Dental Anatomy and

N o m e n c l a t u re f o r th e
Radiologist
Mohammed Abbas Husain, DDS

KEYWORDS
! Tooth naming ! Dental anatomy ! Dental restorations ! CT imaging

KEY POINTS
! The Universal and Federation Dentaire International systems are the major systems for numbering
teeth.
! In the United States, the universal system assigns a number 1 to 32 to each of the permanent teeth,
and letters A to T to each of the primary teeth.
! Teeth consist of a crown and one or more roots. The crown is visible within the oral cavity; the root is
embedded in the alveolar bone.
! Teeth are made up of 4 dental tissues (enamel, dentin, pulp and cementum), most of which have
distinct radiographic densities on computed tomography (CT) imaging.
! Dental restorations are common and include fillings, crowns, root canal obturation materials, and
dental implants. On CT imaging, most of these materials create substantial metallic artifacts.

INTRODUCTION (succedaneous) dentition. Whether primary or per-

manent, the dentitions are further subdivided based
The dentition is frequently encompassed in imag- on the location of a tooth in the upper or lower jaw,
ing studies of the head and neck. As a result, inci- or within a specific quadrant of the oral cavity. The
dental abnormalities of the dentition are frequently teeth in the upper jaw are referred to as the maxil-
visualized by interpreting radiologists. The abnor- lary teeth and in the lower jaw as the mandibular
malities encountered can potentially alter the teeth. The 4 quadrants of the oral cavity are desig-
course of patient treatment and may require nated the maxillary right, maxillary left, mandibular
referral to dental practitioners. To effectively iden- left, and mandibular right quadrants (Fig. 1). The di-
tify and communicate the abnormalities that are vision into quadrants serves as a convenient basis
observed, a good understanding of dental devel- for 1 type of tooth classification system described
opment, morphology, and terminology is required. elsewhere in this article, because the types of teeth
This article provides an overview of dental anat- in each quadrant are repeated. For example, the
omy and nomenclature, allowing the radiologist permanent dentition consists of 8 teeth in each
to communicate confidently and accurately with quadrant: 2 incisors (central and lateral), a canine,
regard to the dentition. 2 premolars, and 3 molars, yielding a total of 32
teeth (Fig. 2A). In the primary dentition, each quad-
TOOTH NOMENCLATURE, NAMING, rant contains 5 teeth: 2 incisors (central and lateral),
AND NUMBERING a canine, and 2 molars (Fig. 2B). These teeth are
Humans develop 2 sets of dentitions, often referred repeated in each of the 4 quadrants of the oral cav-
radiologic.theclinics.com

to as the primary (deciduous) and permanent ity giving a total of 20 teeth.

Disclosures: None.
Section of Oral and Maxillofacial Radiology, UCLA School of Dentistry, 10833 Le Conte Avenue, 53-067A CHS,
Box 951668, Los Angeles, CA 90095-1668, USA
E-mail address: [email protected]

Radiol Clin N Am - (2017) -–-

http://dx.doi.org/10.1016/j.rcl.2017.08.001
0033-8389/17/! 2017 Elsevier Inc. All rights reserved.
2 Husain

Fig. 1. Graphic drawing demon-

strates division of the oral cavity
into 4 quadrants. (Courtesy of
dentalcare.com.)

Quadrant 1 Quadrant 2
Maxillary right Maxillary left

Quadrant 4 Quadrant 3
Mandibular right Mandibular left

Teeth can be referred to by name or by num- be as follows: permanent maxillary right central
ber. Naming teeth is generally more cumbersome incisor. The qualifier specifying the type of denti-
owing to the multiple qualifiers necessary to tion, permanent or primary, is unnecessary once
specify a given tooth. Nonetheless, the nomencla- all the primary teeth have been exfoliated. Addi-
ture of tooth naming is universally accepted and tionally, it is unnecessary when referring to per-
so is useful when there is doubt about the appro- manent teeth that have no primary analog, such
priate number assigned for a tooth. This may arise as the first and second premolars and third
if there is uncertainty about the classification sys- molars.
tem being used (such as when interpreting inter- Two main classification systems exist for the
national studies), or when teeth may have numbering of teeth: the universal system and the
moved position secondary to extractions or or- Federation Dentaire International system. Despite
thodontic tooth movement. This is a common its name, the universal system is actually quite
scenario after orthodontic extraction of the first country specific; it is the system adopted in the
premolars. The second premolars frequently United States by the American Dental Associa-
have moved into the position of the first premo- tion.2 In this system, only teeth are numbered.
lars, and this may create confusion about its The numbering begins in the upper right quadrant
appropriate tooth number. The convention for with #1 referring to the maxillary right third molar
naming teeth should follow this sequence: denti- (Fig. 3A). The numbering continues along the
tion (primary or permanent), jaw (maxillary or maxillary arch from the right side to the left ending
mandibular), side (right or left), tooth name with the maxillary left third molar, which is
(incisor, canine, premolar, or molar).1 An example assigned #16. The numbering then drops to the
of a tooth name following this convention would lower left quadrant beginning with the mandibular
 Dental Anatomy and Nomenclature 3

A Permanent teeth B Deciduous teeth

Central incisors

Lateral incisors Central incisor

Cuspid Lateral incisor

1st premolar
Canine
Upper teeth 2nd premolar
1st molar First molar

2nd molar Upper teeth

Second molar

3rd molar or
wisdom teeth

Second molar Lower teeth

2nd molar

1st molar
Lower teeth First molar
2nd premolar
1st premolar Canine
Cuspid
Lateral incisor
Lateral incisors
Central incisor
Central incisors

Fig. 2. (A) Types of permanent teeth (incisors, canines, premolars, and molars) found in each quadrant. (B) Types
of primary teeth (incisors, canines, and molars) found in each quadrant. Note the repetition in types of teeth
found across the quadrants.

left third molar, assigned #17, and continues second molar is the first tooth in the series
around the mandibular arch. The last tooth in this assigned letter A, and the primary mandibular right
system is the mandibular right third molar, which second molar is the last tooth in the series and
is assigned #32. The universal system classifies assigned the letter T.
the primary dentition in an analogous fashion, but The Federation Dentaire International system
using letters of the alphabet A through T rather is more widely used globally and adopted
than #1 to #32 (Fig. 3B). The primary maxillary right by the World Health Organization and the

A Permanent teeth B Deciduous teeth

8 9 E F
7 10
6 11 D G
5 12
C H
4 13
Upper right Upper left Upper right I
B Upper left
3 14

A J
2 15
Maxillary Maxillary

1 16

32 17

Mandibular Mandibular
31 18
T K

Lower right 30 19
Lower left Lower right Lower left
29 20 S L

28 21 R M
27 22 Q N
26 25 24 23 P O

Fig. 3. (A) Universal numbering system for permanent teeth. (B) Universal numbering system for primary teeth.
The universal numbering system is the most widely accepted system in the United States. Note that numbering
always begins in the maxillary right quadrant and ends in the mandibular right quadrant.
4 Husain

International Association For Dental Research.2 number 23 (spoken as “two–three” rather than
It is a system in which both dental quadrants “twenty-three”). The “2” in “23” reflects the posi-
as well as the teeth are numbered. Each quad- tion of the tooth in the upper left quadrant, and
rant is assigned a number, 1 to 4, starting with the “3” reflects the position of the tooth within
the upper right, assigned number 1, and the quadrant relative to the midline (Fig. 4A).
continuing clockwise to the lower right quadrant, Primary teeth are numbered in a similar way,
assigned number 4. Individual teeth are also except that the quadrants are assigned the
numbered, but only within a specific quadrant. numbers 5 to 8, rather than 1 to 4. The individual
This numbering begins from the midline with teeth in each quadrant are numbered 1 to 5,
the central incisor, assigned number 1, and con- reflecting the fewer number of primary teeth
tinues posteriorly to the third molar, which is (Fig. 4B).
assigned number 8. The total number assigned One of the most common anatomic variants
to any given tooth is a combination of the quad- involving the dentition with implications for tooth
rant number and tooth number. For example, the numbering is hyperdontia, or the presence of su-
permanent maxillary left canine is assigned the pernumerary teeth. When such teeth are present

Fig. 4. (A) Federation Dentaire International (FDI) numbering system for permanent teeth. (B) FDI numbering sys-
tem for primary teeth.
 Dental Anatomy and Nomenclature 5

they are named in the universal system using a anterior and posterior, but refer specifically to the
combination of numbers and letters, referencing proximity of objects or surfaces to the dental
the closest erupted permanent tooth. For arch midline (Fig. 6). Objects closer to the dental
example, a supernumerary tooth located buccal midline are mesial, whereas those further away
to tooth number #20 would be referred to as tooth are distal. The terms facial and lingual are similar
#20A (Fig. 5). Hyperdontia commonly occurs as a to the terms medial and lateral, although the point
phenomenon in isolation. However, in cases of of reference is the alveolar arch. More specific
multiple, unerupted supernumerary teeth the pos- terms are sometimes used in lieu of the terms
sibility of a hereditary syndrome such as Gardner facial and lingual. The term palatal is sometimes
syndrome or cleidocranial dysplasia should be used to describe objects lingual to the maxillary
considered.3 Hypodontia, or the lack of develop- teeth. Additionally, the terms labial or buccal can
ment of 1 or more teeth, is also a common be used for objects facial to the dental arch based
anatomic variant that mostly occurs in isolation, on proximity to the lips (anterior teeth) or cheeks
but can also be associated with a hereditary syn- (posterior teeth). Finally, coronal and apical are
drome.4 However, it usually has no implications terms used in a similar way to the terms superior
for tooth naming. and inferior, but describe the relationship of ob-
jects in specific relationship to the crown and
apices of a tooth. Objects that are closer to the
ANATOMIC RELATIONSHIPS IN THE crown or superior to it are coronal, whereas those
DENTOALVEOLAR ARCH that are closer to the apices or inferior to them are
apical.
Terminology used to describe the relationship of
teeth, or objects in relation to teeth, differ from
conventional anatomic nomenclature. Although TOOTH ANATOMY
still generally understood, terminology such as
inferior, posterior, medial, lateral, anterior, and Teeth are made up of 2 basic components: a
posterior are less commonly used when speaking crown and 1 or more roots. The crown of a tooth
about objects in the dentoalveolar arch. More is generally that which is seen clinically within the
common are the terms mesial, distal, facial, mouth in a patient without periodontal bone loss.
lingual, coronal, and apical. The use of the terms To be precise, the exact boundary of the crown
mesial and distal are somewhat analogous to and root(s) of a tooth is the cementoenamel junc-
tion. This is a junction, clearly evident on tooth
specimens, where 2 distinct dental tissues
(described in more detail later) meet on a given
tooth. That which is above the cementoenamel

Facial
Mesial
Labial Distal

Incisal

Lingual
Occlusal
Occlusal
Buccal

Buccal

Fig. 5. Oblique sagittal cone-beam computed tomog-

raphy demonstrates a supernumerary tooth follicle
between the roots of the mandibular left premolars
(white arrow). The tooth would conventionally be
Midline
referred to as #20A or #21A given its proximity to
these teeth. Note also the orientation of the mandib- Fig. 6. Common terminology used to specify tooth
ular molars, #17 and #18, which are mesioangularly surfaces: mesial/distal, facial/lingual, and occlusal/
impacted (black arrow). incisal.
6 Husain

junction is covered by enamel and makes up the

crown, and that which is below is covered by
Enamel
cementum and makes up the roots. The crowns
of different teeth vary greatly in their morphology,
Dentin
depending on where they are in the mouth. Ante-
rior teeth, which include the central and lateral in- Pulp chamber
cisors and canines, have prominent incisal edges,
whereas the posterior teeth (premolars and mo- Gingiva
lars) have multiple cusps and large occlusal tables.
Differences in the morphology of the anterior and
posterior teeth reflect their varied functions. The Cementum
incisal edges of anterior teeth function in cutting, Periodontal
whereas the broad occlusal tables of posterior ligament
teeth facilitate chewing.
The roots of teeth differ in their morphology,
Alveolar bone
depending on the type of tooth in question. Teeth
can either be single rooted or multirooted. The
incisors, canines, and premolars other than the
Fig. 7. A molar tooth shows the various dental tissues
maxillary first premolars are generally single
that compose the tooth (enamel, dentin, cementum,
rooted. Molar teeth and the maxillary first premo-
and pulp) as well as the distinction between crown
lars are multirooted. However, exceptions to and roots. The components of the periodontium
these general trends are not uncommon and (gingiva, alveolar bone, and periodontal ligament)
should be expected. In particular, third molars are identified.
tend to have the most variable root morphology.
When naming individual roots in a multirooted
teeth, the point of reference is the furcational somewhat less calcified than the enamel. The
area, or the area between the roots of the tooth. dentin surrounds both the pulpal tissues within
Common terms used to describe the roots in 2 the tooth. Where the enamel and dentin meet is
rooted teeth are mesial/distal or buccal/lingual what is called the dentinoenamel junction. Within
and in 3 rooted (maxillary) teeth are mesiobuccal, the roots of teeth, cementum is the outermost tis-
distobuccal, and palatal (or lingual). Additionally, sue and surrounds the underlying dentin. The min-
for the purposes of description, tooth roots are eral content of cementum is similar to that of
divided into thirds: the cervical, middle, and api- dentin and is, therefore, isoattenuating on radio-
cal. The cervical third is that which is closest to graphs (Fig. 8) and difficult to differentiate radio-
the crown, whereas the apical is that which in- graphically. Where the enamel and cementum
cludes the root terminus. meet makes up the cementoenamel junction. As
The terminology used to designate different described, this junction marks the boundary be-
surfaces of teeth is similar to that which is used tween the crown and roots of a tooth.
to specify anatomic relationships in the dentoal- The pulp tissues fill the internal cavities of a
veolar area. Teeth either have 4 or 5 surfaces tooth, both the pulpal chamber and root canal.
depending on whether they are anterior or poste- The pulp tissues are made of nerves and vessels
rior teeth. All teeth have a buccal/facial, lingual/ that enter through the apical foramen of a tooth.
palatal, mesial, and distal surfaces. Posterior The pulp tissue has a number of functions,
teeth have an additional occlusal surface that including a nutritive and sensory function. Through
forms the occlusal table. The contacting surfaces the pulp, sensations of pain are mediated and
of adjacent teeth may also be referred to as the blood flow is controlled. Given the soft tissue na-
proximal surfaces. ture of the pulp, it demonstrates the most radiolu-
As for the physical makeup of teeth, they are cent appearance relative to other dental tissues.
made up of 4 basic dental tissues: enamel, dentin, The pulpal tissues are subdivided into 2 distinct
cementum, and pulp (Fig. 7). The first 3 dental tis- areas. The pulpal tissues at the center of the crown
sues are mineralized hard tissues, whereas the of a tooth are referred to as the pulpal chamber
pulp is a nonmineralized soft tissue. The outer and can make up a significant portion of the
aspect of the crown of teeth is made of enamel. crown, particularly in the posterior teeth of young
Enamel is the most mineralized substance in the adults. The pulp tissue within the roots of teeth
human body and is distinctly radiopaque on radio- are referred to as the pulpal canals and are usually
graphs. Deep to the enamel is dentin, which centered within the roots. The pulpal canals
makes up the bulk of the crown and roots, and is extend from the apical foramen to the pulpal
 Dental Anatomy and Nomenclature 7

lost. The occlusal stimulus to the periodontium is

absent and the periodontal bone is resorbed. The
periodontium refers specifically to that portion of
the maxilla and mandible that surrounds the roots
of teeth. The superior most portion of the peri-
odontal bone demonstrates a cortication and is
referred to as the alveolar crest. Additionally, a
thin area of corticated bone is noted surrounding
the roots of teeth and is called the lamina dura.
When the cortications of the alveolar crest or lam-
ina dura are lost, this is a sign of pathology. Be-
tween the lamina dura and the root of tooth is a
thin radiolucent zone that contains the PDL (see
Fig. 8). The PDL contains fibers that attach the
roots of teeth to the alveolar socket and serve a
proprioceptive role. Normally, the PDL should
have uniform thickness around the root of the
tooth. Localized widening of the PDL space is a
common sign of pathology, usually inflammatory
in nature.
The soft tissue, which covers the periodontal
bone, is the gingiva, also known colloquially as
the “gums.” The gingiva also attached directly to
the roots of teeth, creating a small gingival sulcus.
Inflammation of the gingival tissues can lead to
apical migration of the gingival attachments and
periodontal bone loss.
Fig. 8. Sagittal cone-beam computed tomography
cross-section of the mandibular right canine (tooth
#27) shows the various components of the tooth TOOTH DEVELOPMENT AND ERUPTION
(enamel, dentin, pulp, and cementum) and peri-
The development of teeth can be seen as having
odontal tissues. PDL, periodontal ligament.
2 distinct components: tooth formation and tooth
eruption. The process of tooth formation is a
chamber. When the pulpal tissues necrose, the complex process beginning early in utero. Pri-
tooth is said to have “died” or lost vitality. Pulpal mary teeth begin development at approximately
necrosis and infection are indications for root ca- 6 to 8 weeks in utero, whereas permanent teeth
nal treatment. begin at approximately 20 weeks in utero.5 Tooth
Thus far, descriptions of tooth anatomy have development is initiated by embryonic cells,
taken as their point of reference the permanent which differentiate into cells that produce dental
dentition. However, some general anatomic differ- tissues. These embryonic cells are referred to as
ences should be noted between primary and per- the tooth germ, derived from the ectoderm of the
manent teeth. Primary teeth differ from permanent first pharyngeal arch and the ectomesenchyme
teeth in general by having more bulbous crowns, of the neural crest.6 The tooth germ has 3 main
thinner layers of enamel, relatively larger pulpal components, the enamel organ, the dental
chambers, and roots that are more slender and papilla, and the dental follicle, each of which
splayed. give rise to the different dental tissues that
compose a tooth. The enamel organ contains
PERIODONTIUM precursors of cells that produce enamel and
the dental papilla contains cells, which eventually
The term periodontium, originates from Greek and produce dentin and pulpal tissues. The dental
literally means that which is “around the tooth.” It follicle gives rise to the cementoblasts, osteo-
collectively refers to the alveolar bone, periodontal blasts, and fibroblasts that form cementum, alve-
ligament (PDL) and gingival tissues (gums; see olar bone and the PDL, respectively.7 For a more
Fig. 7). The periodontium is a group of dynamic tis- detailed description of stages of odontogenesis
sues that support the teeth by adapting to and regulatory signaling pathways, the reader is
increased occlusal forces and variations in func- referred to more comprehensive descriptions
tion. Evidence for this is seen when teeth are found elsewhere.5–7
8 Husain

The process of odontogenesis as previously tooth describes its angulation and the extent to
summarized is relatively resilient to environmental which it is covered by bone. Teeth that are
factors, whereas the mechanism of eruption of mostly submerged within the alveolar process
teeth is more easily altered by external factors, are described as full bony impacted. Those
such as tooth obstructions, early tooth loss, or that are partially covered by alveolar bone are
infection. The mechanism of tooth eruption is not partial bony impacted.10 Depending on the
fully understood, although the most widely held angulation of the long axis of the impacted
theory holds that although multiple factors might tooth, the impaction is classified as mesioangu-
be involved, the PDL plays the main role in promot- lar, distoangular, buccoangular, linguoangular,
ing the eruption of a tooth.8 Tooth eruption occurs horizontal, vertical, or inverted (see Fig. 5).
concurrently with the root resorption of the decid- These descriptive terms communicate to some
uous teeth and root formation of the erupting degree the difficulty that might be expected in
tooth. When the tooth has fully erupted, the root the surgical removal of the tooth.11 Teeth that
is often not fully formed, but forms sometime after are impacted are predisposed to a number of
its emergence. complications, including local infection of the
The tooth eruption process is often divided into periodontium (periodontal disease) or overlying
3 broad stages: the primary, transitional (mixed), soft tissue (pericoronitis). Dentigerous cyst for-
and permanent stage. The primary stage begins mation may also occur within the follicle of an
with the eruption of primary central incisors into impacted tooth.11
the oral at about 6 to 12 months postnatal. By
approximately 3 years of age, all the deciduous DENTAL RESTORATIONS
teeth have erupted and root development is
complete.2 Some variability in the exact chronol- A variety of materials and dental prostheses are
ogy of tooth development is common, and mir- used to restore the form and function of teeth
rors the variability seen in other similar growth within the oral cavity. Depending on the type of
indicators. restoration, a different set of materials may be
The mixed dentition stage refers to the phase of used. For example, direct partial coverage resto-
development when both primary and permanent rations, commonly known as “fillings,” typically
teeth are present within the dental arches use 1 of 2 different filling materials: amalgam or
(Fig. 9). This begins at approximately 6 years of composite. Dental amalgam is probably the
age with the eruption of the first mandibular mo- more widespread material and is actually a com-
lars and lasts until approximately 11 to 12 years bination of different metals including silver, mer-
of age, with the exfoliation of the last deciduous cury, and tin. Fillings of this material are
teeth (usually the primary second molars or commonly referred to as “silver fillings.” This
canines). dental material is highly radiopaque and thus
The final stage of eruption is that of the perma- distinct from other dental tissues (Fig. 10). On
nent dentition and begins after all the deciduous CT imaging, the material creates a metallic artifact
teeth have been exfoliated. With the exception of that can interfere with the assessment of dental
the third molars, the permanent teeth fully erupt disease. Composite material is a resin material
by approximately the age of 13 to 14. The third and the main alternative to amalgam. Its use
molars erupt significantly later at approximately has gained increasing popularity, largely for
the ages of 18 to 25. aesthetic reasons. Most patients find the tooth-
Frequently, teeth do not erupt within their ex- colored nature of the material aesthetically prefer-
pected developmental timeframe. This delay able to the silver color of dental amalgam.
may occur for a variety of reasons, including Composite material bonds with the underlying
malpositioning of the tooth, inadequate arch tooth structure. Radiographically, it appears less
space, genetic abnormalities affecting the erup- opaque than dental amalgam but more opaque
tion mechanism, or the presence of pathology or than enamel. Earlier versions of composite mate-
dense bone along the eruption pathway. Inade- rial, however, appeared radiolucent radiographi-
quate arch space is the most frequent cause of cally. This feature should not be mistaken on
tooth impaction. The most frequently impacted radiographs for dental caries.
teeth are the third molars and maxillary canines.9 Full coverage coronal restorations are also
Generally, impacted third molars are considered known as dental crowns. These restorations are
for surgical removal. Other teeth, such as the usually made of full metal, full porcelain, or a
canines, may be surgically exposed and combination as in the case of porcelain
brought into the dental arch using orthodontic fused to metal crowns. The restorations require
techniques. Terminology describing an impacted tooth preparation before placement. The tooth
 Dental Anatomy and Nomenclature 9

structure around the periphery of the crown of a

tooth must be removed to make space for the
dental prosthesis. The dental crown is placed
over the prepared tooth to restore the form and
function of the tooth. On CT imaging, the
crown appears opaque, regardless of
which of the 3 materials is used (Fig. 11). More-
over, full metal crowns tend to have the most
opaque appearance and create the most metallic
artifact.
A fixed partial denture, or bridge, is a dental
prosthesis designed to replace one or a small
number of missing teeth. A bridge can be thought
of as a series of fused dental crowns, one or more
of which fill an edentulous space. The most com-
mon type of bridge is a 3-unit bridge, which con-
sists of 2 dental crowns placed on teeth adjacent
to an edentulous area. These crowns are fused
to a third crown, or pontic, that replaces a missing
tooth (Fig. 12). The restorative materials available
to make a bridge are identical to those available
to make a dental crown, and have a similar radio-
graphic appearance.
Root canal therapy is a type of endodontic
treatment used to treat infected or necrotic pulp.
The procedure involves accessing, cleaning, and
disinfecting the pulpal chamber and canals.
Once this is completed, the pulpal canals are
instrumented and filled with gutta-percha and
sealer cement. Gutta-percha is a cone-shaped,
nontoxic, latex material that is flexible and highly
radiopaque. The material should fill the entire
length of the pulpal canal. On CT imaging, the
material has a radiodensity of metal and creates
an analogous artifact (Fig. 13). It is used in
conjunction with sealer cement that fills any
gaps left by the gutta-percha within the pulpal ca-
nal. The gutta-percha or sealer may, on occasion,
extend beyond the radiographic apex of a tooth.
In most cases, however, this is of no conse-
quence owing to the biocompatibility of the mate-
rials used.
Dental implants are, at present, the preferred
method of replacing missing teeth and are seen
more frequently in older patients who are more
likely to be edentulous. Although different types
of implants exist, the most common and contem-
porary type is the root form implant. This type
of implant demonstrates a cylindrical shape

Fig. 9. Cone-beam computed tomography panoramic =

reformats of patients in the 3 stages of tooth erup- unerupted. (C) Permanent dentition: complete exfoli-
tion. (A) Primary dentition: only primary teeth are ation of all primary teeth, only permanent teeth
erupted and permanent teeth follicles are visualized remain in the oral cavity. (From Koenig JL, Tamimi
but unerupted. (B) Mixed dentition stage: a mixture DF, Petrikowski CG, et al. Diagnostic imaging: oral
of primary and permanent teeth are erupted into and maxillofacial. 2nd edition. Philadelphia: Elsevier,
the oral cavity; some permanent tooth follicles are 2017; with permission.)
10 Husain

Fig. 12. Oblique sagittal cone-beam computed to-

Fig. 10. Coronal cone-beam computed tomography mography of the posterior left mandible demon-
through the area of the first molar tooth shows an strates a fixed partial denture (bridge) extending
amalgam restoration (white arrow) on the occlusal from teeth #19 to #21. Note the pontic (yellow arrow)
surface. Note the increased attenuation of the mate- in the edentulous space of tooth #20 that is attached
rial relative to the dental tissues. to the adjacent crowns.

mimicking that of a tooth root. Dental implants are placed onto the implant to restore tooth function.
usually made of titanium and are surgically placed On CT imaging, the implant appears highly radi-
into the alveolar bone. After a period of integration opaque, with significant metallic artifact (Fig. 14).
with the surrounding alveolar bone, a crown is This artifact can obscure evaluation of periimplant
bone, an important factor in assessing the prog-
nosis of an implant. In these cases, clinical
evaluation and intraoral imaging are helpful sup-
plements for more comprehensive evaluation.

DENTAL APPLIANCES
Dental appliances used for orthodontic treatment
are common findings, particularly in young

Fig. 11. Axial cone-beam computed tomography

through the crowns of the mandibular teeth shows
full coverage coronal restorations, commonly referred Fig. 13. Axial cone-beam computed tomography
to as dental crowns, on most of the mandibular molars through the roots of the mandibular teeth shows
(black arrows). Extensive metallic streaking artifact is a root canal treated mandibular left first molar
noted emanating from the crowns (yellow arrows). (black arrow).
 Dental Anatomy and Nomenclature 11

molars and serve as a way of anchoring the or-

thodontic appliance. All the features of a
standard orthodontic appliance are metallic in
nature and create significant metallic artifact on
CT imaging.

SUMMARY
Incidental abnormalities involving the dentition are
likely to be encountered by the radiologist inter-
preting studies of the head and neck region,
particularly on CT imaging. Proper identification
and communication of the abnormalities involving
the dentition first require an understanding of
normal dental anatomy, dental development,
and a familiarity with the radiographic appearance
of common dental restorations. This article has
introduced the basic language of dental anatomy,
the 3 stages of tooth eruption, and specific fea-
tures of dental restorations to assist radiologists
in communicating effectively with their dental
colleagues.

REFERENCES

Fig. 14. Sagittal cone-beam computed tomography 1. Koenig, LJ. Diagnostic imaging: oral and maxillofa-
demonstrates 2 osseointegrated implants within the cial. Salt Lake City: Amirsys Pub; 2012.
maxillary alveolar ridge at the sites of the missing 2. Nelson SJ. Wheeler’s dental anatomy, physiology
maxillary right first and second molars (black arrows). and occlusion. St Louis (MO): Elsevier Health Sci-
The right mandibular first premolar is endodontically ences; 2014.
treated and demonstrates gutta-percha within its root
3. Primosch RE. Anterior supernumerary teeth-
canal (yellow arrow).
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