2 Maxillary Landmarks by HC120520001450

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									                    Radiographic Anatomy


   Radiology terminology:

   Radiopaque those structures are more likely thick bony
    structures that will block the x-ray beams so they will not
    reach the film and it'll appear radiopaque.
   Radiolucent  those structures will permit the x-ray beams
    to pass through them so they will reach the film and that will
    result in a dense area on the radiograph which is called
    radiolucent.


  Slide #2
  Examples of Radiopaque structures:
  1)    Border: lower border of the mandible
  2)    Ridge: mylohyoid ridge
  3)    Process: zygomatic process
  4)    Septum: nasal septum
  5)    Floor: floor of the nose
  6)    Tuberosity: maxillary tuberosity
  7)    Tubercle: Genial tubercle
  8)    Spine: anterior nasal spine

   Slide #3
Examples of radiolucent structures:
   1. Fossa: submandibular salivary gland fossa in the lingual part
      of the mandible.
   2. Sinus: maxillary sinus which is filled with air.
   3. Foramen
   4. Recess
   5. Suture
   6. Canal

  **Why do we have to learn all these terms? To be able to
  distinguish them from the pathological entities.

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   "We learn anatomy to know pathology"

Slide #4
 It's a bitewing radiograph and it shows upper and lower teeth at
the same time, as you may notice different structures have
different densities. For example:
     Enamel is more radiopaque than dentine.
     Amalgam is more radiopaque than enamel because it's metal
        and it doesn't pass the x-rays beams to the film, after you put
        the film in the developer there will be no activated hylide
        crystals so in the fixer all of them will be washed out and the
        film will appear light or radiopaque on the viewer.
     Bone is also radiopaque but with variable densities
    Crystal bone (the most one) > bony trabeculatins > bone
    marrow (the least one).

    Pulp is radiolucent though there is enamel and dentine from
     the buccal and lingual surfaces.

Slide #5
This is a Periapical radiograph, and it shows different densities. You
can see the lamina dura which is radiopaque area around the
tooth.
And the periodontal ligament space is radiolucent because it's
filled with ligaments (soft tissues). We can see the cingulum, it's a
hard tissue so it will be radiopaque. Also we can see part of the
maxillary sinus.

Slide #6:
This is a radiograph for the Inferior border of the mandible, you
can see the submandibular gland fossa, roots, periodontal
ligament space.




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Slide #7
You can Crystal bone, bone marrow spaces, bony trabeculation,
overhanging restoration on the upper molar and a deficient margin
on the lower premolar.

Slide # 8
There is radioluecency around the tooth (the white circle), is it
pathological? No, because this patient is young and his tooth isn't
completely formed yet.

Slide #9
An unerapted tooth which will be erupted soon there will be
radiolucency around the tooth and this is due to the follicular
space (whenever you hear the word "space" that means
radiolucent because it's filled with air). The follicular space itself is
surrounded by a bony structure and that will be radiopaque on the
radiograph.

**The width of the follicular space is important because if the width
exceeds the normal range there may be a cyst which is
"dentegerious cyst".


Slide #11
This patient has periodontal disease, the bone level has reached
the CEJ, there is an inflammation process and because of this
inflammation you can see these canals which are called nutrient
canals they pass vasculature (increase vascularization). Those
canals may still be in the bone resulting in a radiograph like this.
They are more common in periodontal disease and more common
in black males.


Slide #12
Maxillary Incisors:
We can see the two central incisors and the laterals, I will expect to
see the intermaxillary suture, incisive foramen, a shadow of the

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nose ( the film is inside the mouth and the PID is outside, as the x-
rays beams move they will pass through the nose and because it
consists of soft tissue it will absorb some of the beams and that
will result in a shadow image of the edge of the nose, it'll not be a
clear radiopaque area instead it'll have a shadow). Anterior nasal
spine, nasal septum, lateral to it the nasal fossa and inside it we
have the inferior concha on both sides.

Slide #13, 14, 15, 16 and 17:
The doctor just read what is written underneath the pictures so
you'll have to be able to distinguish all the structures.

Slide #18:
This is the incisive foramen, you can't see the borders of this
foramen because the direction of the foramen isn't not the same
direction of the x-rays beams (you can see the walls but they're not
very clear).
The normal size of this foramen should be comparable with the
width of the central incisor, and its range from 8-10 mm. But if its
size exceeds this range this would be an incisive canal cyst or
nasopalatine cyst( it's nonodontogenic cyst).


Slide #19
Median palatine suture.

Slide #20
The arrows point at the soft tissue of the nose. How can I see the
soft tissue of the nose on the centrals? Because the direction of the
x-ray beams is from up so the shadow of the soft tissue will be
down on the central incisors.

Slide #21
You can see the Lip line( because the patient is biting on the bite
block) on the images of the crowns.




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Slide #22
The picture on the left: We can see this radiolucent lesion and it's
not the same size as the incisive canal and it's not in its place. This
is chronic periapical periodontitis.

The picture on the right: The incisive foramen is masked by this
radiopaque entity which is not the anterior nasal spine( where the
two floor of the nose meet), this radiopaque entity has the same
degree of radiopacity of the teeth and it's surrounded by a
radiolucent band which corresponds to the follicle of an unerupted
tooth which is a supernmarery tooth (mesiodense).

Slide #23
The picture on the right: This is edentulous patient:
This is the nasal septum, nasal fossa, anterior nasal spine, instead
of having the incisive foramen there is a big lesion that exceeds the
normal range of this foramen so this is properly an incisive canal
cyst or nasopalatine cyst.

The picture on the left: There are radioleucencies that don't fit with
any of the anatomical landmark we know in this area that's why I'll
be able to know that these are pathological radioleucencies, and if
I look at the condition of the teeth they are badly destroyed and
badly broken and the pulp is necrotic so that cause inflammation
of the bone periapically. Also the width of the canals are not
uniform instead there is variation and that indicates internal root
resorption.

Slide #24
 You can see the Soft tissue of the nose and the lip line, nasal
septum, floor of the nose and the anterior nasal spine.

Slide #25
Maxillary Canines:
We still see the floor of the nose but its shape will be different
because we're seeing it from different direction, and part of the
maxillary sinus which is the anterior wall of the maxillary sinus, also

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we still have some of the soft tissue casting on the radiograph but
more to the lateral side of the nose (ala of the nose). Also between
the lateral and the canine we have a depression in the buccal
surface of the bone and this corresponds to the incisive fossa and
it will appear on the radiograph as a radiolucent area but not
defined (no radiopaque borders) just depression.


Slide #26
We can see the floor of the nose(line 1) and the anterior wall of the
maxillary sinus (line 2) these two lines will meet to form the "Y
line" which is inverted Y, some textbooks call it line of Ennis it's a
landmark of the canine area. What's the radiopaque structure
inside the nasal fossa? The inferior concha.

Slide #27
The radiograph is casted differently, you'll see that there are
anatomical variations between patients even from side to side.
You can see the lateral fossa and you should know that if there is
radioluecency it might be within the normal range (it's not due to
inflammation).

Slide #28
Radiopaque shadow it's soft tissue of the nose (ala of the nose)

Slide #29
This radigraph is maybe for an older patient, so you can see the
nasolabial fold (which is more prominent in the elderly above 40).

Slide #30
The positioning of the film was not correct, The direction is tilted
so you've to be aware! Instead of having the floor of the nose
horizontal it's vertical and the anterior wall of the maxillary sinus is
horizontal.




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Slide #31
We can see the canine, the lateral and the incisive fossa. There is
radioleucency which is not the incisive fossa, the tooth has been
treated before whether its properly treated or not, maybe there is
a broken instrument that cause this pathological radiolucency.


Slide (#32)
Now here we have premolar peri apical area , we maybe don't get
part of floor of the nose, we see more of floor of the maxillary
sinus as we get to the molar area we see a thick radio-opaque
structure which corresponds to the zygomatic process of maxilla ,
Now here we have maxilla and zygomatic bone ,between them we
have what we call buttress or malar process ( which is that piece
of bone from the maxilla to the zygomatic bone which is very thick
that's why it appears radio opaque), inside the sinus you may see
in some patients some radio opaque septations , the sinus is a
cavity full of air lined with muco-periostium , sometimes this wall
which has some septations that make the cavity NOT a smooth
cavity and contain loculi and those septations may appear as
radio-opaque thin lines inside the sinus cavity. Now sometimes the
wall instead of being smooth it may have some loculi has resulted
in a more cavity area , so it would show more radio-lucent , this
radio lucency I call it a sinus recess .

Slide (#33, 34)
Now this is septum inside the sinus and it is thin ( a delicate line )
and we can see the inferior border of the maxillary sinus and also I
can see part of the malar process or zygomatic process of maxilla ,
it may have different shapes according to the view ( from where
the x-ray come ), so sometimes it's U shaped or J shaped it
depends on the position of your PID .

Slide (#35)
Here we have canine , 2 premolars , 1st & 2nd molars and we have
floor of the maxillary sinus , now this very thick radio-opaque
structure is malar process , also we have the nasal floor which

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doesn't stop here it goes all the way to the naso-pharynx
horizontally .

Slide(#36)
Here the black color is the septum , and this is the sinus floor , and
the radio opaque on the six is the palatal root and we have the
mesio buccal root & the desto-buccal root , also we have
dilaceration in the root ,, so it will not be an easy tooth to do
endodontic treatment or even to extract cuz it may fracture, and
this more radio-lucent structure corresponds to a recess inside the
wall of the sinus also we can see floor of the sinus and this thick
radio-opaque structure is malar process .
{the Dr said try to memorize this lecture & the lecture of the next
time as ur name}

Slide (#37)
This is an image of floor of the sinus & this normal thick radio-
opacity is malar process ( if u see it's a land mark for the 2nd molar
tooth ) & the radio-lucency corresponds to the nutrient canal
within the bony wall of the sinus .

Slide (#38,39,40)
This is an image of the naso labial fold. Here we have the maxillary
sinus floor. Here we have sinus but with more locules cuz this area
becomes edentulous so usually the maxillary sinus they
pneumatize ( means that they will extend they will not be the same
size) , in areas of no teeth they may extend and we call this
pneumatization of the maxillary sinus { pneumatization which
means air occupation}.

Slide (#41)
Now in this picture there is an edentulous area so the sinus
become to the crest (pneumatization of the maxillary sinus) and we
have the zygomatic process of the maxilla and it has some
variations.




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Slide (#42)
Now in the molar periapical area you will get few more structures,
you will see part of the mandible in a maxillary radiograph
although this is a maxillary radiograph but because we are more
posterior we will see part of the coronoid process and we will see a
tuberosity either which it's alone or it has the erupted 3rd molar ,&
even if your film was a little bit pushed backward you would get
part of the hamular process         ( It's from the sphenoid bone
exactly from the medial pterygoid plate ) Also we have the
posterior border of the maxilla ,Now between the pterygoid & the
maxilla we have pterygo-maxillary fissure (we don't see that in
periapical radiographs , we see that actually in lateral
cephalometric radiographs) . Now here we still have the floor of
the maxillary sinus, and this is the septum and we also can see
floor of the nose, the 3rd molar, the tuberosity area & part of the
coronoid process .
Now when I ask u list to me some anatomical land marks that u see
in the mandibular radiographs , you should NOT say coronoid
although it's a mandibular structure, but it's not a land mark of the
mandibular radiographs, it's a land mark of the maxillary
radiographs .

Slide ( #43)
Again here we have the tuberosity, sinus floor, zygomatic process
of maxilla ( the Dr said that by seeing more radiographs u will be
able to know these land marks ).

Slide ( #44)
Now here this is the coronoid process also we can see the hamular
process , the tuberosity, the zygomatic process of the maxilla &
this radiolucency is the sinus. Now this zygomatic process as we
said is a piece of the maxilla that will continue and meet the
zygomatic bone , so u would expect that this radio opacity that
extends from the malar process is the inferior border of the
zygomatic bone .




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Slide (#45)
Here again we have the sinus floor, nutrient canal (bcz it's radio
leucent I don't call it septum or ridge or tuberosity) , also we have
septation inside the sinus, this thick radio opacity is the zygomatic
process of maxilla, and this that extends from this process is the
inferior border of the zygomatic bone, also we have the maxillary
tuberosity .

Slide (#46)
Again this sinus contain a radio opaque mass ( and u know that the
maxillary sinus should appear completely radio luecent even the
walls which are made of mucus membrane should not appear on
radiographs & if it starts to appear this mean that this mucus
membrane is inflamed {filled with fluid (mucocitice) } , now this
appearance which I can describe as a dome shaped appearance (
soft tissue appearance ), & this is an entity called mucus retention
pseudo cyst which doesn't need actually a treatment , It's due to
blockage in the mucus secreting cyst, this blockage will accumulate
the mucus and will cause this swelling .

Slide (#47)
Here again we have floor of the sinus, tuberosity area, coronoid
process, this thick entity is the malar process and this line is floor
of the nose .

Slide (#48)
Again here we have the maxillary sinus floor also we have the
tuberosity area and we have a supernumerary teeth also we can
see the coronoid process .


        Our best wishes: Tuqa Al-Waqfi & Rahaf Ahmad 
      la la 3anjad Tuqa Al-Waqfi & Rahaf Ahmad  
                       Bye bye :D :D




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