Proposal for internet-based Digital Dental Chart for personal dental identification in forensics

A dental chart is very useful as a standard source of evidence in the personal identification of bodies. However, the kind of dental chart available will often vary as a number of types of odontogram have been developed where the visual representation of dental conditions has relied on hand-drawn representation. We propose the Digital Dental Chart (DDC) as a new style of dental chart, especially for open investigations aimed at establishing the identity of unknown bodies. Each DDC is constructed using actual oral digital images and dental data, and is easy to upload onto an Internet website. The DDC is a more useful forensic resource than the standard types of dental chart in current use as it has several advantages, among which are its ability to carry a large volume of information and reproduce dental conditions clearly and in detail on a cost-effective basis.     

Self-assessment of the forensic value of dental records.

One of the most important aspects of a person's dental record may well prove to be it's potential value should the forensic dental identification of their remains become necessary. The better the quality of the antemortem dental records, the easier and faster the identification of the remains will be. The forensic dentist must be able to select identifying features by decoding the deceased's antemortem dental records. A study was conducted on two groups of dentists who were asked to self-assess the forensic dental value of the dental records maintained in their own practices. The three most frequently recorded identifying dental features, other than caries and restorations, were the presence of diastemas, displaced or rotated teeth, and dental anomalies. Surveyed dentists imbedded identifying information into the removable prosthetic devices fabricated for their patients an average of only 64% of the time. Only 56% of the two groups combined felt that their dental chartings and written records would be extremely useful in dental identifications. It is concluded that the quality of antemortem dental records available for comparison to postmortem remains varies from inadequate to extremely useful. Practicing dentists can become valuable members of the dental identification process by developing and maintaining standards of record keeping which would be valuable in restoring their patients' identity.     

Craniofacial identification by comparison of antemortem and postmortem radiographs: two case reports dealing with burnt bodies

Two cases of positive identification of burnt bodies by radiographic comparison are reported. They emphasize that antemortem radiographs of the head are an important but sometimes overlooked source of information which can frequently provide useful objective data for comparison purposes. A positive identification can easily be achieved by medical examiners through visual comparison of the antemortem with the postmortem cranial and facial structures, even of bodies severely damaged by fire. In these bodies the radiographs of the skull can graphically depict structures which are often unique to the individual, such as the frontal sinus pattern and the morphology of dental restorations. However, the process of identification through radiographs is appropriate only in burnt bodies in which antemortem radiographs of the alleged deceased are available for comparison and unique craniofacial structures are still present on the body in a well-preserved state or at least not completely destroyed by fire, depending on the extent of the burn injury. Matching of corresponding features seems preferable to other methods of personal identification such as skull-photo superimposition, morphometric analysis, and/or other computer-aided methods since these techniques need trained personnel, as well as expensive equipment which is not invariably available in the medical examiner's office or department of anthropology.     

Antemortem records of forensic significance among edentulous individuals

The identification of edentulous individuals is problematic due to poor provision of labelled dental prostheses. Dental records may still provide useful information for odontologists in the comparative identification process. The purpose of this study was to determine the level of forensically significant information contained within the dental records of a population of denture wearers attending the University of Manchester School of Dentistry. Two hundred and two dental records were examined and a proforma completed. The mean age of the patients was 72 years. Medical history were absent in 4% of all records and only 67.8% of the written records were rated as good. Thirty-two percent of the records contained one or more panoramic radiographs but 30% of these were over 3 years old rendering their usefulness in identification procedures questionable. In total only 18% of the examined records contained antemortem information that would enable identification. These data suggest that the process of denture marking is an essential in order to ensure that the identification of this population can be undertaken expediently by dental means.     

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.     

Usefulness of Forensic Dental Symbols© and Dental Encoder© database in forensic odontology

Abstract: A new universal graphic dental system, Forensic Dental Symbols^©, has been created to provide precision in the construction of dental records, improve standardization, and increase efficiency in dental identification procedures. Two hundred and thirty‐four different graphic symbols representing the most frequent clinical status for each tooth were designed. Symbols can be then converted to a typographic font and then are ready to use in any computer. For the appropriate use, manipulation, and storage of dental information generated by the Forensic Dental Symbols^©, Dental Encoder^© database has been created. The database contains all the information required by INTERPOL Disaster Victim Identification (DVI)‐dental‐forms. To explore the possibilities that Dental Encoder^© offers, an antemortem dental database from a Spanish population of 3920 military personnel had been constructed. Data generated by Dental Encoder^© were classified into sex and age groups. The program can perform an automatic search of the database for cases that match a selected clinical status presented in a single tooth or a combination of situations for several teeth. Moreover, Dental Encoder^© allows information to be printed on INTERPOL DVI‐dental‐forms, or the inclusion of any completed form into any document, technical report, or identification of dental report.     

A new algorithm for use in computer identification

On 9 May 1987, a Soviet-made IL-62M Polish airliner, LOT Flight 5055, crashed, exploded, and burned, killing the crew and 183 passengers. A forensic science team from the Armed Forces Institute of Pathology, comprised of 6 dental officers, 3 forensic pathologists, and 3 medical photographers, worked in concert with the Polish forensic science team. The small number of antemortem records and the extreme fragmentation of the remains presented a new scenario for computer use. Typically, the Computer-Assisted Postmortem Identification (CAPMI) software is used to compare remains against an antemortem database. Results are listed by the number of tooth-to-tooth matches based on restorative or other characteristics or both. The Polish disaster confounded this approach to some degree, however, and suggested a reconsideration of the theory on which the sort is made, that is, that the cases with maximum number of matches to preexisting dental records would be the most likely identification (ID) match. A hypothesis was constructed that, if searches were accomplished for fragments with a minimum number of mismatches, the correct matches would appear higher in the rank order. Six antemortem records (that had all dental information) were sorted against one hundred and twelve postmortem fragmented records. The resulting report was reordered so that records were listed by minimum number of mismatches. There was significant improvement in rank placement for all of the records. Thus it was accepted that in the situation of highly fragmented remains a different sorting based on the number of mismatches is indicated. Programming changes to make this option available have been implemented in the new version of CAPMI.     

The use of dental aging techniques in forensic odontological practice

Many studies have been published describing numerous techniques to determine the aging of individuals from dental tissues. However, few case reports demonstrate how such techniques can be employed by the forensic odontologist undertaking casework. Indeed, many of the techniques are highly complex and utilize equipment not generally available to odontologists outside of the university or hospital systems. This paper describes five cases where dental aging was used for identification in the absence of materials for any other techniques. In each case the Bang and Ramm method was employed using sectioned teeth. Teeth were sectioned, photographed, and scaled in image analysis software. Bang and Ramm equations were employed, and in each case an age was derived. The estimated age was supplied to the coroner, who was able to use the information to positively identify five individuals for whom no other identification system was feasible.     

Burned beyond recognition: systematic approach to the dental identification of charred human remains

Forensic dental evaluation methods for use in a systematic approach to the dental identification of charred human remains are described. A systematic, conservative approach prevents the loss of valuable dental information before a thorough picture of the individual's dental remains has been adequately documented. The presenting conditions of fire victims are explained and illustrated with photographs, and a series of illustrations and text describe the damage seen in the dentition of the fire victim. A systematic four-stage process for gaining access to the intraoral structures of charred human remains is outlined and illustrated. Utilizing methods of access to the oral structures that maintain the integrity of the dentition through each stage of the evaluation of charred remains will prevent the loss of potential dental information before a thorough dental charting, intra-oral photographs, and radiographs can be obtained.     

Missing persons-missing data: the need to collect antemortem dental records of missing persons

The subject of missing persons is of great concern to the community with numerous associated emotional, financial, and health costs. This paper examines the forensic medical issues raised by the delayed identification of individuals classified as "missing" and highlights the importance of including dental data in the investigation of missing persons. Focusing on Australia, the current approaches employed in missing persons investigations are outlined. Of particular significance is the fact that each of the eight Australian states and territories has its own Missing Persons Unit that operates within distinct state and territory legislation. Consequently, there is a lack of uniformity within Australia about the legal and procedural framework within which investigations of missing persons are conducted, and the interaction of that framework with coronial law procedures. One of the main investigative problems in missing persons investigations is the lack of forensic medical, particularly, odontological input. Forensic odontology has been employed in numerous cases in Australia where identity is unknown or uncertain because of remains being skeletonized, incinerated, or partly burnt. The routine employment of the forensic odontologist to assist in missing person inquiries, has however, been ignored. The failure to routinely employ forensic odontology in missing persons inquiries has resulted in numerous delays in identification. Three Australian cases are presented where the investigation of individuals whose identity was uncertain or unknown was prolonged due to the failure to utilize the appropriate (and available) dental resources. In light of the outcomes of these cases, we suggest that a national missing persons dental records database be established for future missing persons investigations. Such a database could be easily managed between a coronial system and a forensic medical institute. In Australia, a national missing persons dental records database could be incorporated into the National Coroners Information System (NCIS) managed, on behalf of Australia's Coroners, by the Victorian Institute of Forensic Medicine. The existence of the NCIS would ensure operational collaboration in the implementation of the system and cost savings to Australian policing agencies involved in missing person inquiries. The implementation of such a database would facilitate timely and efficient reconciliation of clinical and postmortem dental records and have subsequent social and financial benefits.     

Methods for identification of 28 burn victims following a 1996 bus accident in Spain

A car collided head-on with a bus containing 56 passengers plus the driver. A few seconds after the crash, the bus caught fire and 28 persons (15 male and 13 female) lost their lives. All the deceased were almost completely incinerated. To establish the identity of the victims, the judge in charge of the case designated a multidisciplinary Identification Commission. Postmortem procedures included a general external examination, routine photographs, dental examination, dental (intraoral and extraoral) and general radiographs (chest, ankle, etc.), and complementary biological methods for identification (e.g., DNA analysis). The antemortem information, including dental and medical records available, were transcribed onto the INTERPOL disaster victim identification forms. The detailed ante- and postmortem information were compared manually. In this disaster dental identity could be established in 57% of the victims, whereas dental evidence did not allow by itself the identification of 12 burned victims. Odontological examination and complementary radiographic procedures were found to be accurate, economic and rapid methods of identifying badly burned victims in this bus accident.     

Dental devices; reclassification of root-form endosseous dental implants and endosseous dental implant abutments. Final rule

The Food and Drug Administration (FDA) is reclassifying root-form endosseous dental implants and endosseous dental implant abutments from class III to class II (special controls). Root-form endosseous dental implants are intended to be surgically placed in the bone of the upper or lower jaw arches to provide support for prosthetic devices, such as artificial teeth, in order to restore the patient's chewing function. Endosseous dental implant abutments are separate components that are attached to the dental implant and intended to aid in prosthetic rehabilitation. FDA is reclassifying these devices on its own initiative on the basis of new information. Elsewhere in this issue of the Federal Register, FDA is announcing the availability of the guidance document that will serve as the special control for these devices. FDA is taking this action under the Federal Food, Drug, and Cosmetic Act (the act), as amended by the Medical Device Amendments of 1976 (the 1976 amendments), the Safe Medical Devices Act of 1990, the Food and Drug Administration Modernization Act of 1997, and the Medical Device User Fee and Modernization Act of 2002.     

Dental products devices; reclassification of endosseous dental implant accessories. Food and Drug Administration, HHS. Final rule

The Food and Drug Administration (FDA) is reclassifying the manually powered drill bits, screwdrivers, countertorque devices, placement and removal tools, laboratory pieces used for fabrication of dental prosthetics, trial abutments, and other manually powered endosseous dental implant accessories from class III to class I. These devices are intended to aid in the placement or removal of endosseous dental implants and abutments, prepare the site for placement of endosseous dental implants or abutments, aid in the fitting of endosseous dental implants or abutments, aid in the fabrication of dental prosthetics, and be used as an accessory with endosseous dental implants when tissue contact will last less than an hour. FDA is also exempting these devices from premarket notification. This reclassification is on the Secretary of Health and Human Services' own initiative based on new information. This action is being taken under the Federal Food, Drug, and Cosmetic Act (the act), as amended by the Medical Device Amendments of 1976 (the 1976 amendments), the Safe Medical Devices Act of 1990 (the SMDA), and the Food and Drug Administration Modernization Act of 1997 (FDAMA).     

Dental and Chronological Age in Children Under Oncological Treatment

The current oncology treatment has improved the survival of children with several types of cancer, and the effect of radiotherapy and/or chemotherapy treatment on dental maturation in comparison with chronological age is not widely known. The aim of this work was to evaluate and compare the impact of radiotherapy and/or chemotherapy treatment during dental maturation with chronological age in Chilean children diagnosed with cancer. Study Design was cross‐sectional study on children diagnosed with different types of cancer and treated with radiotherapy and/or chemotherapy when they were ages of 0.1 to 13 years. Demirjian tables for both girls and boys are used to determine the dental age. The association between chronological and dental age was highly significant. Nevertheless, a linear relation between chronological and dental age was not observed when the data were stratified by BMI and type of treatment. This study confirmed that dental age is an indicator of chronological age but that other variables, such as body mass index, in children with cancer could be confounder variables. Thus, further studies are necessary to investigate the influence of BMI on tooth eruption/maturation in children under oncological treatment.     

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.     

Information,apprehension, and deterrence: Exploring the limits of police productivity

The capacity of police departments to solve crimes and apprehend offenders is low for many types of crime, particularly crimes of profit. This article reviews a variety of studies of police apprehension and hypothesizes that an important determinant of the ability of the police to apprehend criminals is information. The complete absence of information for many types of crime places fairly clear upper bounds on the ability of the police to effect solutions.To discover whether these boundaries are high or low we analyzed data from the 1973 National Crime Panel about the types and amount of information potentially available to police through victim reports and patrol activities. The evidence suggests that if the police rely on information made readily available to them, they will never do much better than they are doing now. On the other hand, there appears to be more information available to bystanders and passing patrols than currently is being used, which suggests that surveillance strategies and improved police methods for eliciting, recording, and analyzing information supplied by victims and witnesses might increase the probability of solving crimes and making arrests. In light of this we review a few possibly helpful innovations suggested in the literature on police productivity and procedure.     

A new system for computer aided dental identification in mass disasters

In recent years, several computer programs for dental identification in mass disasters have been developed. Unfortunately, it may be difficult to get access to such programs. The Norwegian police presently utilizes a text retrieval program, NOVA¹STATUS, for detection work. This program is based on the British STATUS ONE program, and it enables the user to find from a large pool of postmortem dental registration one or several sets containing specific information about one tooth or several teeth. The complete relevant set(s) can be displayed for visual examination and comparison. A coding system for dental information has been developed as well as a system for interrogating the computer. This system and its efficiency have been tested on a simulated small scale disaster where various well-known difficulties in dental identification were included.     

Intelligent dental identification system (IDIS) in forensic medicine

This study reports the design and development of the intelligent dental identification system (IDIS), including its efficiency and reliability. Five hundred patients were randomly selected from the Dental Department at Police General Hospital in Thailand to create a population of 3000 known subjects. From the original 500 patients, 100 were randomly selected to create a sample of 1000 unidentifiable subjects (400 subjects with completeness and possible alterations of dental information corresponding to natural occurrences and general dental treatments after the last clinical examination, such as missing teeth, dental caries, dental restorations, and dental prosthetics, 100 subjects with completeness and no alteration of dental information, 500 subjects with incompleteness and no alteration of dental information). Attempts were made to identify the unknown subjects utilizing IDIS. The use of IDIS advanced method resulted in consistent outstanding identification in the range of 82.61-100% with minimal error 0-1.19%. The results of this study indicate that IDIS can be used to support dental identification. It supports not only all types of dentitions: primary, mixed, and permanent but also for incomplete and altered dental information. IDIS is particularly useful in providing the huge quantity and redundancy of related documentation associated with forensic odontology. As a computerized system, IDIS can reduce the time required for identification and store dental digital images with many processing features. Furthermore, IDIS establishes enhancements of documental dental record with odontogram and identification codes, electrical dental record with dental database system, and identification methods and algorithms. IDIS was conceptualized based on the guidelines and standards of the American Board of Forensic Odontology (ABFO) and International Criminal Police Organization (INTERPOL).