The Analysis of a World War I U.S. Service Member's Dental Remains Recovered in France

In October 2009, the grave of an unknown World War I (WWI) U.S. service member was exhumed in Rembercourt‐Sur‐Mad Village, in the Lorraine Region of France. The skeletal remains and material evidence were accessioned into the Joint POW/MIA Accounting Command's (JPAC) Central Identification Laboratory (CIL). The personnel records for the associated casualty were requested, received, and reviewed. A dental profile was present among the service member's personal information. There were multiple points of concordance between the dental records of the associated casualty, and the recovered dental remains to include eight restored teeth, 15 unrestored teeth, and three antemortem missing teeth. Distinctive restorations which compared favorably included a porcelain crown and multiple gold foil fillings. All lines of evidence (historical, material evidence/personal effects, anthropological, and dental) and the circumstances of loss compared positively with the associated casualty. On April 1, 2010, the previously unaccounted‐for U.S. service member was positively identified and on June 23, 2010, was buried with full military honors at Arlington National Cemetery.     

A Retrospective Review of Forensic Odontology Reports Written by the Joint POW/MIA Accounting Command Central Identification Laboratory for Remains Identified from the Korean War

As of August 2014, the Joint POW/MIA Accounting Command has identified the remains of 1980 previously unknown U.S. service members; 280 were from the Korean War. To determine the accuracy and completeness of the available antemortem (AM) dental records, a review of the AM/postmortem (AM/PM) dental record comparisons from 233 Forensic Odontology Reports written in support of remains identified from the Korean War was performed. Seventy‐two AM/PM comparisons resulted in exact dental chartings while 161 contained discrepancies which were explainable. Explainable discrepancies include undocumented treatment (103), incorrectly charted third molars as missing (82), differing opinions of specific molars present/missing (20), and erroneous treatment documentation and/or misidentification of teeth present/missing (22, other than molars). Reassessment has revealed varying levels of completeness for our available AM dental records, the need to thoroughly review our computerized comparisons, adjust our comparisons to include molar pattern variations/third molars, and updating our database comparison program.     

A Comparison of US and Japanese Dental Restorative Care Present on Service Members Recovered from the WWII Era

The documentation of dental materials used in the USA during the WWII era is readily available, while references for the Japanese are minimal. It was therefore important to build a photographic database of Japanese restorative care which could be utilized as a comparison tool for the deployed odontologist. The dental restorative care of approximately 400 US and 100 Japanese sets of remains was evaluated. Both countries share many similar restorative techniques to include collared crowns, full‐coverage restorations, cantilever bridge/pontics to close spaces; restorative materials such as amalgam, gold, and zinc phosphate (temporary) restorations; and removable prostheses. The dental restorative materials most commonly used by US dentists include the amalgam and silicate cement, while the full‐coverage crown was the type of restoration most frequently seen on the Japanese remains. Silicates, porcelain and replaceable crowns, and partial‐coverage prepared crowns were not observed on the recovered Japanese remains.     

Detection of Tooth‐Colored Restorative Materials for Forensic Purposes Based on Their Optical Properties: An In Vitro Comparative Study

Victim identification using dental records involves antemortem and postmortem comparison of dental charts. Since dental restorations may be part of such records, identifying them accurately is critical. The objective of this study was to compare the diagnostic reliability and validity of two optical methods for identifying tooth‐colored restorations (digital imaging fiber optic transillumination (DiFOTI) using near infrared light, and fluorescence‐aided identification of restorations (FAIR)) with conventional diagnostic methods. Four examiners identified and charted tooth‐colored restorations in three sets of typodonts on the bench using conventional visual and tactile examination, DiFOTI (DIAGNOcam?) and FAIR. All examinations were repeated after 4 weeks. Both the sensitivity (95%) and specificity (97%) of the FAIR method were significantly higher than those for DiFOTI (82% and 82%) and for conventional inspection (71% and 82%). In conclusion, FAIR method performed better than conventional examination and DiFOTI, and was more reliable for identifying tooth‐colored restorations.     

Positive Dental Identification Using Tooth Anatomy and Digital Superimposition

Dental identification of unknown human remains continues to be a relevant and reliable adjunct to forensic investigations. The advent of genomic and mitochondrial DNA procedures has not displaced the practical use of dental and related osseous structures remaining after destructive incidents that can render human remains unrecognizable, severely burned, and fragmented. The ability to conclusively identify victims of accident and homicide is based on the availability of antemortem records containing substantial and unambiguous proof of dental and related osseous characteristics. This case report documents the use of digital comparative analysis of antemortem dental models and postmortem dentition, to determine a dental identification. Images of dental models were digitally analyzed using Adobe Photoshop^TM software. Individual tooth anatomy was compared between the antemortem and postmortem images. Digital superimposition techniques were also used for the comparison. With the absence of antemortem radiographs, this method proved useful to reach a positive identification in this case.     

A Review of Proposed Positive Dental Identifications from the World War II Era

In 1949, the American Graves Registration Service Pacific Zone proposed the identification of 27 sets of remains (skulls/crania/mandibles) based on comparisons with written dental records. All were denied, and the remains were buried as unknowns. In 2003 and 2015, the remains were exhumed by the DPAA. Currently, 26 individuals previously recommended for identification have been positively identified. The DPAA Science Director's opinion corresponded with 24 of their recommendations, while DNA excluded three. Caution should be taken by the forensic scientist when building assemblages through skeletal and dental articulation. The forensic odontologist must always consider variations in restorative care/extraction patterns and the possibility of documentation errors when reviewing/interpreting historical and current day dental records used for AM/PM comparisons. The odontologist should base their opinion on the strength of the antemortem/postmortem comparison, number and type of concordances, and distinct dental care and extraction patterns.     

Implant Bone Integration Importance in Forensic Identification

Odontological identification consists of the comparison of antemortem dental information regarding a missing person with postmortem data from an unidentified corpse or human remains. Usually, the comparison concerns morphologic features that the operator chooses among all the visible characteristics because of inter‐individual uniqueness; for this reason, implants can be of enormous assistance. A case concerning the recovery of a burnt oral implant, connected to a bone fragment, among 2780 charred bone fragments, suspected to have belonged to a victim of homicide, is presented to demonstrate that dental implants and their site of bone integration represent a very precious element for personal forensic identification. Because of their morphological invariability in time and because of their morphologic uniqueness, they were used as evidence to associate unidentified human charred remains to a missing person where DNA analysis failed to do so. The case illustrates the fundamental contribution, not yet described in literature, given by the clinical aspects of tooth replacement with dental implants to a forensic discipline. Clinical practitioners should therefore be aware of the great importance of their work and of dental records in a forensic identification scenario.     

Root Morphology and Anatomical Patterns in Forensic Dental Identification: A Comparison of Computer‐Aided Identification with Traditional Forensic Dental Identification*

Abstract: An online forensic dental identification exercise was conducted involving 24 antemortem–postmortem (AM–PM) dental radiograph pairs from actual forensic identification cases. Images had been digitally cropped to remove coronal tooth structure and dental restorations. Volunteer forensic odontologists were passively recruited to compare the AM–PM dental radiographs online and conclude identification status using the guidelines for identification from the American Board of Forensic Odontology. The mean accuracy rate for identification was 86.0% (standard deviation 9.2%). The same radiograph pairs were compared using a digital imaging software algorithm, which generated a normalized coefficient of similarity for each pair. Twenty of the radiograph pairs generated a mean accuracy of 85.0%. Four of the pairs could not be used to generate a coefficient of similarity. Receiver operator curve and area under the curve statistical analysis confirmed good discrimination abilities of both methods (online exercise = 0.978; UT‐ID index = 0.923) and Spearman’s rank correlation coefficient analysis (0.683) indicated good correlation between the results of both methods. Computer‐aided dental identification allows for an objective comparison of AM–PM radiographs and can be a useful tool to support a forensic dental identification conclusion.     

Differences in morphological age-related dental changes depending on postmortem interval.

Morphological methods for age estimation from teeth have been developed and applied to samples without taking the postmortem interval into consideration. We studied differences in morphological age-related changes between fresh extracted teeth and teeth from human skeletal remains in order to develop appropriate dental age estimation methods according to the time after death. Forty-three permanent teeth from dental patients were compared to 37 teeth obtained from human skeletal remains with a postmortem interval from 21 to 37 years. Morphological age-related changes were investigated by measuring variables on intact and half-sectioned teeth. A new computer assisted image analysis procedure to avoid subjectivity was developed to measure variables in sectioned specimens. Dental color, translucency length, attrition, cementum apposition, and secondary dentin showed higher values in teeth from human skeletal remains than in fresh extracted teeth. Variables obtained by morphometric analysis of computer-generated images (tooth length, tooth width, root length, and root area) showed higher values in fresh extracted teeth than in teeth from skeletal remains. The postmortem interval affects age-related morphological changes, and therefore different methods should be used for teeth of unknown postmortem interval.     

A Study of the Human Decomposition Sequence in Central Texas*

Abstract: Decomposition studies utilizing nonhuman subjects as human analogues are well established, but fewer studies utilizing intact human remains exist. This study provides data from a controlled decomposition study involving human remains in Central Texas. A 63.5‐kg unmodified cadaver was placed in an open‐air site and observed over a 10‐week period from April 11 through June 19, 2008. A wire enclosure restricted scavenger access. State of decomposition and environmental conditions were recorded daily for the first 36 days and then every 2 weeks thereafter. Results indicated a high degree of correlation with other decomposition studies originating in the southwestern United States, although slight deviations for the average duration of early events were noted. The data were also utilized to test a quantitative method for estimating the postmortem interval. Results indicated preliminary support for a quantitative approach. Additional research is encouraged to further establish the human decomposition data set for Central Texas.     

Identification of a skeleton using DNA from teeth and a PAP smear.

Identification of unknown living or deceased persons using dental treatment records is an established forensic technique. However, some cases remain unidentified, especially when antemortem dental records are not available for comparison to postmortem dental records. Cytological smears have been previously reported to be potential sources of DNA reference samples which can be compared to DNA recovered from found human remains. The case described here involves an adult skeleton which exhibited extensive, complex dental restorative treatment. A putative identification of the found skeleton as a missing woman was established using circumstantial evidence found at the scene. However, it became important to establish a positive identification using reliable scientific methods. When it was discovered that antemortem dental records were not available because the treatment was completed in another country and the treating dentist could not be found, cytological smears stained with Papanicolaou (PAP) stain obtained from the putative decedent's medical records were used as a reference DNA sample. DNA was recovered from the teeth of the skeleton using cryogenic grinding. Comparison of the genotypes resulted in the conclusion that the DNA originated from the same source. The use of PAP smears in this way is seen as a valuable resource in cases where positive identification using traditional dental and medical records is not possible.     

Effect of Heat on the Fluorescence Properties of Tooth‐Colored Restorative Materials and Their Forensic Implications

During antemortem and postmortem comparison of dental records of carbonized victims, restorations may be part of such records. The objective of this study was to evaluate the effect of heat on the fluorescence behavior of contemporary tooth‐colored restorative materials and natural tooth structure when subjected to range of temperatures, using illumination with 405 nm wavelength light. A total of 132 human extracted teeth restored with tooth‐colored restorative materials were exposed to heat (200, 500, 900, 1200°C) in an oven for 30 min. Samples were imaged before and after heat treatment. All tooth‐colored restorative materials underwent changes in color and in fluorescence properties, at each of the temperatures used. Resin‐based restorative materials still fluoresced at 200°C, and at 500°C underwent major color changes due to volatilization of resin. Materials containing inorganic fluorophores still fluoresced at 900°C, while at 1200°C, none of the materials tested in this study showed any fluorescence.     

The 2018 California Wildfires: Integration of Rapid DNA to Dramatically Accelerate Victim Identification

In November 2018, Butte County, California, was decimated by the Camp Fire, the deadliest wildfire in state history. Over 150,000 acres were destroyed, and at its peak, the fire consumed eighty acres per minute. The speed and intensity of the oncoming flames killed scores of people, and weeks before the fire was contained, first responders began searching through the rubble of 18,804 residences and commercial buildings. As with most mass disasters, conventional identification modalities (e.g., fingerprints, odontology, hardware) were utilized to identify victims. The intensity and duration of the fire severely degraded most of the remains, and these approaches were useful in only 22 of 84 cases. In the past, the remaining cases would have been subjected to conventional DNA analysis, which may have required months to years. Instead, Rapid DNA technology was utilized (in a rented recreational vehicle outside the Sacramento morgue) in the victim identification effort. Sixty-nine sets of remains were subjected to Rapid DNA Identification and, of these, 62 (89.9%) generated short tandem repeat profiles that were subjected to familial searching; essentially all these profiles were produced within hours of sample receipt. Samples successfully utilized for DNA identification included blood, bone, liver, muscle, soft tissue of unknown origin, and brain. In tandem with processing of 255 family reference samples, 58 victims were identified. This work represents the first use of Rapid DNA Identification in a mass casualty event, and the results support the use of Rapid DNA as an integrated tool with conventional disaster victim identification modalities.     

A minimally destructive technique for sampling dentin powder for mitochondrial DNA testing

The purpose of this paper is to present the horizontal sectioning technique used by odontologists at the Central Identification Laboratory to sample dentin for mtDNA analysis. From the perspective of DNA testing, anthropologists and odontologists at the Central Identification Laboratory work with ancient remains. In many instances, the lack of comprehensive antemortem records, the potential for fragmentation and commingling, and environmental exposure makes the use of traditional forensic identification techniques difficult or impossible. Teeth are highly resistant to environmental degradation and are an excellent source of mitochondrial DNA (mtDNA). This technique is simple, quick, and relatively conservative, allowing for preservation of the majority of the external portion of the tooth structure.     

The use of amalgam powder and calcium hydroxide to recreate a radiopaque image of a lost dental restoration

Radiographs of dental restorations are highly reliable when used to identify postmortem dental remains. A problem exists if key dental restorations are missing or defective, which results in the loss of a comparative radiographic image. This article describes a simple method allowing the odontologist to quickly recreate a temporary radiopaque restoration. This article presents a method of using amalgam powder (radiopaque material) and calcium hydroxide (radiopaque material and transport medium for the amalgam powder) to recreate a radiopaque image on a tooth that has lost a dental restoration. Amalgam powder and calcium hydroxide is easily obtained (in any dental office), fairly clean, easy to manipulate, inexpensive, inert, stable, and able to be removed without damaging the dental remains. The amalgam powder/calcium hydroxide mixture can easily be re-shaped or modified to reflect the radiopaque image of the original restoration. Radiographic comparison of the "restored" dental remains to the antemortem radiographs is now possible. The use of this technique is presented in a case report.     

Objective measurement of dental color for age estimation by spectroradiometry

Age-related changes in tooth color have been described previously, however, the use of dental color for age estimation in forensic odontology has been limited due to the difficulty of measuring color objectively. This study presents an objective method for determining dental color to estimate the age of an individual. Dentine color in 250 teeth from patients ranging in age from 10 to 89 years was determined by spectroradiometry. Color measurements were performed as suggested in the CIE 1931 (International Commission on Illumination). Chromaticity coordinates (x, y, z), luminance (Y), whiteness index (WIC, Z%, WIC) and yellowness index (YI) were obtained. Correlations between these colorimetric variables and aging were established by linear regression analyses. All the variables fit the mathematical model with correlation coefficients ranging from 0.53 to 0.75. This method of color measurement produced an expected associated error of calibration averaging 13.7 years about the mean estimated values, at a 70% level of confidence. Two different multiple regression models for dental age estimation were tested, and variables that made the greatest contributions to age calculation were identified. To determine the effect of postmortem interval on tooth color and its influence in age estimation, 37 teeth obtained from human skeletal remains buried during an interval ranging from 21 to 37 years were also studied. In this material, the correlation between age and dental color measured by spectroradiometry was weaker than in fresh extracted teeth.It is concluded that determination of dentine color by spectroradiometry is a potentially useful objective method to estimate age in forensic studies in combination with other methods.     

牙髓细胞DNA含量与死后经过时间的相关性

目的探讨死后不同环境温度下离体牙的牙髓细胞平均DNA含量变化与死后时间(PM I)的相关性。方法采用细胞图像分析系统(PIPS-2020),测定离体即刻至15d牙齿在低温环境(10~15℃)和高温(30~35℃)环境下牙髓细胞DNA含量变化值,并对其数据进行统计学分析。结果在不同的环境温度下,牙髓细胞DNA降解的速度有所不同,温度的升高有加速牙髓细胞DNA降解的趋势,且DNA降解存在一个平台期。低温组牙髓细胞平均DNA含量与PM I之间的相关系数r=0.953,相关指数R2=0.917;高温组的相关系数r=0.991,相关指数R2=0.971。结论牙髓细胞平均DNA含量与PM I之间具有高度相关性,测定牙髓细胞的DNA变化情况对推断3d(高温环境)或6d(低温环境)后的PM I有参考价值。     

X‐ray Scattering Evaluation of Ultrastructural Changes in Human Dental Tissues with Thermal Treatment

Micro‐ and ultrastructural analysis of burned skeletal remains is crucial for obtaining a reliable estimation of cremation temperature. Earlier studies mainly focused on heat‐induced changes in bone tissue, while this study extends this research to human dental tissues using a novel quantitative analytical approach. Twelve tooth sections were burned at 400–900°C (30‐min exposure, increments of 100°C). Subsequent combined small‐ and wide‐angle X‐ray scattering (SAXS/WAXS) experiments were performed at the Diamond Light Source synchrotron facility, where 28 scattering patterns were collected within each tooth section. In comparison with the control sample, an increase in mean crystal thickness was found in burned dentine (2.8‐fold) and enamel (1.4‐fold), however at a smaller rate than reported earlier for bone tissue (5–10.7‐fold). The results provide a structural reference for traditional X‐ray scattering methods and emphasize the need to investigate bone and dental tissues separately to obtain a reliable estimation of cremation temperature.     

DNA Identification of Commingled Human Remains from the Cemetery Relocated by Flooding in Central Bosnia and Herzegovina

The floods in Bosnia and Herzegovina in May 2014 caused landslides all over the country. In the small village of ?eri?i, near the town of Zenica, a landslide destroyed the local cemetery, relocated graves, and commingled skeletal remains. As the use of other physical methods of identification (facial recognition, fingerprint analysis, dental analysis, etc.) was not possible, DNA analysis was applied. DNA was isolated from 20 skeletal remains (bone and tooth samples) and six reference samples (blood from living relatives) and amplified using PowerPlex^® Fusion and PowerPlex^®Y23 kits. DNA profiles were generated for all reference samples and 17 skeletal remains. A statistical analysis (calculation of paternity, maternity, and sibling indexes and matching probabilities) resulted in 10 positive identifications. In this study, 5 individuals were identified based on one reference sample. This has once again demonstrated the significance of DNA analysis in resolving the most complicated cases, such as the identification of commingled human skeletal remains.     

Ellis Kerley's service to the military.

The purpose of this paper is to present the contributions Ellis Kerley has made to the United States Department of Defense in the area of forensic anthropology. His service began at the end of the Korean War in the identification laboratory established in Kokura, Japan, under the direction of T.D. Stewart. Ellis developed his research on the quantification of cortical bone microstructure as a means of age estimation while at the Armed Forces Institute of Pathology. In December 1985, Ellis was asked by the Army to form a commission to evaluate the Central Identification Laboratory, HI (CILHI). This lab is tasked with the mission of search and recovery and identification of American personnel killed or listed as missing from past military conflicts. Ellis's team reviewed the identification process and documentation, the qualifications of lab personnel, the adequacy of facilities and equipment, and some questionable cases. Their written report was supplemented with testimony in front of congressional committees. Ellis served as scientific director of CILHI from 1987 until 1991. In addition to overseeing the daily case work, he led several missions to Vietnam to examine human remains and served as spokesman for the lab. His input helped the lab gain needed scientific credibility. Despite the frustrations of trying to identify human remains within the Army's casualty and memorial affairs system, Ellis always maintained the utmost dignity, compassion, and respect for the victims and their families.