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Table of Contents
REVIEW ARTICLE
Year : 2018  |  Volume : 6  |  Issue : 4  |  Page : 89-92

Role of maxillofacial radiology in expediting forensic odontology


Department of Oral Medicine and Radiology, Saraswati Dental College, Lucknow, Uttar Pradesh, India

Date of Web Publication14-May-2019

Correspondence Address:
Dr. Shruti Sinha
Department of Oral Medicine and Radiology, Saraswati Dental College, 233 Tiwari Ganj, Faizabad Raod, Lucknow, Uttar Pradesh.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_5_19

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  Abstract 

In the last few decades, forensic odontology has developed as a separate specialty that deals with examination of dental evidences, their proper evaluation, and correct management for law proceedings in the interest of justice. It is mainly concerned with person identification, age estimation, gender determination, human abuse, bite mark investigation, and DNA analysis, in incidents of natural disasters and medico-legal cases. Maxillofacial radiology is a promising tool in forensic science as radiographs capture the exact anatomic and skeletal features that can then be matched with the original records for person identification and can also provide minute forms of comparison between antemortem and postmortem radiographs in cases of mass disasters. The use of imaging is increasing day by day as it is efficient, quick, and comparatively easy, less expensive as compared to available DNA technologies, and can also be applied to both living individuals as well as dead. The present article aims to discuss the various trends that have evolved in forensic radiology and to appraise their contribution in the field of forensic odontology.

Keywords: Forensic science, forensic odontology, forensic radiology, person identification, crime investigation, age estimation, gender determination


How to cite this article:
Sinha S, Singh C, Chandra S, Singh SK, Mehta P. Role of maxillofacial radiology in expediting forensic odontology. Int J Oral Care Res 2018;6:89-92

How to cite this URL:
Sinha S, Singh C, Chandra S, Singh SK, Mehta P. Role of maxillofacial radiology in expediting forensic odontology. Int J Oral Care Res [serial online] 2018 [cited 2019 Jul 16];6:89-92. Available from: http://www.ijocr.org/text.asp?2018/6/4/89/258114




  Introduction Top


Forensic is a Latin word meaning “before the forum.” Odontology refers to the study of teeth or dentistry. Forensic odontology, therefore, has been defined by the Federation Dentaire Internationale (FDI) 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.”[1] It primarily deals with identification based on recognition of unique features present in an individual’s dental structure.

Forensic maxillofacial radiography has become a routine procedure in dental/medical hospitals and clinics. It is emerging as a field that assists the forensic odontologist in dental identification, which can be classified into two. The first is comparative identification, which attempts at conclusive identification by comparing the dead individual’s teeth with presumed dental records of the individual. The second, reconstructive identification or dental profiling, attempts to elicit the ethnicity, gender, age, and occupation of the dead individual. This is performed when virtually no clue exists about the identity.[2] It also play a vital role in crime investigation, especially child abuse.[3]


  Prolouge to History Top


In 1896, Prof. Arthur Schuster introduced radiology in forensics to visualize the lead bullets in the hand of a dead person.[3] In 1921, Schuller suggested the utilization of radiography for purposes of identification.[4] In 1927, Culbert and Law described the complete radiological identification of the skull by using pneumatic cells of the sinuses.[4],[5] In 1956, Frykholm reported the identification of two individuals based on dental X-ray films in the “OrmenFriske”disaster.[6] In 1967, Sir Godfrey Hounsfeld introduced computed tomography (CT) and magnetic resonance imaging (MRI) in forensic for identification, and it is considered the “Gold Standard” for comparing antemortem and postmortem radiographs.[7] In 1990, Kultman reported 100% success in comparison of antemortem and postmortem radiographs of the frontal sinuses.[6] In 1991, Happonen et al. recommended the use of orthopantomography in identification, which enables visualization of the jaws and related structures as a single radiograph.[4],[7] The same year, Haerting et al. stated that panoramic dental radiography is the only regularly updated and “truly reliable identification card” for comparison radiography.[7]


  Person Identification Top


According to Acharya and Taylor, identity is defined as “the characteristics by which a person may be recognized.” The identification of a person is required when the body is disfigured or mutilated beyond recognition as a result of man-made or natural mass disasters and casualties. Proper identification of the dead is needed for both legal and humanitarian reasons. It may also help in cases of property settlement, enabling remarriage of a surviving spouse, and allowing for cremation or burial of the dead body according to its religious norms.[2]

Dental hard tissues are gaining importance in the identification process as teeth are one of the strongest structures in the body and are not easily decomposed as other body structures even after death. Moreover, most restorative materials used by the dentists for restoring teeth (acrylic 540°C, gold and amalgam 870°C, porcelain 1100°C) are also resistant to postmortem changes and destruction by fire and, therefore, can be used for identification.[2],[8] Thus, the use of dental evidence is becoming the method of choice in establishing the identity of decomposed, burned, traumatized, and skeletonized human remains. The basis for dental identification is the theory that no two human dentitions are same. Kieser-Nelson has assessed this uniqueness of teeth mathematically.[2]


  Dental Identification Procedures Top


A dental record contains information of treatments undergone and dental status of a person during his or her lifetime and thus constitutes the antemortem dental data. It may be obtained from the treating dentists and hospital records. Such records are mainly in the form of radiographs, casts, photographs, and so on. In the comparative type of identification, the forensic odontologist must rely on anatomical structures common between antemortem and postmortem radiographic examinations.[2] It can be assessed based on factors such as teeth present, teeth missing, crown structure, root morphology, pulp anatomy, occlusion, wear and tear of tooth structure, pathology, different treatment procedures, alveolar bone pattern, and spatial relationship between the teeth.[5],[8] Radiographic records provide objective evidence of the dental treatment provided up to the point in time.[9] Bite‑wing radiography is considered as a good candidate for potential victim identification.[10] Digitized techniques also allow a precise analysis of the spatial relations of teeth roots and supporting structures on ante- and postmortem images.[9] Kirchhoff et al. in 2008 conducted a study, focusing on diagnosis accuracy of postmortem CT for identification.[11]

Craniofacial reconstruction is considered when no ante- and postmortem data are available of the unknown person.[2],[8] The progress made in computer science and computer software programs on medical imaging techniques allows the superimposition of known and unknown skull radiographs.[8] There are two means by which oral radiological examination may aid in reconstructive identification. The first is to assess and define the angulation of anterior teeth that have been lost postmortem and the second is to examine reassembled macerated remains prior to facial approximation exercises.[9]


  Identification in Disasters Top


Forensic dentists are usually a part of a forensic identification team in cases of disasters. According to Clark,[12] almost 50% of identification is from dental evidence. He further states that dental examination is usually done after photography, fingerprinting, and medical autopsy. A portable dental radiography apparatus should be installed at a convenient area within the temporary mortuary, taking all precautions against the risk of radiation hazards. The postmortem unit is responsible for processing the radiographs and may also need photographs of the teeth.[2]


  Gender Determination Top


Gender determination is one of the prime factors employed to determine the biological profile of unidentified human remains. The skeletal features of the craniofacial complex exhibit a wide range of dimorphic features that helps to determine the sex of the individual.[13] The anatomical structures such as the mandibular ramus, orbit, nasal aperture, and frontal sinus, which are distinctly visible in the radiographs, are deemed trustworthy in sex prediction. Gerder can be determine in various radiographs like cephlograms, paronamic view, occlusal view, posterio/anterior view and so on. CT and cone beam CT are also used nowadays for gender determination. A study conducted by Ghosh et al. in 2009 found that females have a significantly higher value of gonial angle than their male counterpart.[5] Bhuyan et al. in 2018 conducted a study by using panoramic radiograph as a forensic aid in age and gender estimation.[14]


  Age Estimation Top


Estimating age is the most important prerequisite for identification of the dead. In forensic odontology, it is required in cases where the age of the person has to be proved in legal cases. Dental age estimation is considered to be the most reliable mean of the age estimation as it is not much affected by environmental factors.[15] Until now, a multiplicity of methods has been used to estimate age based on dental tissue and tooth morphology. Radiographic age estimation using teeth relies on developmental stages of teeth. Age estimation in children and adolescents is based on appearance of tooth germs, mineralization, degree of crown completion, time of eruption of the tooth in the oral cavity, root completion of erupted or unerupted teeth, degree of resorption of deciduous teeth, and measurement of open apices in teeth. In adults, age-related traits such as attrition, development of third molar, and secondary dentin formation help in the determination of age.[1],[8] The age of the individual, including prenatal, neonatal, and postnatal life can be assessed using dental radiographs.[1],[16]


  Crime Investigation Top


The interpretation of radiographic image provides useful evidence in criminal and civil jurisdiction in the case of injury and child abuse. Radiographs also provide evidence of bullets or foreign bodies in the soft tissues following firearm incidence and explosion. Forensic radiologists suggest different techniques for specific head injury. CT is recommended for detection of subarachnoid hemorrhages whereas MRI is superior in revealing subdural hematomas, concussive injuries, and shear injuries. CT and MRI are equally efficient for demonstrative epidural hematoma, and CT advocated detection of fractures.[11]


  Advantages of Forensics Radiology Top


Radiographs are simple, easy, and quick modes of obtaining the information in a nondestructive manner in both living individuals and deceased. They are economical compared with DNA techniques, and more importantly, they have their acceptance in courts of law as legal evidence.[1],[14]


  Limitation of Radiology in Forensic Top


Postmortem intraoral radiography is difficult to perform, particularly when there is restricted mouth opening due to rigor mortis affecting the mandibular muscles, which causes major problem in placing and retaining radiographic films in the mouth.[10],[16] In some instances, only a fragment or a part of tooth/jaw has to be radiographically examined. In such cases, orientation of radiographs in accurate position is a challenging task.[16] Radiographs are more prone to mishandling. They are highly technique sensitive and require good skill to produce images without any defects, which can be troublesome at times as they can mimic foreign bodies or pathologies and add to the confusion of the investigators.[16]


  Scope and Future Aspect of Radiology in Forensic Top


Recent advancements in the field of radiology allow identification of body parts that are located far from each other in conditions like mass disasters. New digital technique has been used for identification where tooth root morphology and spatial orientation of the roots between antemortem and postmortem radiographs are compared. The use of high resolution eLU-CT (eXplore Locus Ultra flat panel CT) reduces problems such as streak artifacts caused by metallic dental fillings.[16] Transported multislice CT, MRI, and cone beam CT have become valuable tools, as they can perform postmortem dental scans in a short span of time and scan even those areas that are difficult to access. They even find hidden injuries and pathologies so that autopsy can be focused on that particular region sometimes even eliminating the need for autopsy.[15] Dental biometrics is a new innovation utilizing dental radiographs for human identification.[16]


  Conclusion Top


Thus, we can see that radiographs are an excellent tool and have become a vital component of modern medical practice, thereby significantly contributing to decision-making situations in forensic odontology. Dental and craniofacial radiographs are an important assessment tool in race, gender, and stature estimation due to diversity in human physical constitutional makeup. Advancements in radiological techniques such as CT, CBCT, and MRI can also be utilized as an aid in forensics odontology. They even play an important role in various criminal investigations. Even surgical means of autopsy can be substituted by virtual autopsy, thereby making full use of radiology. Furthermore, studies related to forensic radiology should be encouraged and implemented for educational and research purposes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sahin KA, Chatra L, Shenai P. Dental and craniofacial imaging in forensic. Journal of Forensic Radiology and Imaging 2013;1: 56-62.  Back to cited text no. 1
    
2.
Rajendra R, Sivapathasundharam B . Shafer’s Text Book of Oral Pathology. 6th ed. Noida, India: Elsevier; 2009.  Back to cited text no. 2
    
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Chandrashekhar T, Vennila P. Role of radiology in forensic dentistry: A review J Indian Acad Oral Med Radiol 2011;23: 229-31.  Back to cited text no. 4
    
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Jawaid M, Amir A, Shahnawaz K, Qamar Y, Upadhay P, Singh J. Maxillofacial imaging in forensic science: A newer approach—A review. International Journal of Contemporary Medical Research 2016;3:2491-5.  Back to cited text no. 5
    
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Singal K. History of dental radiographs. Indian Journal of Forensic Medicine & Toxicology 2016;10:144-6.  Back to cited text no. 6
    
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Carvalho SPM, Silva RHAD, Junior CL, Peres AS. Use of image for human identification in forensic dentistry. Radiol bras 2009;42:125-30.  Back to cited text no. 7
    
8.
Kumar R, Athota A, Rastogi T, Karumuri SK. Forensic radiology: An emerging tool in identification. J Indian Acad Oral Med Radiol 2015;27:416-22.  Back to cited text no. 8
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Wood RE. Forensic aspects of maxillofacial radiology. Forensic Sci Int 2006;159 Suppl 1:S47-55.  Back to cited text no. 9
    
10.
Manigandan T, Sumathy C, Elumalai M, Sathasivasubramanian S, Kannan A. Forensic radiology in dentistry. J Pharm Bioallied Sci 2015;7:S260-4.  Back to cited text no. 10
    
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Kirchhoff S, Fischer F, Lindemaier G, Herzog P, Kirchhoff C, Becker C, Bark J, Reiser MF, Eisenmenger W. In post-mortem CT of the dentition adequate for forensic identification Comparison of dental computed tomography and visual dental record. Int J Legal Med 2008;122:471-9.  Back to cited text no. 11
    
12.
Clark DH. Mass Disaster Procedures in Practical Forensic Odontology. Oxford: Wright; 1992.  Back to cited text no. 12
    
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Kaushal S, Patanik VVG, Sood V, Agnihotri GA. Sex determination. In north Indians using mandibular canine index. Journal of Indian Academy of Forensic Medicine 2004;26:45-9.  Back to cited text no. 13
    
14.
Bhuyan R, Mohanty S, Bhuyan SK, Pati A, Priyadarshini S, Das P. Panoramic radiograph as a forensic aid in age and gender estimation: preliminary retrospective study. J Oral Maxillofac Pathol 2018;22:266-70.  Back to cited text no. 14
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Samuel SG, Pandey A, Dahiya MS. A report on the current status of radiology in forensic odontology in the Indian scenario. Int J Forensic Odontol 2017;2:34-7.  Back to cited text no. 15
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Achar MS, Shetty SR, Al-Bayati SAAF, Joshua A, Suneja R. Importance’s of radiology in forensic odontology: A brief review. Eur J of Forensic Sci 2015;2:28-30.  Back to cited text no. 16
    




 

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  In this article
   Abstract
  Introduction
  Prolouge to History
   Person Identific...
   Dental Identific...
   Identification i...
  Gender Determination
  Age Estimation
  Crime Investigation
   Advantages of Fo...
   Limitation of Ra...
   Scope and Future...
  Conclusion
   References

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