The upper jaw (maxillae) Radiographic Anatomy First lecture The upper jaw (maxillae) Leif Kullman Assoc. Prof. OMF Radiology

As you know is x-rays an important tool to diagnose different diseases The radiographic recognition of disease requires a sound knowledge of the radiographic appearance of normal structures That’s why we will start already now with anatomy

First some definitions Radio-opaque =White or gray areas Metal – enamel – dentin - bone Radiolucency =Black areas Less grey than neighboring area white

Findings in radiographs Hard tissues, such as bones and teeth =radiopaque view Anatomic landmarks foramens, cavities are radiolucent and bone ridges radiopaque Cysts bone lesion visible as cavity = radiolucency Fillings amalgam as white areas composites as grey areas, less radio-opaque than teeth root canal filling as grey, more radio-opaque than tooth Prosthodontic appliances crowns =radiopaque

Facial bones and some landmarks visible in dental radiographs of the upper jaw. We will concentrate on the upper jaw today Upper jaw region----some basic structures to start with Maxilla Zygomatic bone Nasal cavity Maxillary Sinus Orbit

Different dental radiographs Periapical x-ray Bite wing small x-ray showing crowns of teeth Occlusal x-ray showing teeth from above, along the axis of teeth Panoramic view OPG showing all teeth, jaws and surroundings Lateral view Posterior-anterior view Tomographic methods especially CT= computed tomography, based on radiation MRI= magnetic resonance imaging, based on magnetic fields All these intraoral x-rays All these extraoral x-rays…..what’s that?

Extra-oral Radiography Include all views made of the orofacial region with the film positioned extra-orally. Used to visualize the skull and facial structures, for detection of disease or injury or to evaluate skeletal growth. All extra oral radiograph require screen film and intensifying screen, that’s why they will only give us a low radiation dose even if they are quite big (the screen will enhance the ‘small’ radiation coming)

Occlusal view but nor normal anatomy!

Periapical x-ray (intraoral ones)

A FMS or CMS can be taken 9 in the upper and 7 in the lower jaw and 4 bitewings

Normal findings in x-rays Teeth dentin and enamel have different shades due to variation in mineralization radiopacity: enamel – dentin – pulp cemento-enamel junction should be recognized Periodontium lamina dura thin layer of dense bone surrounding the root periodontal ligament space thin radiolucent area between root and lamina dura alveolar crest bone that extens between the teeth normal level no more than 1,5 mm from cemento-enamel junction

Normal bone findings in x-rays cortical bone superficial layer of all bones better visible in mandible than in maxilla dense and hard bone cancellous bone s.c. trabecular bone trabeculation varies net-like appearance

Today the upper jaw!!

Normal findings in x-rays, upper jaw Intermaxillary suture visible in occlusal radiographs Anterior nasal spine visible in periapical radiograph Incisive foramen visible in periapical or occlusal radiograph Maxillary sinus in OPG and periapical x-rays Zygomatic process in opg and periapical x-rays

A1 j i k L a c b d e f g h Name the following structures a enamel b dentin c enamel-dentin junction d pulp horn e pulp chamber f root canal g furcation area h cancellous bone between the roots i furcation area…..enamel pearl? j lamina dura k PDL space l lamina dura (approximal) i k L a c b d e f g h

Locate the radiographic apices of these teeth b a Identify the teeth: 21, 22, 23 (24, 25) Locate the radiographic apices of these teeth c d   Name the structures: a floor of nasal fossa b inverted Y (crossing sinus max-nasal cavity) c floor of sinus max d soft tissue of the nose

The lateral fossa between the lateral and the canine

Upper anterior

a d c b e 12, 11; 21 22 a nasal septum b nasal mucosa g c nasal fossa Identify the teeth and name the structures e d 12, 11; 21 22   a nasal septum b nasal mucosa c nasal fossa d floor of the nasal fossa e anterior nasal spine f intermaxillary suture g incisive foramen h soft tissue of the nose g f h

a Identify the teeth and name the structures b f Identify the teeth: 14, 13, 12   a floor nasal cavity b floor sinus max c filling, plastic d filling in plastic e PDL of the second root f Lateral fossa e d c

Canine view/x-ray

Identify the teeth: and name the structures a b d Identify the teeth: 21, 22, 23, 24, 25, 63, 64, 65 Estimate the age: 8-9 y   a floor nasal fossa b bony crypt (developing tooth) c follicular space d not fully formed root . c

Premolar and molar view

B1 a c b d Locate the radiographic apexes of these teeth. Name the structures   a zygomatic arch bZygomatic bone inferior border c tooth bud d follicular space

B2 a c d b Locate the radiographic apexes of these teeth. Name the following structures   a lateral part of floor of nasal fossa b sinus max inferior border c septum in sinus max d posterior wall of SM

d c a b Identify the teeth and name the strucures Identify the teeth: 17 to 27 (55 to 53, 63 to 65) Name the following structures a Nasal septum, intermaxillary suture b superior foramina of the nasopalatine canal c sinus max d nasolacrimal duct

B4 d d c b a b tuberosity a Proc. Coronoideus c pterygoid plates d proc. Zygomaticus Locate the radiographic apices of these teeth Name the following structures

B5 a b f c e d Identify the area and name structures Identify the area:upper anterior (midline), edentulous patient   Name the following structures a nasal fossa b mucosa of nasal fossa c floor of nasal cavity d nose e nose opening f anterior nasal spine e d

Thanks for today….now answer this question!!