clinical case
agnieszka Przystańska
1, a, B, D, e*, Mariusz Glapiński
2, a, B, D, e*, Tomasz Kulczyk
3, B, D, F,
Dorota lorkiewicz-Muszyńska
4, a, B, eForensic Odontology in Practice: the Role of Prosthethic
Dental Treatment in Personal Identification
Praktyka odontologiczno-sądowa: rola uzupełnień protetycznych
w procesie identyfikacji osobniczej
1 Department of anatomy, Poznań University of Medical sciences, Poland 2 Oral Rehabilitation clinic, Poznań University of Medical sciences, Poland
3 Department of Biomaterials and experimental Dentistry, Poznań University of Medical sciences, Poland 4 Department of Forensic Medicine, Poznań University of Medical sciences, Poland
* authors contributed equally to this work.
A – concept, B – data collection, C – statistics, D – data interpretation, E – writing/editing the text, F – compiling the bibliography
Abstract
Personal identification by dental means is one of the most effective methods used in medico-legal practice, espe-cially when dealing with victims of natural disasters, fires and traffic accidents. The aim of a postmortem exami-nation is to collect odontological (including surgical, prosthetic and orthodontic) data significantly relevant for identification purposes. it is important not only to determine the type of prosthetic treatment, but also to provide detailed descriptions of materials and methods of construction. Thorough knowledge of dental techniques and prosthetic treatment allow us to ascertain the time and place of the treatment. Prosthetic components, in addition to all other material culture, can be very useful in the dating of the remains. The post mortem investigation results of the individual odontological profile of the victim, saved and documented in a special form are then compared with the available antemortem data of missing persons (Dent. Med. Probl. 2013, 50, 4, 486–490).
Key words: forensic odontology, personal identification.
Streszczenie
identyfikacja osobnicza za pomocą danych odontologicznych jest jedną z najskuteczniejszych metod stosowanych w praktyce medyczno-sądowej szczególnie w przypadku identyfikacji ofiar katastrof naturalnych, pożarów oraz wypadków komunikacyjnych. Pośmiertne badanie odontologiczne ma na celu zebranie jak największej liczby danych o znaczącej przydatności dla procesu identyfikacji w tym śladów leczenia chirurgicznego, protetycznego i ortodontycznego. Dla potrzeb identyfikacji ważne jest nie tylko określenie rodzaju uzupełnienia protetycznego, lecz przede wszystkim szczegółowy opis materiału i metody wykonania. Znajomość technik protetycznych i metod leczenia umożliwia określenie czasu, a często także miejsca wykonania uzupełnienia. elementy protetyczne, obok ujawnionych wszelkiego rodzaju przedmiotów kultury materialnej, mogą okazać się bardzo przydatne podczas datowania szczątków. W wyniku badania powstaje zapisany w postaci formularza i udokumentowany zdjęcia-mi rentgenowskizdjęcia-mi indywidualny profil odontologiczny ofiary, który jest następnie porównywany z dostępnyzdjęcia-mi danymi zażyciowymi osób zaginionych (Dent. Med. Probl. 2013, 50, 4, 486–490).
Słowa kluczowe: odontologia sądowa, identyfikacja osobnicza.
Dent. Med. Probl. 2013, 50, 4, 486–490
issn 1644-387X © copyright by Wroclaw Medical University and Polish Dental society
Personal identification by dental means is one of the most effective methods used in medico-le-gal practice when significant mechanical damage, advanced post mortem changes, charring, or
frag-mentation of the body makes the victim’s identifi-cation using other methods impossible. Odonto-logical methods have an efficiency rate of 92% [1] making them particularly useful in identifying
where the remains were found and to possibly se-cure the loose parts as single teeth, bony fragments or dentures. every single detail, even the smallest, can be crucial for personal identification. One should al-so remember to securely attach every piece of evi-dence found to the bony material for further analysis. sending a skull and mandible without loose teeth or dentures is inadmissible and may lead to wrong con-clusions. also, attempts to stick or bond loose ele-ments are inadvisable and should only be made by a qualified and experienced forensic odontologist.
Post mortem Examination
The preliminary forensic odontological evalua-tion, such as selection of evidence (ex. separation of animal material) begins at the scene and is then con-tinued in the laboratory. The aim of a post mortem examination is to collect odontological (including surgical, prosthetic and orthodontic) data signifi-cantly relevant for identification purposes. it is con-ducted in the following steps [2]:
1. Quantitative analysis of the dental status. 2. assessment of teeth location.
3. evaluation of morphological characteristics of individual teeth.
4. Dental pathologies. 5. Dental records.
6. Radiographic and photographic documentation.
such as crowns, bridges, intraradicular elements, and implants (Fig. 1), although a detailed investi-gation of personal identification of fire victims in scandinavian countries revealed the latter are the least likely to be found across all age groups [4].
For identification purposes, not only the deter-mination of the restoration type is important, but first and foremost, a detailed description of materi-als and methods of construction. Thorough knowl-edge of dental techniques and prosthetic treat-ment allows us to ascertain the specific time and place of the treatment. Prosthetic components, in addition to all other material culture, can be very useful in the dating of the remains. andersen et al. [4] found that removable dentures (complete and partial) were present in 12% of all fire vic-tims over the age of 35 years. edentulous jaw oc-curs in over 50% of people over 40 years [5], thus the probability of wearing dentures increases in vic-tims along with their age. The removable dentures require a detailed evaluation regarding the mate-rial and technique used. The precise description of the dentures is essential for both handwritten and computer-aided form filling (Figs. 2, 3) [6].
Example 1. Case history: among the remains
a complete upper denture that correlates with maxil - lary parameters and profile of the investigated skull. This is a complete, caoutchouc denture with porcelain teeth. The element of the sucker attaching the denture to the palate is visible. Dentures of this type had been used from the interwar period to the end of the 50s (Fig. 4).
information concerning materials used for dental restorations is very important in the itification process. The presence or lack of den-tal treatment as well as the number and quali-ty of dentures can be an indicator of socioecono-mic status, or at least the place of origin [7]. also the material used (gold, porcelain, composite, steel), may provide an additional source of information about the victim. Unusual examples of treatment may be an indicator of place of residence [8]. For example, crowns and bridges in the anterior region made of gold are frequently observed in citizens of Russia and the former soviet Union (Fig. 5).
also significant is the fact that restorations are always clearly visible on X-ray images,
facili-Fig. 1. example of prosthetic dental treatment (bridge)
in post mortem investigation
Ryc. 1. Przykład uzupełnień protetycznych (most)
tating comparative analysis of available ante
mor-tem dental records. it should be noted that all fixed
and removable restorations are prepared individu-ally for each patient in the dental technical labora-tory and are usually well described in the patient’s dental records making them a valuable source of information for comparative analysis. in some countries, it is customary to mark the dentures with the laboratory symbol or initials of the doc-tor; however, the prevalence of this kind of tech-nology is negligible [9, 10].
Fig. 3. example of prosthetic dental treatment
(den-ture) in post mortem investigation
Ryc. 3. Przykład uzupełnień protetycznych (proteza)
w badaniu pośmiertnym
Fig. 2. example of prosthetic dental treatment
(den-ture) in post mortem investigation
Ryc. 2. Przykład uzupełnień protetycznych (proteza)
w badaniu pośmiertnym
Fig. 4. Denture with the element of the sucker
attaching to the palate found within the remains
Ryc. 4. Proteza z elementem po przyssawce mocującej
do podniebienia znaleziona przy szczątkach
Fig. 5. example of gold prosthetic dental treatment in
post mortem investigation
Ryc. 5. Przykład uzupełnień protetycznych
Forensic Odontological
Record
all the information gathered from a post
mor-tem odontological examination is saved in a
spe-cial format.
Example 2 (Table i). all around the world, in order to identify the victims of disasters, special interpol forms [11] (pink for post mortem exami-nation and yellow for the ante mortem) are used. completing the form is not easy; it requires some experience and knowledge of abbreviations and symbols. Because of the potential for mistakes and the possibility that dental practitioners might be involved in the identification of victims (not only forensic odontologists) in the area, it is important for every dentist to have an opportunity to read and complete the form prior to going on duty.
Conclusions
The post mortem investigation results of the individual odontological profile of the victim, saved and documented in a special form, is then compared with the available ante mortem data of missing persons (medical and dental records, radio-logical documentation, gypsum casts, wax bites).
Prosthetic components, in addition to disclo-sing any kind of material culture can be very useful in dating the remains. Dentures provide valuable information about the victim, especially when the medical records are reliable and contain all the de-tails necessary for identification. Recently, it has been suggested that prosthetic restorations can be marked using chips [12] containing basic informa-tion about the contractor (who keep records of pa-tients), or the patient. The usefulness of such a so-lution would be invaluable.
present, porcelain-fused-to-metal crown
connec-ted by metal bar to crown on tooth 16 12 22 present, caries D
present, sound 11 21 present, tooth coloured filling M present, sound 41 31 present, sound
present, sound 42 32 present, sound present, sound 43 33 present, caries D present, tooth coloured filling MO 44 34 present, caries OD porcelain-fused-to-metal crown connected by
me-tal bar to crown on tooth 48 45 35 missing post mortem missing ante mortem 46 36 missing ante mortem missing ante mortem 47 37 missing ante mortem porcelain-fused-to-metal crown connected by
me-tal bar to crown on tooth 45 48 38 missing ante mortem comments:
Tartar. Regression of alveolar process of mandible from tooth 34 toward tooth 45 (from 2 mm to 4 mm). Between teeth 38 and 35 atrophy of alveolar process following tooth loss, bone remodeling due to the prosthetic treatment.
Prosthetic restorations:
Maxilla: teeth 12 and 16 porcelain fused to metal (PFM) crowns connected by the bar with ball attachments on the top of the bar placed in position 15 (patrix). Tooth 24 PFM crown with ball attachment placed on distal (patrix). crowns 12, 16, 24 grinded for clasps; partial skeletal denture, acrylic saddles, acrylic artificial teeth. elastic rings in matrices.
Mandible: teeth 45 and 48 porcelain fused to metal (PFM) crowns connected with the bar with ball attachments on the top of the bar placed in position 47 (patrix). Tooth 35 PFM crown with ball attachment placed on distal (patrix) – tooth is missed – deduction based on the skeletal denture construction; partial skeletal denture, acrylic saddles, acrylic artificial teeth, lingual surface made of metal alloy. elastic rings in matrices.
References
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Address for correspondence:
Dorota lorkiewicz-Muszyńska Department of Forensic Medicine Poznań University of Medical sciences Święcickiego str 6 60-781 Poznań Poland Tel. +48 61 854 64 15 e-mail: dlorkiew@ump.edu.pl Received: 30.09.2013 Revised: 31.10.2013 accepted: 7.11.2013
Praca wpłynęła do Redakcji: 30.09.2013 r. Po recenzji: 31.10.2013 r.
