Age estimation by measurements of developing teeth: accuracy of Cameriere's method on a Brazilian sample

Developing teeth are commonly the criteria used for age estimation in children and young adults. The method developed by Cameriere et al. (Int J Legal Med 2006;120:49-52) is based on measures of teeth with open apex, and application of a formula, to estimate chronological age of children. The present study evaluated a sample of panoramic radiographs from Brazilian children from 5 to 15 years of age, to evaluate the accuracy of the method proposed by Cameriere et al. The results has proven the system reliable for age estimation, with a median residual error of -0.014 years between chronological and estimated ages (p = 0.603). There was a slight tendency to overestimate the ages of 5-10 years and underestimate the ages of 11-15 years.     

Age Estimation in Indians Using Demirjian’s 8‐teeth Method

Abstract: Demirjian’s grading of tooth calcification is widely used to assess age of individuals with developing dentitions. However, its application on numerous populations has resulted in wide variations in age estimates and consequent suggestions for the method’s adaptation to the local sample. Conventionally, Demirjian’s method utilized seven mandibular teeth on the left side. A recent modification incorporated the third molar with a view to apply the method on a wider age‐group. Moreover, the revised method developed regression formulas for assessing age. This paper tested the 8‐teeth method using 547 Indians (348 females, 199 males) aged 7–25 years. Demirjian’s formulas resulted in inferior age prediction in Indians (9.2% misclassification at 99% confidence interval vs. 0% misclassification in the original study); therefore, India‐specific regression formulas were developed, which gave better age estimates (mean absolute error, MAE = 0.87 years) than the original formulas (MAE = 1.29 years). This suggests that Demirjian’s 8‐teeth method also needs adaptation prior to use in diverse populations.     

Morphometric analysis of third molar root development by an experimental method using digital orthopantomographs

Abstract:  The aim of the study was to conduct a morphometric analysis of the root development of the third molar, with the purpose of overcoming the limits of an exclusively morphological analysis. The study was divided in two phases. The first one was the verification of the existence of a constant crown-root (C/R) ratio on a sample of 100 third molars, characterized by a complete root development. The value obtained was used in the second phase to predict the final root's length, knowing the crown height. So we have calculated, on a sample of 322 third molars with developing roots, the final ratios between incomplete roots and complete roots. Statistical analysis was then made with 90%, 95%, and 99% confidence intervals. The results showed a significant difference according to the age of the subject and the limit values, lower and upper, for subjects aged 16 and 17 years versus those aged 18 and 19. For each analysis, the width of the class of tolerance and other statistical indicators were calculated. The results we obtained support the advantage of a morphometric study as opposed to an exclusively morphological study, but all the techniques used to determine the age of a living subject can provide only indications of the biological age, but no certainties as regards chronological age.     

Morphologic patterns of lip prints in a portuguese population: a preliminary analysis

Lip prints are thought to have the ability to distinguish individuals and, hence, have a potential use in human identification purposes. However, questions remain regarding their utility for sex determination. This study aimed to classify lip prints for different individuals in a Portuguese population and to determine whether sex differences exist. Lip prints of 25 females and 25 males were obtained using dark-colored lipstick and cellophane tape. Lip prints were analyzed using a magnifying lens and classified according to the Suzuki and Tsuchihashi classification. A Type II pattern was found to be most common. A comparison of lip-print patterns between males and females showed results with a statistically significant difference: Type III pattern was most common in males, and a Type II pattern in females. This study corroborates the hypothesis that lip prints are able to distinguish individuals and may be useful in sex determination.     

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.     

Antemortem dental records: attitudes and practices of forensic dentists

This study was designed to provide insight concerning the attitudes and practices of forensic dentists regarding antemortem dental records reviewed for purposes of dental identification. Forensic dentists were invited to participate in a 10 item survey. The majority of the respondents reported a considerable amount of experience in dental identifications of the deceased. Sixty-six percent reported having suspected dental negligence or fraud in their antemortem record reviews. Only 17% believe that a forensic dentist should report suspected dental negligence, while 31% agree that dental fraud should be reported. Their response to additional issues addressed in the study suggests diversity in the practices and attitudes of forensic dentists in the use of antemortem dental records. In conclusion, opening a dialogue among practicing forensic dentists may lead to a standardized set of recommendations by the appropriate societies in the forensic dental community.     

Study of Chilean Children’s Dental Maturation*

Abstract: In forensic science, determining a person’s chronological age has become a challenge for researchers. Determining age using dental calcification is becoming increasingly important. The objective of this study is to estimate the dental age of the children’s population in Region VIII, Chile. The sample was randomly taken from children under the care of the Faculty of Dentistry at the Universidad de Concepción in Chile. The study encompasses 159 children between 3 and 14 years of age. The dental age was determined following the Demirjian method. The Bland–Altman method was applied to establish the correlation. It was determined that the range between chronological and dental age is similar, and the degree of correlation between both ages is nearly perfect. In conclusion, the degree of correlation between the chronological and dental ages for each gender is also very good although it is slightly higher for females.     

Computer‐aided Dental Identification: An Objective Method for Assessment of Radiographic Image Similarity*

Abstract: A pilot study evaluated a computer‐based method for comparing digital dental images, utilizing a registration algorithm to correct for variations in projection geometry between images prior to a subtraction analysis. A numerical assessment of similarity was generated for pairs of images. Using well‐controlled laboratory settings, the method was evaluated as to its ability to identify the correct specimen with positive results. A subsequent clinical study examined longitudinal radiographic examinations of selected anatomical areas on 47 patients, analyzing the computer‐based method in making the correct identification based upon a threshold level of similarity. The results showed that at a threshold of 0.855, there were two false negative and two false positive identifications out of 957 analyses. Based on these initial findings, 25 dental records having two sets of full mouth series of radiographs were selected. The radiographs were digitized and grouped into six anatomical regions. The more recent set of films served as postmortem images. Each postmortem image was analyzed against all other images within the region. Images were registered to correct for differences in projection geometry prior to analysis. An area of interest was selected to assess image similarity. Analysis of variance was used to determine that there was a significant difference between images from the same individual and those from different individuals. Results showed that the threshold level of concordance will vary with the anatomical region of the mouth examined. This method may provide the most objective and reliable method for postmortem dental identification using intra‐oral images.     

Detection and classification of composite resins in incinerated teeth for forensic purposes

The great demand for esthetic restorations has resulted in placement of large numbers of composite resin fillings. The popularity of these materials is reflected in the quantity and variety of resin brands currently on the market. The ability to distinguish resin brands can aid in positive identification of burn victims, assuming that appropriate dental records exist. Scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDS) was used to characterize the structure and composition of 10 modern resins. The structure of each resin was unique to manufacturer, and elemental analysis allowed separation into distinct groups. These 10 resins were also placed in extracted teeth and incinerated at 900 degrees C for 30 min, simulating near cremation conditions. The resins were identifiable by SEM/EDS after incineration, and the elemental composition remained almost unchanged. The data produced are immediately useful for resin identification in forensics, and comparative analysis can be readily performed using standard equipment. This work represents the initial stage of database generation.     

Age estimation by pulp/tooth ratio in canines by peri-apical X-rays

Estimation of age in individuals has received considerable attention in forensic science, in which it is a widely used method for individual identification, together with paleo-demographic analyses to establish mortality patterns in past populations. The present investigation, which is a continuation of a previously published pilot study, was conducted to examine the possible application of the pulp/tooth area ratio by peri-apical images as an indicator of age at death. A total of 200 peri-apical X-rays of upper and lower canines were assembled from 57 male and 43 female skeletons of Caucasian origin, aged between 20 and 79 years. They belong to the Frassetto osteological collection of Sassari (Sardinia) and are housed in the Museum of Anthropology, Department of Experimental and Evolutionistic Biology, University of Bologna. For each skeleton, dental maturity was evaluated by measuring the pulp/tooth area ratio on upper (x(1)) and lower (x(2)) canines. Very good agreement was found between intraobserver measurements. Statistical analysis was performed in order to obtain multiple regression formulae for dental age calculation, with chronological age as dependent variable, and gender, and upper and lower canines as independent variables. Stepwise regression analysis showed that gender did not contribute significantly to the fit (p=0.881) whereas variables x(1) and x(2) and the first-order interaction between them did. These two variables explained 92.5% of variations in estimated chronological age and the residual standard error was 4.06 years. Lastly, two simple linear regression equations were obtained for age estimation using canines from the maxilla and mandible separately. Both models explained 86% of variations in estimated chronological age and allowed an age-at-death estimate with a residual standard error of about 5.4 years.     

Age estimation by pulp/tooth ratio in canines by mesial and vestibular peri-apical X-rays

Changes in the size of the pulp canal, caused by apposition of secondary dentine, are the best morphometric parameters for estimating age by X-rays. The apposition of secondary dentine is the most frequently used method for age estimation in adult subjects. In two previous papers, we studied the application of the pulp/tooth area ratio by peri-apical X-rays as an indicator of age at death. The aim of the present study was to test the accuracy of age evaluation by combined analysis of labio-lingual and mesial peri-apical X-rays of lower and upper canines. A total of 200 such X-rays were assembled from 57 male and 43 female skeletons of Caucasian origin, aged between 20 and 79 years. For each skeleton, dental maturity was evaluated by measuring the pulp/tooth area ratio according to labio-lingual and mesial X-rays on upper (x(1), x(2)) and lower (x(3), x(4)) canines. Very good agreement was found between intra-observer measurements. Statistical analysis showed that all variables x(1), x(2), x(3), and x(4) and the first-order interaction between x(1) and x(3) contributed significantly to the fit, so that they were included in the regression model, yielding the following regression formula: Age = 120.737 - 337.112x(1) - 79.709x(2) - 364.534x(3) - 65.655x(4) + 1531.918x(1)x(3) . The residual standard error of estimated ages was 3.62 years, with 94 degrees of freedom, and the median of the residuals was -0.155 years, with an interquartile range of 4.96 years. The accuracy of the method was ME = 2.8 years, where ME is the mean prediction error. The model also explained 94% of total variance (R(2) = 0.94).     

On the applicability of secondary dentin formation to radiological age estimation in young adults

The literature provides linear regression formulas for dental age estimation that is based on radiological two-dimensional measurements of the pulp size. The aim of the present study was to explore whether the previously presented regression formulas could lead to statistically sound results and to appropriate repeatability when applied to young individuals. Orthopantomograms (OPGs) of 44 Austrian individuals, aged between 13 and 24 years, were selected at random. In accordance with the reported method, six teeth on each OPG were chosen to carry out the measurements. Statistical analysis was performed in order to assess the difference between the estimated and the true chronological age. The regression formulas reported by Kvaal et al. (1995) led to a consistent underestimation; the regression formulas reported by Paewinsky et al. (2005) resulted in a constant overestimation of age. The statistical analysis of intraobserver and interobserver variation revealed a variation width below 2%, respectively.     

Yet another method for marking incisal edges of teeth for bitemark analysis

Over the years many methods have been proposed and presented for marking or "highlighting" the incisal edges of anterior teeth on a dental stone model -- one of the critical steps in production of transparent overlays for bitemark analysis. A method is presented here that is an extension and refinement of the "paint the edges" method shown at least as early as 1966 by Gustafson. This method uses "invisible ink" and ultraviolet illumination to produce a very high contrast image of the incisal edges of the teeth on the model. The advantages of this new method are that it is nondestructive, it does not leave visible marks on the models, operator subjectivity in selecting the portions of anterior teeth to be highlighted is reduced, and the author submits that this technique lends itself to easy construction of overlays using computer image-processing software such as Adobe Photoshop and ImageJ.     

Lessons learned from large-scale comparative dental analysis following the South Asian tsunami of 2004

The aim of this study was to examine the quality of the ante-(AM) and postmortem (PM) dental data that were submitted for entry into the PLASS data system in Phuket, Thailand, following the Boxing Day (December 26) Tsunami, 2004. The investigators were two forensic odontologists who were part of the New Zealand Disaster Victim Identification team that worked at Wat Yang Yao morgue and at the Information Management Center in Phuket. Our findings underline the usefulness of dental data in human identification, but point to a number of significant sources of error. Of the 78 PM records received, only 68% of radiographs and 49% of photos confirmed the accompanying dental charting. This underlines the value, particularly of photographs of the dental arches, in quality control. It also points to a large error component, which may have been due to inexperience of the operators, fatigue, poor conditions in the temporary morgue, or the problem of tooth-colored fillings. Of the 106 AM records received, 62% were of unacceptable quality and 64% were either not accompanied by radiographs or had poor quality radiographs. These results indicate that AM data collection ideally needs to be collated and checked by a forensically trained dentist(s) in the country of origin.     

Age Estimation from the Teeth Using a Modified Demirjian System*

Abstract: The estimation of age at time of death is often an important step in the identification of human remains. The purpose of this study was to test the applicability of the Demirjian system on a sample of the Sydney child population and to develop and test age‐prediction models using a large sample of Sydney children (1624 girls, 1637 boys). The use of the Demirjian standards resulted in consistent overestimates of chronological age in children under the age of 14 by as much as a mean of 0.99 years. Of the alternative predictive models derived from the Sydney sample, those that provided the most accurate age estimates are applicable for the age ranges 2–14 years, with R‐square = 0.94 and a 95% confidence interval of ±1.8 years. The Sydney‐based standards provided significantly different and more accurate estimates of age for that sample when compared to the published standards of Demirjian.     

Uniqueness of the Dentition as Impressed in Human Skin: A Cadaver Model*

Abstract: Bitemark interpretation assumes that the human dentition is unique and that its attributes can be accurately transferred to skin. A cadaver model was used to investigate whether the correct biter could be determined from similarly aligned dentitions once the dentitions were impressed in human skin. One‐hundred dental stone models, which were measured and determined to be unique, were divided into 10 groups based upon similarities of mal‐alignment patterns. One model was randomly selected from each group and bites were produced on unembalmed human cadavers. Metric/angular measurements and hollow volume overlays of the models were compared with the bites made. The percentage of dentitions from each group as well as the 100 dental model population that could not be excluded as the biter was determined. Results showed difficulty distinguishing the biter from individuals with similarly aligned dentitions and in some cases, an incorrect biter appeared better correlated to the bite.     

Statistical Evidence for the Similarity of the Human Dentition

Abstract: Recent scrutiny of forensic science has focused on unreliability of expert witness testimony when based on statements of individuality. In bitemark analysis, assumptions regarding uniqueness of the dentition have been based on use of the product rule while ignoring correlation and nonuniformity of dental arrangement. To examine the effect of these factors, two separate sets of scanned dental models (n = 172 and n = 344) were measured and statistically tested to determine match rates. Results were compared to those of a prior study. Seven and 16 matches of the six anterior lower teeth were found in the respective data sets. Correlations and nonuniform distributions of tooth positions were observed. Simulation tests were performed to verify results. Results indicate that given experimental measurement parameters, statements of dental uniqueness with respect to bitemark analysis in an open population are unsupportable and that use of the product rule is inappropriate.     

Palatal rugae pattern in a Portuguese population: a preliminary analysis

Palatal rugae have been related with specific racial groups and are said to be useful in sex discrimination. This work aimed to characterize the palatal rugae patterns in a Portuguese population. Fifty plaster casts were examined for first and third rugae shape evaluation; shape, frequency, and association with sex were studied. In females, the most prevalent first rugae were the straight type on the right and the curve type on the left; in males, the straight type was the most prevalent on both sides. The most frequent third rugae type was sinuous on both sides, in both sexes. No significant sexual dimorphism in rugae shape was found (p > 0.05). When comparing these results with those from other investigations, it was clear that a particular rugae pattern could be established for different ethnic groups. However, the small sample size justifies further work in larger samples to validate these findings.     

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.