آناتومی رادیوگرافی طبیعیnormal radiographic anatomy

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NORMAL RADIOGRAPHIC ANATOMY ° The radiographic recognition of disease requires a sound knowledge of the _ radiographic appearance of normal structures. © Intelligent diagnosis mandates an appreciation of the wide range of variation in the appearance of normal anatomic structures. © most patients demonstrate many of the normal radiographic landmarks, but it is a rare patient who shows them all. © Accordingly, the absence of one or even several such landmarks in any individual should not necessarily be considered abnormal. 

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NORMAL RADIOGRAPHIC ANATOMY: TEETH ° Teeth are composed primarily of dentin, with an enamel cap over the coronal portion and a thin layer of cementum over the root surface. 

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TEETH ۶۰۲86 enamel cap characteristically appears more radiopaque than the other tissues because it most dense naturally occurring substance in the body. Being 90% mineral, it causes the greatest attenuation of x-ray photons. ° The dentin is about 75% mineralized, and because of its lower mineral content its radiographic appearance is roughly comparable to that of bone. ° The thin layer of cementum on the root surface has a mineral content (50%) comparable to that of dentin. Cementum is not usually apparent radiographically because the contrast between it and dentin is so low and the cementum layer is so thin. 

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FIG. 9-1 Teeth are composed of pulp (arrow on the second molar), enamel (arrow on the first molar), dentin (arrow on the second premolar), and cementum (usually not visible radiographically), 

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NORMAL RADIOGRAPHIC ANATOMY: TEETH ° The pulp of normal teeth is composed of soft tissue and consequently appears radiolucent. ©The chambers’ and ۲۵۵۲ canals containing the pulp extend from the interior of the crown to the apices of the roots. Although the shape of most pulp chambers is fairly uniform within tooth groups, great variations exist among individuals in the size of the pulp chambers and the extent of pulp horns. 

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CERVICAL BURNOUT FIG. 9-2 Cervical burnout caused by overexposure of the the enamel and alveolar lateral portion of teeth betwee crest (arows) ©Diffuse radiolucent areas with ill- defined borders may be apparent radiographically on the mesial or distal aspects of teeth in the cervical regions between the edge of the enamel cap and the crest of the alveolar ridge. This phenomenon, called cervical burnout, is caused by the normal configuration of the affected teeth, which results in decreased x-ray absorption in the areas in question. © Furthermore, the perception of these radiolucent areas results from the contrast with the adjacent, relatively opaque enamel and alveolar bone. Such radiolucencies should not be confused with root surface caries, which frequently have a similar appearance. 

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LAMINA DURA ° A radiograph of sound teeth in a normal dental arch demonstrates that the tooth sockets are bounded by a_ thin radiopaque layer of dense bone 5 Lamina dura. 9 ۲۳15 layer is continuous with the shadow of the cortical bone at the alveolar crest. It is only slightly thicker and no more highly mineralized than the trabeculae of cancellous bone in the area. 

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LAMINA DURA ° The thickness and density of the lamina dura on the radiograph vary with the amount of occlusal stress to which the tooth is subjected. ° The laminadura is wider and more dense around the roots of teeth in heavy occlusion, and thinner and less dense around teeth not subjected to occlusal function. 

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LAMINA DURA A 8 FIG. 9-6 The lamina dura (orrows) appears asa thin opaque layer of bone around teeth, ‘A, and around a recent extraction socket, B, 

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LAMINA DURA FIC. 9-7. Thelamina dures poorly visualized onthe dtl dulace of wie premolar foros) but x early Seen on the ei race °The appearance of the lamina dura is a valuable diagnostic feature. ° The presence of an intact lamina dura around the apex of a tooth strongly suggests a vital pulp. ° The absence of its image around an apex on a radiograph may be normal. Rarely, in the absence of disease the lamina dura may be absent from a molar root extending into the maxillary sinus. 

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FIG. 9-8 A double periodontal ligament space and lamina dura (arrows) may be seen when there is a convexity of the proximal surface of the root. 

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ALVEOLAR CREST FIG, 9-9. The alveolar crests (arrows) are seen as cortical borders ofthe alveolar bone. 5۲۳6 gingival margin of the alveolar process that extends between the teeth is apparent on radiographs as a radiopaque line, the alveolar crest ©The level of this bony crest is considered normal when it is not more than 1.5 mm from the CEJ of the adjacent teeth. °The crest of the bone _ is continuous with the lamina dura and forms a sharp angle with Rounding of these sharp junctions is indicative of periodontal disease. 

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PERIODONTAL LIGAMENT SPACE °Because the periodontal ligament (PDL) is composed primarily of collagen, it appears as a radiolucent space between the tooth root and the lamina dura. © Usually it is thinner in the middle of the root and slightly wider near the alveolar crest and root apex, suggesting that the fulcrum of physiologic movement is in the region where the PDL is thinnest. ©The thickness of the ligament relates to the degree of function because the PDL is thinnest around the roots of embedded teeth and those that have lost their antagonists. 

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PERIODONTAL LIGAMENT SPACE on the mesal surface ofthis canine arows) and thin on the seen as a nartow radiolucency between the tooth root and Aisa surface lamina dura FIG. 9-11 The periodontal ligament space appears wide FIG, 9-10 The petiadontal ligament space (arows) is © 

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CANCELLOUS BONE © The cancellous bone (also called trabecular bone or spongiosa) lies between the cortical plates in both jaws. It is composed of thin radiopaque plates and rods (trabeculae) surrounding many small radiolucent pockets of marrow. °The Trabeculae in the anterior maxilla are typically thin and numerous, forming a fine, granular, dense pattern , and the marrow spaces are consequently small and relatively numerous. °In the posterior maxilla the trabecular pattern is usually quite similar to that in the anterior maxilla, although the marrow spaces may be slightly larger. 

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CANCELLOUS BONE FIG, 9-14 The trabecular pattern in the posterior ‘mandible is quit variable, generally showing large marrow spaces and sparse abeculatian, especialy inferiorly (arrows) 

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CANCELLOUS BONE °In the anterior mandible the trabeculae are somewhat thicker than in the maxilla, resulting in a coarser pattern with trabecular plates that are oriented more horizontally. °In the posterior mandible’ the periradicular trabeculae and marrow spaces may be comparable to those in the anterior mandible but are usually somewhat larger .The trabecular plates are oriented mainly horizontally in this © region also. 

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MAXILLA °Intermaxillary Suture : thin radiolucent line in the midline between the two portions of the premaxilla ° Anterior Nasal Spine : just below the junction of the inferior end of the nasal septum and the inferior outline of the nasal fossa. Located in the midline, some 1.5 to 2 cm above the alveolar crest. ° Nasal Fossa : air-filled nasal fossa (cavity) ° Incisive Foramen : in the maxilla . the oral terminus of the nasopalatine canal. It transmits the nasopalatine vessels and nerves °lateral Fossa : gentle depression in the maxilla near the apex of the lateral incisor 

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FIG. 9-16 The intermaxillary suture may terminate in a V-shaped widening (arrow) at the alveolar crest. © 

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FIG. 9-17 The anterior nasal spine is seen as an opaque V-shaped projection from the floor of the nasal fossa in the midline (arrow). © 

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FIG. 9-19 The nasal septum (black arrow) arises directly above the anterior nasal spine and is covered on each side by nasal mucosa (white arrow). © 

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FIG. 9-18 The anterior floor of the nasal fossa (arrows) appears as opaque lines extending laterally from the ante- rior nasal spine. G 

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FIG. 9-21 The floor of the nasal fossa (arrows) may often be seen extending above the maxillary lateral incisor and canine. 

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۴۱6۵۰ 9-22 ۰1۳6 floor of the nasal fossa (arrows) extends posteriorly, superimposed with the maxillary sinus. 

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A B FIG. 9-23 A, The incisive foramen appears as an ovoid radiolucency (arrows) between the roots of the central incisors. B, Note its borders, which are diffuse but within normal limits. 

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FIG. 9-24 The lateral walls of the nasopalatine canal FIG. 9-25 The superior foremina of the nasopaatine {ortows) extend fom the ineve foramen to the lor of the canal (aroma) appear just lateral to the nasal septum and nasal Tossa poiteror tothe anterior nasal spine 

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FIG, 9-26 The lateral fossa is a diffuse radiolucency (arrows) in the region of the apex of the lateral incisor. It is formed by a depression in the maxilla at this location. 

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MAXILLA ° Nose 6 Nasolacrimal Canal The nasal and maxillary bones form the nasolacrimal canal. It runs from the medial aspect of the anteroinferior border of the orbit inferiorly, to drain under the inferior concha into the nasal cavity. visualized on periapical radiographs in the region above the apex of the canine. The nasolacrimal canals are routinely seen on maxillary occlusal © projections in the region of the molars 

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MAXILLARY SINUS : air-containing cavity lined with mucous membrane. three-sided pyramid, with its base the medial wall adjacent to the nasal cavity and its apex extending laterally into the zygomatic process of the maxilla. © Its three sides are (1) the superior wall forming the floor of the orbit, (2) the anterior wall extending above the premolars, and (3) the posterior wall bulging above the molar teeth and maxillary tuberosity. * The sinus communicates with the nasal cavity via the ostium some 3 to 6mm in diameter positioned under the posterior aspect of the middle turbinate. * considerable variation in size. They enlarge during childhood, achieving mature size by the age of 15 to 18 years. ® The right and left sinuses usually appear similar in shape and size, © although marked asymmetry is occasionally present. 

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MAXILLARY SINUS : ©The floors of the maxillary sinus and nasal cavity are seen on dental radiographs at approximately the same level around the age of puberty. °In older individuals the sinus may extend farther into the alveolar process, and in the posterior region o[ the maxilla its floor may appear considerably below the level of the floor of the nasal ۰ © Anteriorly each sinus is restricted by the canine fossa and is usually seen to sweep superiorly, crossing the level of the floor of the nasal cavity in the premolar or canine region. Consequently, on periapical radiographs of the canine, the floors of the sinus and nasal cavity are often superimposed and may be seen crossing one another, forming an inverted Y in the area 

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FIG. 9-27 The soft tissue outline of the nose (arrows) is superimposed on the anterior maxilla. 

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FIG. 9-30 The inferior border of the maxillary sinus (arrows) appears as a thin radiopaque line near the apices of the maxillary premolars and molars. 

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FIG, 9-31 The anterior border of the maxillary sinus (white arrows) crosses the floor of the nasal fossa (black © arrow), 

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۸ 8 FIG, 9-32 The floor of the maxillary sinus (arrows) extends toward the crest of the alveolar ridge in response to missing teeth 

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FIG. 9-35 This bony nodule (orrow) is a normal variant of the floor of the maxillary sinus FIG. 9-33 Neurovascular canals (arrows) in the lateral wall (of the maxilary sinus. 

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FIG. 9-34 A septum (arrow) in the maxillary sinus formed by a low ridge of bone on the sinus wall. (See also Fig. 9- 32, B). 

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۱۱۱۷۴۶۲۲۷ ۱ FIG, 9-31 The anterior border of the maxillary sinu (white arrows) crosses the floor of the nasal fossa (blac arrow), 

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6 Zygomatic Process and Zygomatic Bone © Nasolabial Fold : An oblique line demarcating a region that appears to be covered by a veil of slight radiopacity frequently traverses periapical radiographs of the premolar region. The line is the nasolabial fold, and the opaque veil is the thick cheek tissue superimposed on the teeth and the alveolar process. © Pterygoid Plates 

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A 8 FIG. 9-36 The zygomatic process of the maxilla (orrows) protrudes laterally from the maxillary wall. ‏كنا‎ size may be quite variable: small with thick borders (A) or large with thin borders (B). 

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iG. 9-39. Merygod plates (orows) located postarior to the masilary tuberosity FIG, 9-38 The nasolabial fold (arrows) extends across the canine-premolar region. HG, 9-40. The hamular process (arow) extends down ‘ward from the media pterygoid plate 

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MANDIBLE ‘Symphysis Genial Tubercles : The genial tubercles (also called the mental spine) are located on the lingual surface of the mandible slightly above the inferior border and in the midline. Attach of genioglossus muscles and geniohyoid muscles . “Mental Ridge : On periapical radiographs of the mandibular central incisors, the mental ridge (protuberance) may occasionally be seen as two radiopaque lines sweeping “Mental Fossa: depression on the labial aspect of the mandible extending laterally from the midline and above the mental ridge. 

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FIG. 9-41 Mandibular symphysis (arrows) in a newborn infant. Note the bilateral supernumerary primary incisors adjacent to it 

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FIG. 9-42 Genial tubercles (arrow) on the lingual surface of the mandible in this cross-sectional mandibular occlusal view. 

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FIG. 9-43 The genial tubercles (arrow) appear as a FIG. 9-44 Lingual foramen (arrow), with a sceratic radiopaque mas, inthis case without evidence ofthe lingual border, in the symphyseal regan of the mandible, foramen, 

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FIG. 9-45 Mental ridge (arrows) on the anterior surface FIG. 9-46 The mental fossais a radiolucent depression on af the mandible seer ۳ the anterior surface of the mandible (arrows) between the ieee ‏ا ی‎ alveolar ridge and mental ridge 

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MANDIBLE ° Mental Foramen © Mandibular Canal © Nutrient Canals © Mylohyoid Ridge ° Submandibular Gland Fossa © External Oblique Ridge ° Inferior Border of the Mandible ° Coronoid Process 

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FIG. 9-48 The mental foramen (arrow) (over the apex of the second premolar) may simulate periapical disease. Con- tinuity of the lamina dura around the apex, however, indi- cates the absence of periapical abnormality. FIG. 9-47 The mental foramen (arrow) appears as an oval radiolucency near the apex of the second premolar, 

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FIG. 9-50 The mandibular canal superimposed over the apex of a molar causes the image of the petiodontal liga- ment space to appear wider (arrow). The presence of an intact lamina dura, however, indicates that there is no per: apical disease. its FIG. 9-49 Mandibular canal. Arrows denote radiopaque superior and inferior cortical borders. 

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FIG, 9-52 Nutrient canals demonstrated by radiolucen- ‘ies (arraws) in the anterior mandible of a patient with severe periodontal disease FIG, 9-51 Nutrient canals (arrows), demonstrated by radiopaque cortical borders, descend fron the mandibular first molar, 

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FIG. 9-56 External oblique ridge (arrows), seen as a radiopaque line near the alveolar crest in the mandibular third molar region, FIG. 9-54 The mylohyoid ridge (arrows) mi especially when a radiograph is exposed with excessive ‏نومه‎ ‎ative angulation. FIG, 9-53 Mylohyoid ridge (orrows) running atthe level fof the molar apices and above the mancibular canal 

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۴۱6, 9-57 The inferior border of the mandible (arrows) is seen as a dense, broad radiopaque band, FIG. 9-55 Submandibular gland fossa (arrows), indicated by a poorly defined radiolucency and sparse trabecular bone below the mandibular molars. 

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FIG. 9-58 Coronoid process of the mandible (arrows) superimposed on the maxillary tuberosity. 

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A — Nasal fossae (nasal cavities) B — Median palatine suture (intermaxillary suture) C — Incisive foramen (anterior palatine foramen) D — Root canal E — Dentin F — Enamel © 

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C — Median palatine suture (intermaxillary suture). Radiolucent line D — Overlapping of teeth 

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A — Soft tissue of nose B — Upper lip line (border of a heavy upper lip) Cc — Lamina dura (radiopaque line) and periodontal ligament space (radiolucent line) surrounding the tooth root 

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FIG. 9-19 The nasal septum (black arrow) arises directly FIG. 9-18 The anterior floor of the nasal fossa (arrows) above the anterior nasal spine and is covered on each side appears as opaque lines extending laterally from the ante- buy nasal mucosa (while arrow), rior nasa spine. 

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۸ --. ۷6 canal (nasopalatine canal) B — Lateral 8 fossa (thin bone) Cc — Walls of the incisive canal 0 D — Metal xray instrument 

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A — Anterior nasal spine B — Anterior borders (floor) of nasal fossae Cc — Nasal septum D — Nasal fossae 

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A — Median palatine c suture B — Pulp chamber Cc — Root canal 

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A — Tip of nose (cartilaginous) B — Upper lip 

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A — Soft tissue of nose (arrows) B — Lateral fossa (due to thinness of bone) 

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A — Palatal torus (torus palatinus) B — X-ray instrument 

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L — Anterior wall of maxillary sinus M — Anterior border (floor) of nasal fossa 

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L — Anterior wall of maxillary sinus M — Anterior border (floor) of nasal fossa L — Maxillary sinus (antrum) M — Anterior border (floor) of nasal fossa N — Nutrient canal leading to a nutrient foramen 

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L — Septum in maxillary sinus M — Anterior wall of right maxillary sinus N — Anterior border (floor) of nasal fossa O — Patient's right nasal fossa 

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۱] - 560۲۵ in maxillary sinus M — Floor of maxillary sinus N — Maxillary sinus (antrum) O — Unerupted third molar P — X-ray dental instrument (metal rod) 

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L — Maxillary sinus (antrum) M — Septum in maxillary sinus N — Floor of maxillary sinus 

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L — Torus palatinus 

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L — Anterior wall of maxillary sinus M — Floor of the maxillary sinus N — Maxillary sinus (antrum) Notice that the roots of the molars project into the sinus © 

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Small arrows --- Maxillary tuberosity L — Zygomatic process of maxilla (Ushaped) M — Floor of maxillary sinus N — Dental instrument (hemostat) superimposed on the crowns of teeth 

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| --.- ۷ sinus Arrows --- Floor of maxillary sinus 

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L — Nutrient Foramen and canal 

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L — Hamular process M — Maxillary tuberosity N — Coronoid process O — Zygomatic process of the maxilla (U-shaped) 

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L — Zygomatic arch M — Pterygoid plates N — Coronoid process is (ron) extends award the crest ofthe alveoli edge in ۵ 

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‘Small arrows --- lower border of zygoma L — Septa in maxillary sinus M — Zygomatic process of maxilla (U-shaped) N — Floor of maxillary sinus (near the alveolar ridge surface) 

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FIG, 9-22 The floor of the nasal fossa (arrows) extends posteriorly, superimposed with the maxillary sinus. 

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E — Mental ridge F — Lower border of mandible G — Genial Tubercles E — Mental fossa (depression in bone) The mental fossa could be misdiagnosed © as an | apical lesion 

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Mandibular tori 

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Mental foramen 

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A — External oblique ridge B — Internal oblique ridge (the anterior extension is the mylohyoid ridge) C — Inferior cortical border of mandible D — Submandibul (gland) fossa 

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Mandibula r canal (Inferior alveolar canal) near apices of third molar ©. 

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X — Submandibular fossa 

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FIG. 9.6 The lamina dura (arrows) appears asa thin epaque layer of bone around teeth, ‘A, and around a recent extraction socket, 8. 

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FIG, 9-14 The tabecular pattern inthe posterior mandible is quite variable, generally showing large marrow spaces and sparse trabeculation, especialy infer (arrow). FIG. 9-12 The trabecular pattern inthe antenor maxilla is characterized by ne trabecular plates and multiple small, trabecular spaces (arom) 

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FIG. 9-13 _ The trabecular pattern in the anterior mandibe FIG. 9.38 The nasolabial fold (arows) extends across the 's characterized by coarser trabecular plates and larger canine-premolr region. ‘marrow spaces (artew) than in the anterior manila,