Role of oral radiology in forensic dentistry [autosaved]/ oral surgery courses

ROLE OF ORAL RADIOLOGY INROLE OF ORAL RADIOLOGY IN
FORENSIC DENTISTRYFORENSIC DENTISTRY
Sharad Pawar Dental College
Sawangi (M), Wardha.
INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing DentalLeader in continuing Dental
EducationEducation
www.indiandentalacademy.com

FORENSIC ODONTOLOGY?
Forum – ‘court of law’
Odontology – ‘study of teeth’
Forensic Odontology is defined as “that branch
of dentistry which, in the interest of justice, deals
with the proper handling and examination of
dental evidence, and with the proper evaluation
and presentation of dental findings”. ( Federation
Dentaire Internationale; FDI)

HISTORY:
 First dental evidence (U.S court, Nov 23,1849)
Webster – Parkman case
charred fragments of mineral teeth fused to gold
( Dr. Nathan cooley.)
 The first treatise- Dr. Oscar Amoedo (1898)
L’Art Dentaire en Medicine Legale.
Father of Forensic Odontology.
• Adolph Hitler- Identified from dental radio-graphs and
spare crowns.

FORENSIC
RADIOLOGY

FORENSIC RADIOLOGY :-
It deals with diagnostic imaging with radiological
techniques to assist physicians (AM) and
pathologists (PM).

Radiology has been used extensively in-
 Age estimation
 Sex determination
 Identifying unknown human
remains

 Race identification
 Mass disaster/individual
identification
 Identification of foreign objects
 Preparation and presentation of
dental evidence in both civil and
criminal legal procedures.

Teeth are relatively resistant to environmental
insults after death
Human dentition is never the same in any two
individuals (Morphology and arrangement )
Basis for Dental IdentificationBasis for Dental Identification

DENTAL IDENTIFICATION PROCEDURESDENTAL IDENTIFICATION PROCEDURES
Comparative Dental Identification
Identification by comparing the dead
individual's teeth with presume; dental
records of the individual.
DENTAL PROFILING
ethnicity or 'race'
gender
age
 habits
 occupation of the dead individual

Four steps in post-mortem dental identification-
 Oral autopsy,
 Obtaining dental records,
 Comparing post- and ante-mortem dental data, and
 Writing a report and drawing conclusions.

Examining soft tissue injuries, fractures,
and presence of foreign bodies
samples of hard and soft tissues may be
obtained for further investigations.
All information pertaining to the body
must be entered onto the standard
'Interpol post-mortem form', which is
color-coded in pink.

Dental RecordsDental Records
 Dental records contain information of treatment and
dental status of a person during his/her life.
 Obtained from the treating dentist, specialist or hospital
records.
 In form of dental charts, radiographs, casts and/or
photographs.
 Available dental records should be
transcribed onto the standard 'Interpol ante-mortem
form', which is color-coded in yellow.

Age-
Illegal documentation of birth
immigrated illegally
Who committed crime and age is
necessary to decide punishment
Case of adoption, legal matters.

Essential factor for identity
of person and critical
component in
dental profiling.
Dentition begins to develop at about four months after
conception upto 3rd
decade of life.
Based on formation of root and crown structure.

 Third molar development as an indicator of chronological age on
radiographs.
 After age 14, estimation becomes difficult as most dentition is
complete except 3rd
molar
 Stages of tooth mineralization and Demirjian stages of crown and
root formation
(stages were named 'A to 'H'. )
based on radiograph can be
used to estimate approx. age.
{i.e. under 18 years }
J Forensic Sci, 2002: 47; (3): 531-535

 Adult - estimation by pulp- tooth area ratio of molar teeth
before root canal treatment.
 With computer aided drafting
programme ratio is calculated.
 Size of pulp reduces
with age.
J Forensic sci,2004: 49 ;(6):1319-1323

Age is also calculated by pulp-tooth ratio using
Micro focus Computed Tomographical scanning of
teeth ( incisors and canines)
Can be used after root canal treatment, gives
three dimensional view.
Costly, expertisation required, time consuming
and can’t use at large scale.
(J Forensic sci, Jul 2004: vol.49 no4; 787-790)

Other techniques makes the use of skull
radiograph to access the cranial sutures closure,
epiphyseal growth of long bones
Dental age shows less variability than does
skeletal age.
Dental radiographs are preferred over dental
charting because less chances of error, better
reproducibility and high objective nature.

Identification of person
Necessary in case of life insurance cases,
road traffic accidents., re-marriages, crimes.
Due to decomposition, burning, mutilation of bodies
radiologist are called as teeth are resistant to majority of
these factors.
Comparison of antemortem and postmortem radiograph.
Premortem dental records may be obtained from the
treating dentist, specialist or hospital records.

Ante mortem radiograph. Postmortem radiograph
Digitized images showing a
horizontal section of the roots
randomly selected from the
antemortem radiograph
horizontal section of the roots is
superimposed on the postmortem
radiograph with cut and paste
commands. Thus identity proved
Case I
Case II
J Can Dent Assoc 2004; 70(7):453–8www.indiandentalacademy.com

Digitalized radiographs are preferred as two images can
be compared with use of computers, contrast can be
adjusted, easy to store and transfer, good resolution.
Pattern of bone loss, periodontal disease, trabecular
pattern, any pathology, restorations, anatomical
structures, foreign body, cavity preparations are
compared .
OPG’s provide complete view of both jaws and teeth in
one image.

Use of amalgam powder and calcium hydroxide to
recreate a radiopaque image of lost dental restoration is
used in post mortem identification.
No two dental preparation are exactly alike, the floor and
walls of preparation are unique features and may be use
in comparison.
antemortem
Postmortem after
restoration
J Forensic Sci, 2002 Vol.47, No3; 609-613

Use of frontal sinus radiographs (>20years).
Postmortem radiographs with similar orientation and
magnifications are taken with low exposure values.
Arbitrary baseline is drawn and
outline the shape of interest which
is compared with final outline
after scanning and saving in
JPG format and using “tpsDig”
software package.
J Forensic Sci, Jan 2005, Vol.50, no2; 18-22

Nutrients canals of alveolar process is also used for
dental identification of deceased individual.
They may provide only landmark for antemortem and
postmortem comparison in edentulous patients.
Nutrient canals are related to hypertensive, diabetic
patients and increases with age.
J Forensic Sci, 2002, Vol.47,no2; 381-383

Other techniques in identification :-
Root morphology of molars
Morphology of pulp cavities
Upper first molars and its relation to
maxillary sinus
Morphology of mandible

Study conducted on 300 children(6-13 years)
without fillings and caries.
Two bitewing radiographs were taken at time
interval of 1-1.5 years.
Radiographic expertise comparison between GDP
and OMR.
GDP - 78.0% correct
OMR – 98.7% matches
(J Forensic Odontostomatol 2006; 24: 42-46)

 Denta-scan and CT are taking over to periapical and
panoramic radiographs:
 Fast screening in mass disaster
 Easy data storage
 Fine details
 No special positioning techniques
 No need of jaw resection
 Mutilated, decomposed, charred bodies.
(J Forensic sci, Jan 2006: vol.51 no1; 112-119)

 X-ray fluorescence spectrometer(XRF)
 Radiolucent fillings not detected by radiographs
 Small quantity required
 Fast, accurate, portable.
 Correctly identify resin by brand.
 A spectra is obtain and compared to reference spectra.
J Forensic Sci, Jan 2007, Vol.52,no1;157-165

Digital image subtraction using bitewing radiograph.
J Forensic Odontostomatol 1994; 12:1-5
A1
E1D1
C1B1
A2
D2
B2
E2
C2

 Extra oral radiographs with altered geometry and
modification in X-ray unit
Criminal investigation
Cause of death
Type of injury
J Forensic Odontostomatol 1997; 15:17-21
Child abuse

Determination of Sex
 Based on Cranial features
 Crests and ridges more pronounced in
males (A, B, C)
 Chin significantly more square
in males (E)
 Jaw (I, E), mastoid process wide
and robust in males
 Forehead slopes more in males (F)

Determination of Race
 Cranium is the only reliable bone.
 Mongoloid (Asian decent and Native American decent)
 wider cheekbones, horseshoe shape dental arch, width between
eyes greatest, taurodontism, 5 cusp in molars
 Negro (African decent and West Indian decent)
 more prominent ridges, wider nasal opening, ‘u’ shape dental arch.
 Caucasian (all ‘white’ individuals)
 narrow everything, ‘v’ shape dental arch

CONCLUSION
1. With rapid increase in criminal
activity worldwide, it become
mandatory to provide justice and
safeguard the interest of the
general population.
2. For this purpose forensic radiology
can play a pivotal role in providing
justice to innocent masses.

REFERENCES
Adams BJ. Establishing personal identification based on
specific pattern of missing,filled and unrestored teeth. Journal
of forensic science.2003:48: pp 487-96.
Loton L, Rethman M.The computer assisted Postmortem
Identification (CAPMI) system- A computer based
identification programme developed by US army Institute of
dental research for rapid identification of human remains.
Journal of forensic science.1988:33 pp 977-84.

Goodman NR, Eddeson LB, The efficiency of X ray
screening system at a mass disaster. Journal of
forensic science.2002 (47), 127-130.
Ranganathan K, Rooban T. Forensic Odontology: A review. J
Forensic Odontology Vol 1, Issue 1, 2008.
CJ. Mc Kenna: Radiography in forensic dental identification.
A review: J Forensic Odontology Vol 17, Issue 2, 1999.

Rudnik SA. The identification of murdered victim using
comparison of Ante mortem and post mortem dental records.
Journal of forensic science.1984(24), 349-54.
S Fridell, J Ahlqvist: The use of dental radiograph for
identification of children with unrestored dentition: J Forensic
Odontology Vol 24, Issue 2, 2006.

Ann Wenzel, Lis Anderson: A quantitative analysis of
Subtraction image based on bite wing radiograph for
simulated victim in forensic dentistry: J Forensic Odontology
Vol 12, Issue 1, 1994.
Raymond G Miller, Jennifer P: Identification through X ray
Fluorescence analysis of dental restorative resin materials: A
comprehensive study. Journal of forensic science.2007, vol 52
no. 1

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