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Introduction the Material in This Program Has Been Divided Into Maxillary and Mandibular Features

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Introduction the Material in This Program Has Been Divided Into Maxillary and Mandibular Features Introduction The material in this program has been divided into maxillary and mandibular features. First time learners of this material may prefer to read through the textual material in sequence while clicking on highlighted text to view anatomic features and illustrations. Students who are already familiar with radiographic anatomy and who wish a quick review of radiographic features may find the alphabetic lists that can be accessed from the menu in the frame on the left to be a more efficient way to review material. Additional views may be seen and feature descriptions may be reviewed by clicking on the image and then clicking on the desired highlighted term. Objectives As you explore this program, keep the following objectives in mind. After completing the material you should be able to: Name normal anatomic structures labeled on an intraoral radiograph, and Point out or trace on an intraoral radiograph the anatomic structures named. To help you review and make sure you've met the program objectives, quizzes are included for you to test yourself. Although this is a stand-alone exercise, it may be helpful for you to review text chapters on dental anatomy and the bones of the head to fully integrate the material into your knowledge of clinical anatomy. Material on dental anatomy and head and neck anatomy can be found in a 1 number of sources including several web locations listed on the Other Web Resources page of this program. Mandibular Anatomy To understand this part of the program well, you should already be familiar with the basic shape, and anatomical features of the mandible, and you should know the meaning of certain anatomical descriptive terms such as fossa, ridge and foramen. Dental and Periodontal Anatomy First of all, several structures of the tooth and periodontium must be clearly identifiable in any periapical radiograph. These structures, labeled in the drawing, include the enamel, dentin, pulp, periodontal membrane and alveolar bone. In a periapical radiograph, the enamel, which is the hardest substance in the human body, appears as the most radiopaque (lightest) part of the crown of the tooth. The dentin is a less-mineralized hard structure of the tooth between the enamel and the pulp and is not as radiopaque as the enamel. The pulp is the radiolucent (dark) area in the center of the root and crown where the soft tissues, which include the nerves and blood supply, are located. The periodontal membrane appears in a periapical radiograph as a space, or dark radiolucent line, adjacent to the tooth root. Next to the periodontal ligament space there is a thin light or radiopaque line called the lamina dura ,which is the radiographic representation of the outer cortex of the alveolar bone. Finally, the radiograph also shows the alveolar bone, the supportive housing for all of the dentition. 2 As you progress through this program, you'll see many different radiographs which all show normal features. You'll note that even normal features don't have the same appearance or distinctiveness in every patient. You'll also see many features that are not labeled or discussed specifically. Examine each radiograph carefully. Try to identify each feature, and compare different views of similar features. Remember that you're using this program to teach yourself, so start now to develop your interpretive and analytical skills. The mandible forms the skeleton of the lower jaw and houses the lower dentition. Since the mandible is an articulated bone, it is movable, and thereby capable of providing necessary movements for the mastication of food and the production of speech. To facilitate this movement the mandible has several areas of attachment for the muscles participating in mastication and speech. These bony prominences for muscle attachments are often referred to as ridges and tubercles. This drawing demonstrates where some of these muscles are located. More will be said about these areas later in the program. The lower border of the mandible is the thick cortical plate that forms the lower edge of the mandible. The solid thickness of bone along the inferior border of the mandible is seen in the radiograph as a uniform wide radiopaque band at the margin of the mandible. The mental ridges are elevated ridges of bone located 3 along the anterior aspect of the mandible. The ridges are also known as the mental tubercles and fuse at the midline to form the mental protuberance, the anteriormost aspect of the mandible. This periapical radiograph demonstrates the radiopaque margin of the mental ridges. Study these and compare the varying appearance of these landmarks. The genial tubercles are small bony spines found on the lingual aspect of the mandible adjacent to the midline at the attachment of the geniohyoid and genioglossus muscles. In this close-up view you can clearly see the genial tubercles on the lingual midline. Notice also the small opening right in the middle of the tubercles. This is called the lingual foramen, an opening in the lingual midline of the mandible for a small vessel. This illustration demonstrates the function of the genial tubercles, or mental spines as they are sometimes called, as a locus for the attachment of the geniohyoid and genioglossus muscles. This occlusal radiograph of an edentulous mandible depicts the genial tubercles as seen in an axial plane. If you look closely here you can also discern the attached muscles, which make up the floor of the mouth. In this periapical radiograph of the mandibular anterior region, the genial tubercles appear as a distinct circular radiopacity, an area of dense bone, near the midline below the apices of the teeth. The lingual foramen appears as a small circular radiolucent area surrounded by the genial tubercles. The soft tissues of the superior margin of the lower lip will often be projected onto the anterior periapical 4 radiograph and are seen as a horizontal step or change in the general radiopacity of crowns of the teeth. The darker side of the step is toward the incisal edge of the crowns and represents the air space above the lip. Sometimes this lip line is projected lower and will be superimposed over the free gingival margin or the crest of the alveolar ridge. In some individuals, a particularly prominent lower lip may produce a second horizontal line which delineates the rolled portion of the lip from the thinner soft tissues of the face between the lip and above the chin. The lower arrows in this image denoted the inferior margin of the lower lip. Note that the soft tissues of the face immediately below the inferior margin of the lip are not as thick and appear slightly more radiolucent. The top most arrows in this image point to the superior margin of the lip. Another soft tissue shadow that occasionally appears on mandibular anterior periapical films is the margin of the soft tissue of the chin. This feature tends to appear on radiographs of individuals who have prominent chins and in those situations where the central ray parallels the upper "shelf" of the chin. The difference in thickness of soft tissues of the chin shelf and those just below the lip are sufficient to cause an abrupt change in density or a "density step" on the image. The chin soft tissue margin, delineated by the white arrows, should not be confused with the mental ridges, demonstrated by the black arrows, which appear as radiopaque bands below the soft tissue border of the chin. In the mandible, as in the cranium shown here, nutrient 5 canals, which hold blood vessels, run along the inner surface of the bone cortex, where they lie in slight depressions. These are visible radiographically because the bone is proportionately thinner where it is displaced by a vessel and thus appears more radiolucent. Radiographically, nutrient canals appear as uniform thin radiolucent lines. The margin of these lines is often slightly more radiopaque than the adjacent bone. Sometimes these canals can be seen running toward the apices of teeth as accessory branches of the inferior alveolar canal. In this instance the canals contain both blood vessel and nerve supplies to the tooth and are termed accessory canals. Nutrient canals are most noticeable when they appear between roots or within edentulous areas where they lie against the bony wall and reduce the thickness of bone in the area of the vessel. Another anatomical feature you will encounter occasionally is shown in this clinical intraoral image. The rounded protuberances on the lingual surfaces of the alveolar process are called mandibular tori, or singularly, a mandibular torus. This fairly common feature is a hard, bony enlargement of the alveolar cortex. Radiographically, mandibular tori appear as large rounded radiopacities in the area of the roots of the teeth, usually the canines and premolars. The tori are quite distinct in these two anterior periapical projections. The mental foramen is an opening in the facial aspect of the mandible in the premolar area. This photograph of the mandible demonstrates the usual location of the mental foramen. You can see that its position will cause 6 it to appear radiographically near the apex of the lower second premolar. As this drawing demonstrates,the mental foramen provides the exit point from within the mandible for the mental nerve, as well as the inferior alveolar artery. In periapical radiographs the mental foramen appears as a rounded radiolucency in the apical region distal to the canine and mesial to the first molar. Often it is not as distinct as some other landmarks, but recognizing it is important. Sometimes the mental foramen will be superimposed on the apex of a premolar, and will give the appearance of pulpal pathology.
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