads/2012/09/mandibular-true-occlusal-example.jpghttp://drgstoothpix.com/wp-content/uploads/2012/09/mandibular-true-occlusal-pid-position-dxttr.jpghttp://drgstoothpix.com/wp-content/uploads/2012/09/mandibular-true-occlusal-film-position-dxttr.jpg


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Mandibular $ateral

The mandib!lar lateral ol!sal radiograph is made !sing a size > film%phosphor plate. The film%phosphor plate

is positioned with thelong axis parallel to the facial surfaces of the posterior teeth2 The entral ray (PID) isaimed with a #ertial angle of 146 degrees through the center of interest (typially the molar or premolarregion).

Diagram showing long*a'is of film parallel with faial s!rfaes of

posterior teeth (pin" arrows).

Eong*a'is of film parallel with faial s!rfaes of posterior teeth.

PID positioned (entered on area of interest) with a #ertial angle of *FC degrees and a horizontal angle of BCdegrees.
http://drgstoothpix.com/wp-content/uploads/2012/09/mandibular-lateral-occlusal-pid-position-dxttr.jpghttp://drgstoothpix.com/wp-content/uploads/2012/09/mandibular-lateral-occlusal-film-position-dxttr.jpghttp://drgstoothpix.com/wp-content/uploads/2012/09/maxillary-lateral-film-positioning-diagram.jpg


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,o- -as that missed. (Periapical & Radicular cyst)Posted on by Dr. Shawneen Gonzalez0+ 1omments 2

?eing that the two pre#io!s posts on radiographi entities either loo"ed o#er or misdiagnosed reated $!ite a fewomments and $!estions, I ha#e deided to ma"e this a more reg!lar series. The plan (as of now) is to post one

a month on the first ednesday of the month. This months ase is a ase of a misinterpretation.?elow are the one beam 1T images for this ase. &o patient information was pro#ided with the images.

Aeonstr!ted pantomograph showing well*defined, ortiated, o#oid radiol!ent area e'tending frommandib!lar left first molar to impated third molar. There is thinning and inferior displaement of the inferior

border of the mandible.

1ross*setional slies near mandib!lar left first molar showing alifiations within the radiol!ent lesion not

#isible on reonstr!ted pantomograph. There is thinning of the faial and ling!al ortial plates with adisontin!ity of the ling!al ortial plate.

-nitial interpretation.?ased on the images abo#e with the e'pansion % displaement of the ortial plates andm!ltiple alifiations within the lesion, the initial interpretation had an odontogeni neoplasm s!h as a

alifying epithelial odontogeni t!mor (13T) as the top possibility.

/istopathological &iagnosis. Periapial % Aadi!lar yst

$esson learned.I was e'ited !pon seeing the alifiations and a!tomatially went to an entity (13T) whihis m!st less ommon than a radi!lar yst. This ase is a good e'ample of showing how a long standing yst anha#e dystrophi alifiations o!r within the entity. This is also where information abo!t the teeth ad7aent,
http://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/10/03/how-was-that-missed-periapical-radicular-cyst/#commentshttp://drgstoothpix.com/2012/10/03/how-was-that-missed-periapical-radicular-cyst/#commentshttp://drgstoothpix.com/radiographic-interpretation/cysts-of-the-jaws/radicular-cyst/http://drgstoothpix.com/wp-content/uploads/2012/10/hwtm-periapical-cyst-xsect.jpghttp://drgstoothpix.com/wp-content/uploads/2012/10/hwtm-periapical-cyst-pantomo.jpghttp://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/10/03/how-was-that-missed-periapical-radicular-cyst/#commentshttp://drgstoothpix.com/radiographic-interpretation/cysts-of-the-jaws/radicular-cyst/


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s!h as tooth #itality may ha#e hanged the initial interpretation. I "now its easy to go to the oddest and least

ommon disease proesses o!t there (st!dents and fa!lty ali"e are all g!ilty of this)K howe#er there is a reasonthe saying Lommon things o!r ommonly/ is o!t there. This ase was a good reminder to al-aysgo thro!ghommon disease proesses first before 7!mping to less ommon disease proesses.

ase of the -ee+: /hird Molar in Maxillary *inusPosted on by Dr. Shawneen Gonzalez0&o 1omments 2

This wee"s ase topi is an interesting finding of a ma'illary third molar de#eloping in the ma'illary sin!sad7aent to a s!pern!merary tooth on a 1?1T san. -nterpretation This ase shows a mi'ed

radiol!ent%radiopa$!e entity in the right ma'illary sin!s. The radiopaity is that of tooth str!t!re. The

appearane is onsistent with a de#eloping third molar pre#ented from its typial loation (near the rest of theal#eolar ridge) by another tooth (s!pern!merary tooth).

Aeonstr!ted pantomograph showing mi'ed radiol!ent%radiopa$!e entity in right ma'illary sin!s (orange

arrow).


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1oronal #iew

Sagittal #iew
http://drgstoothpix.com/wp-content/uploads/2012/10/cotw-cross-sectional-slices.jpghttp://drgstoothpix.com/wp-content/uploads/2012/10/cotw-sagittal.jpghttp://drgstoothpix.com/wp-content/uploads/2012/10/cotw-coronal1.jpg


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1ross*setional slies

I realize this is 7!st a few sreenshots from a 1?1T san, b!t these sho!ld be ade$!ate to show the basis of this

ase. If yo! ha#e any $!estions abo!t this, please let me "now.

ase of the -ee+: !namel ,ypoplasiaPosted on by Dr. Shawneen Gonzalez0&o 1omments 2This wee" I ha#e a ase of enamel hypoplasia on the ma'illary entral inisors. I ha#e no information on thehistory of this ase and any possible a!ses. If yo! ha#e some ideas, please feel free to share in the omments.

&ote the wa#y radiol!ent lines in the middle portion ofthe rown. This is d!e to the altered formation of the enamel.
http://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/11/02/case-of-the-week-enamel-hypoplasia/#respondhttp://drgstoothpix.com/2012/11/02/case-of-the-week-enamel-hypoplasia/#respondhttp://drgstoothpix.com/2012/11/02/case-of-the-week-enamel-hypoplasia/#respondhttp://drgstoothpix.com/wp-content/uploads/2012/11/enamel-hypoplasia.jpghttp://drgstoothpix.com/author/oralradiology/http://drgstoothpix.com/2012/11/02/case-of-the-week-enamel-hypoplasia/#respond

dental anatomy on radiographs.pdf

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