Anatomy on Radiographs: Intraoral Radiographs Part I

Posted 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 o l!sal radiographs, one on pantomographs and lastly one on s"!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% orti ated edge.

Canals radiol! ent line or band, may or may not ha#e radiopa$!e% orti ated edge(s). &ow on to the anterior portion of intraoral radiographs. Mandible The mandible is a ni e pla e to start as there are fewer anatomi al landmar"s identifiable in the anterior region ( ompared to the ma'illa). There are fo!r anatomi al landmar"s fre$!ently identifiable( ling!al foramen, n!trient anals, mental ridge, and inferior border of the mandible.

The lingual foramen appears as a small radiol! ent ir le dire tly inferior to the entral in isors. It is not always #isible on e#ery patient.

Nutrient canals (vascular canals) are anals ontaining blood #essels o!rsing thro!gho!t the ma'illa and mandible. They are #ery small and more ommonly seen in areas of thin bone (hen e the anterior mandible). They appear as a radiol! ent line or band o!rsing in a #erti al dire tion.

The mental ridge (mental triangle) appears as two obli$!e thi " radiopa$!e bands that that meet in the midline gi#ing it the appearan e of an in#erted ) or triangle shape. This is more ommonly seen when an in reased negati#e #erti al angle is !sed.

The inferior border of the mandible appears as a thi " radiopa$!e band. Maxilla The ma'illa has $!ite a bit more anatomy e#ident in l!ding a good portion of the nasal a#ity.

The intermaxillary suture appears as a thin radiol! ent line between the two ma'illary entral in isors. It may not be #isible on all patients.

The incisive foramen appears as a ro!nd to o#oid radiol! ent area between the roots of the ma'illary entral in isors.

The anterior nasal spine appears as an in#erted radiopa$!e triangle or )*shaped. It is on the midline and s!perior to the api es of the ma'illary entral in isors.

The incisive fossa appears as a well*lo alized radiol! ent area aro!nd the root of the ma'illary lateral in isor. This is d!e to a de rease in bone thi "ness in this region.

The soft tissue of the nose appears as a radiopa$!e area s!perimposed o#er the ma'illary anterior teeth. The tip of the nose is seen o#er the ma'illary entral in isors. The ala of the nose is seen o#er the lateral in isors.

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

The nasal cavity appears as a radiol! ent area s!perior to the floor of the nasal a#ity.

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

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

The line of !nnis (inverted ) is not a tr!e anatomi al landmar" b!t seen only on radiographs d!e to s!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 appears as a !r#ed, thin radiopa$!e line s!perior to the roots of the anine and posterior teeth. The ma'illary sin!s appears as a radiol! ent area s!perior to the border of the ma'illary sin!s.

Anatomy on Radiographs: Intraoral Radiographs Part "

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 se ond premolar.

The inferior alveolar nerve canal (mandibular canal) appears as radiol! ent band with two thin radiopa$!e lines r!nning parallel to ea h other (s!perior and inferior). If only one border it #isible, it is more li"ely the inferior border.

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

The mylohyoid ridge appears as a thi " radiopa$!e line fre$!ently seen near the roots%api es of the posterior teeth.

The submandibular salivary gland fossa appears as an area of more radiol! ent bone inferior to the mylohyoid ridge.

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

The coronoid process is seen on ma'illary molar periapi als. It appears as a triang!lar radiopa$!e area s!perimposed o#er the ma'illary molars and t!berosity.

Maxilla

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

The $ygomatic process of the maxilla appears as a ,, ) or - shaped radiopa$!e line. It is s!perior to the first and se ond molars.

The $ygomatic bone appears as a radiopa$!e area distal to the zygomati pro ess of the ma'illa.

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 se ond 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 Gonzalez 0 &o 1omments 2 3", I am ba " and now onto pantomographs. Sin e these images are larger and will ta"e !p m! h more spa e I ha#e de ided to brea" them down into + parts. I also will ha#e se#eral anatomy identified on ea h radiograph as well. 4ere we go.

Mandible

5The mandib!lar condyle (two thin arrows pointing down) appears as a ro!nded radiopa$!e area in the glenoid fossa on the lateral aspe t of the radiograph. 5new anatomy not #isible on intraoral radiographs. The coronoid process (triangles) appears as a triang!lar radiopa$!e area s!perimposed o#er the ma'illary t!berosity and posterior ma'illary sin!s. The lingual foramen (circle) appears as a small radiol! ent ir le dire tly inferior to the entral in isors. The inferior border of the mandible (multiple thick arrows pointing up) appears as a thi " radiopa$!e band.

The mental foramen (circle) appears as a ro!nd to o#al radiol! ent area seen near the ape' of the se ond premolar. The inferior alveolar nerve canal & mandibular canal (two !r#ed lines) appears as radiol! ent band with two thin radiopa$!e lines r!nning parallel to ea h other (s!perior and inferior).

Maxilla

The line of !nnis % inverted (arrow) is not a tr!e anatomi al landmar" b!t seen only on radiographs d!e to s!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 to the roots of the anine and posterior teeth. The maxillary sinus appears as a radiol! ent area s!perior and medial 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 is s!perior to the first and se ond molars.

Nasal region

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'illary anterior teeth. This is more ommonly seen on patients who are edent!lo!s in the anterior ma'illa.

The nasal septum (orange vertical block) appears as a radiopa$!e band going s!perior from the floor of the nasal a#ity. It is on the midline. The inferior nasal concha (yellow horizontal mass) appears as a ro!nd to o#oid radiopa$!e mass s!perior to the floor 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 Gonzalez 0 6 1omments 2 &ow onto other str! t!res #isible on a pantomograph.

Midface

The orbital rim (green dots) appears as a thi " semi ir !lar radiopa$!e band s!perior to the ma'illary sin!ses. The pterygomaxillary fissure (blue area) appears as an in#erted teardrop shaped radiol! ent area with a thin radiopa$!e border. It is dire tly lateral to the ma'illary sin!s. The $ygomatic bone (yellow line)appears as a radiopa$!e area distal to the zygomati pro ess of the ma'illa. It is s!perimposed o#er the distal aspe t of the ma'illary sin!s and pterygoma'illary fis!re.

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

'ther

The external auditory meatus (yellow circle) appears as a ro!nd to o#oid radiol! ent area lateral to the glenoid fossa and ondyle. The cervical spine (black arrows) appears radiopa$!e and is seen on the lateral aspe t of the pantomograph. It is not seen on all patients and #is!alization is dependent on patient positioning and size. The hyoid (blue dotted circle) appears radiopa$!e inferior to and%or s!perimposed o#er the inferior border of the mandible.

The ear lobe (double green curved lines) appears as a radiopa$!e area lateral to and%or s!perimposed o#er the ram!s of the mandible. The oropharynx (blue dotted line) appears as a radiol! ent band s!perimposed o#er the roots of the ma'illary teeth dire tly inferior to the floor of the nasal a#ity. This is only seen when the patient does not position their tong!e to the roof of the mo!th d!ring the e'pos!re. The soft palate (yellow line) appears as a radiopa$!e mass oming off the floor of the nasal a#ity. This is more readily 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 Gonzalez 0 + 1omments 2 This wee" is e'traoral radiographs, spe ifi ally 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 anatomi al landmar"s !sed in orthodonti s, b!t if yo! wo!ld li"e a post on this, please let me "now and I an reate one.

(ateral )ephalometric *+ull

The right and left sides of the inferior border of the mandible (yellow arrows) are seen s!perimposed o#er ea h other. The right and left maxillary sinuses (green dots) appear as a radiol! ent area s!perior to the api es of the ma'illary teeth. The floor of the nasal cavity (blue line) appears as a horizontal radiopa$!e line at the api es of the ma'illary teeth.

The hyoid (green arrow) appears a radiopa$!e entity inferior to the mandible near the angle. The cervical spine (yellow arrow) is #isible at the lateral aspe t of the image posterior to the mandible. The sella turcica (blue U) appears as a radiopa$!e , s!perior to the ondyle and posterior to the sphenoid sin!ses. The frontal sinuses (orange area) appear as a radiol! ent area at the anterior portion of the s"!ll 7!st s!perior to the orbits.

Anatomy on Radiographs: 'cclusal Radiographs

Posted on by Dr. Shawneen Gonzalez 0 &o 1omments 2 This is the last post I ha#e planned for anatomy and it will be on o l!sal radiographs. Mandible Short and sweet here with only one anatomi al landmar" readily #isible.

The genial tubercles (yellow arrow) appear as a small radiopa$!e mass(es) e'tending off the ling!al aspe t of the mandible.

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 areas s!perior to the ma'illary entral in isor api es and lateral to the nasal sept!m.

The nasolacrimal canal (yellow circles) appear as ro!nd to o#oid radiol! ent areas at the lateral aspe t of the nasal 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 to the nasola rimal anal and nasal a#ity.

The $ygomatic process of the maxilla (blue arrow) appears as a radiopa$!e mass e'tending lateral of the teeth near the le#el of the first molars. The anterior nasal spine (yellow lines) appears as a radiopa$!e ). It is on the midline and pro7e ted near the midroot portion of the ma'illary entral in isors. The soft tissue of the nose (green curved dotted line) appears as a radiopa$!e area s!perimposed o#er the ma'illary entral in isors.

,o- -as that missed. (Impacted teeth)

Posted on by Dr. Shawneen Gonzalez 0 8 1omments 2 I re ently had a re$!est to show some missed and%or misdiagnosed ases. I oddly eno!gh ame a ross one of these ases shortly after that re$!est and de ided to start with two ases of missed impa ted 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 impa ted mandib!lar anine near the inferior border of the mandible slightly to the patients/ left of the midline. I realize this is not a great radiograph (the 7oys of s anning a print o!t of a digital image sorry) b!t yo! sho!ld note a horizontal radiopa$!e entity with the rown and folli le to the patients left (inferior to the first molar%se ond premolar region). It is #ery s!btle and hen e it was missed for +9 years before it was noti ed.

)ase "
This ase was presented to me as a possible implant ase and trying to determine whether or not the patient wo!ld re$!ire a one beam 1T. There is an impa ted tooth (it appears to be a mandib!lar anine) horizontal in the right mandible. The enamel of the rown is ) shaped and at the medial aspe t of the e'ternal obli$!e ridge. It again is #ery s!btle and than"f!lly a!ght before any implants were attempted to be pla ed in this lo ation.

.hile these are both simple ases of impa ted teeth that were missed on the radiographs and were not life threating, 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 Gonzalez 0 &o 1omments 2

This wee" I ha#e a ase of tra!ma to the mandible and its radiographi appearan e 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'a t type of tra!ma fight, a ident, et .). Ta"e a loo" below to see what/s going on.

:ost li"ely, the left mandib!lar fra t!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 s an was performed. 1he " o!t the s o!t #iew below (#iewed as if loo"ing at the patient yo!r right is patients left and #i e #ersa).

&oti e something a miss on the patient/s ride side; < #erti al 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 radiopa ity e#ident. This is an e'ample of two fra t!re segments o#erlapping ea h other reating an area of in reased

radiopa ity. =or more on the the > radiographi appearan es of fra t!res he " it o!t here. 4ere is an a'ial #iew showing the fra t!re of the right angle of the mandible with the two segments o#erlapping ea h other. If yo! loo" in the patients left premolar region, yo! an see the dis ontin!ity of the more readily #isible fra t!re on the pantomograph.

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

Radiographic /echni#ue: Maxillary 'cclusal Radiographs

Posted on by Dr. Shawneen Gonzalez 0 + 1omments 2 This is the first of two posts on o l!sal te hni$!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)

3 l!sal radiographs are made !sing an e'treme bise ting angle te hni$!e. The film%sensor is pla ed on the o l!sal s!rfa es of the teeth. ,sing the long a'is of the tooth and the long a'is of the film%sensor an angle is reated between the two. To determine the dire tion of the ' ray beam, the angle m!st be bise ted first and then orient the ' ray beam perpendi !lar (at BC degrees) to the bise ted angle. This te hni$!e res!lts in more distortion and shortening of the teeth. <ll o l!sal radiographs are made !sing a ro!nd PID.

Maxillary 'cclusal Radiographs

Maxillary Anterior The ma'illary anterior o l!sal radiograph an be made on both ad!lts and hildren. =or an ad!lt, it is made !sing a si$e 0 film%phosphor plate with the long axis antero1posteriorly or hori$ontally2 It is important to ha#e a minim!m of D m of film%phosphor plate anterior to the ma'illary entral in isors. The entral ray (PID) is aimed with a #erti al angle of 304 to 356 degrees7 a horizontal angle of 6 degrees and centered through the tip of the nose. =or a hild, a size + film%phosphor plate is !sed with the long a'is lateral. The entral ray is positioned the same as for an ad!lt.

Eong*a'is of film pla ed antero*posteriorly with a minim!m of D m of film anterior to entral in isors.

PID positioned ( entered on tip of nose) with a #erti al angle of 9>F to 98C degrees and a horizontal angle of C degrees.

G'ample ad!lt ma'illary anterior o l!sal radiograph.

G'ample hild ma'illary anterior o l!sal radiograph. Maxillary tandard !Maxillary Cross"sectional# The ma'illary standard o l!sal radiograph is made with a si$e 0 film%phosphor plate. The film%phosphor plate

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

Eong*a'is of film pla ed horizontally.

PID positioned ( entered on bridge of nose) with a #erti al angle of 98F to 9HC degrees and a horizontal angle of C degrees.

G'ample ma'illary standard o l!sal radiograph. Maxillary $ateral The ma'illary lateral o l!sal radiograph is made !sing a si$e 0 film%phosphor plate with the long axis parallel to the facial surfaces of the posterior teeth. The entral ray (PID) is aimed with a #erti al angle of 356 to 386 degrees and centered slightly inferior to the corner of the eye.

Diagram showing long*a'is of film parallel with fa ial s!rfa es of posterior teeth (pin" arrows).

Eong*a'is of film parallel with fa ial s!rfa es of posterior teeth.

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

G'ample ma'illary lateral o l!sal radiograph.

)ase of the -ee+: Normal pantomograph imaging mimic+ing disease

Posted on by Dr. Shawneen Gonzalez 0 &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.

This area is typi ally where an obser#ers eye are drawn d!e to the ontrast of how radiol! ent it appears ompared to ad7a ent str! t!res. This area is a normal pro7e tion of pantomographs and reated by the s!perimposition of two entities and normal anatomy. The first entity that is s!perimposed is the er#i al spine (#erti al yellow dotted lines). This reates an in reased radiopa$!e area in the mid*line of the radiograph.

The se ond s!perimposition is a ghost image of the opposite ram!s (green dotted line). This reates an in reased radiopa$!e area s!perior to the mid*root and api al portions of the mandib!lar posterior teeth.

The last thing that is ma"ing this area appear more radiol! ent is the normal anatomy of the s!bmandib!lar sali#ary gland fossa where the mandible is thinner in this region reating an appearan e 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 this spe ifi area on a pantomograph, please let me "now. Than"s and en7oyJ

Radiographic /echni#ue: Mandibular 'cclusal Radiographs

Posted on by Dr. Shawneen Gonzalez 0 &o 1omments 2 This is the se ond and last post on o l!sal te hni$!e. =or a refresher on basi o l!sal te hni$!e go here.

Mandibular 'cclusal Radiographs

Mandibular Anterior The mandib!lar anterior o l!sal radiograph is fre$!ently made on both ad!lts and hildren. 3n ad!lts, it is made with a si$e 0 film%phosphor plate with the long axis antero1posteriorly or hori$ontally. It is important to ha#e a minim!m of D m of film%phosphor plate anterior to the mandib!lar entral in isors. The entral ray (PID) is aimed with a #erti al angle of 144 to 156 degrees7 a horizontal angle of 6 degrees and centered on the chin. =or a hild, a size + film%phosphor plate is !sed with the long a'is laterally. The entral ray is positioned the same as for an ad!lt.

Eong*a'is of film pla ed antero*posteriorly with a minim!m of D m of film anterior to entral in isors.

PID positioned ( entered on hin) with a #erti al angle of FF to *8F degrees and a horizontal angle of C degrees.

G'ample ad!lt mandib!lar anterior o l!sal radiograph.

G'ample hild mandib!lar anterior o l!sal radiograph. Mandibular %rue !Mandibular Cross"sectional# The mandib!lar tr!e o l!sal radiograph is one of the most ommonly made o l!sal radiographs. It is made !sing a si$e 0 film%phosphor plate with the long axis laterally. The entral ray (PID) is aimed with a #erti al angle 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 a side depending on what yo! want to #iew.

Eong*a'is of film pla ed horizontally.

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

G'ample mandib!lar tr!e o l!sal radiograph.

Mandibular $ateral The mandib!lar lateral o l!sal radiograph is made !sing a size > film%phosphor plate. The film%phosphor plate is positioned with the long axis parallel to the facial surfaces of the posterior teeth2 The entral ray (PID) is aimed with a #erti al angle of 146 degrees through the center of interest (typi ally the molar or premolar region).

Diagram showing long*a'is of film parallel with fa ial s!rfa es of posterior teeth (pin" arrows).

Eong*a'is of film parallel with fa ial s!rfa es of posterior teeth.

PID positioned ( entered on area of interest) with a #erti al angle of *FC degrees and a horizontal angle of IBC degrees.

,o- -as that missed. (Periapical & Radicular cyst)

Posted on by Dr. Shawneen Gonzalez 0 + 1omments 2 ?eing that the two pre#io!s posts on radiographi entities either loo"ed o#er or misdiagnosed reated $!ite a few omments and $!estions, I ha#e de ided to ma"e this a more reg!lar series. The plan (as of now) is to post on e 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.

Ae onstr! ted pantomograph showing well*defined, orti ated, o#oid radiol! ent area e'tending from mandib!lar left first molar to impa ted third molar. There is thinning and inferior displa ement of the inferior border of the mandible.

1ross*se tional sli es near mandib!lar left first molar showing al ifi ations within the radiol! ent lesion not #isible on re onstr! ted pantomograph. There is thinning of the fa ial and ling!al orti al plates with a dis ontin!ity of the ling!al orti al plate. -nitial interpretation. ?ased on the images abo#e with the e'pansion % displa ement of the orti al plates and m!ltiple al ifi ations within the lesion, the initial interpretation had an odontogeni neoplasm s! h as a al ifying epithelial odontogeni t!mor (1G3T) as the top possibility. /istopathological &iagnosis. Periapi al % Aadi !lar yst $esson learned. I was e' ited !pon seeing the al ifi ations and a!tomati ally went to an entity (1G3T) whi h is m!st less ommon than a radi !lar yst. This ase is a good e'ample of showing how a long standing yst an ha#e dystrophi al ifi ations o !r within the entity. This is also where information abo!t the teeth ad7a ent,

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 pro esses o!t there (st!dents and fa !lty ali"e are all g!ilty of this)K howe#er there is a reason the saying L ommon things o !r ommonly/ is o!t there. This ase was a good reminder to al-ays go thro!gh ommon disease pro esses first before 7!mping to less ommon disease pro esses.

)ase of the -ee+: /hird Molar in Maxillary *inus

Posted on by Dr. Shawneen Gonzalez 0 &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!s ad7a ent to a s!pern!merary tooth on a 1?1T s an. -nterpretation( This ase shows a mi'ed radiol! ent%radiopa$!e entity in the right ma'illary sin!s. The radiopa ity is that of tooth str! t!re. The appearan e is onsistent with a de#eloping third molar pre#ented from its typi al lo ation (near the rest of the al#eolar ridge) by another tooth (s!pern!merary tooth).

Ae onstr! ted pantomograph showing mi'ed radiol! ent%radiopa$!e entity in right ma'illary sin!s (orange arrow).

<'ial #iew showing radiopa ity is that of tooth str! t!re.

1oronal #iew

Sagittal #iew

1ross*se tional sli es I realize this is 7!st a few s reenshots from a 1?1T s an, b!t these sho!ld be ade$!ate to show the basi s of this ase. If yo! ha#e any $!estions abo!t this, please let me "now.

)ase of the -ee+: !namel ,ypoplasia

Posted on by Dr. Shawneen Gonzalez 0 &o 1omments 2 This wee" I ha#e a ase of enamel hypoplasia on the ma'illary entral in isors. I ha#e no information on the history 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 of the rown. This is d!e to the altered formation of the enamel.