Journal of Forensic Odonto-Stomatology最新文献

Forensic age estimation is performed by assessing pulp chamber constrictions due to physiological age-related changes in dental radiographs; however, the estimated ages occasionally deviate from the actual ages. In particular, long-term steroid users tend to demonstrate pulp chamber constrictions in all teeth. Because this is uncommon among younger age groups, caution should be exercised when evaluating pulp chamber constriction. This study investigated the estimated ages of eight PSL users by applying the ratio of pulp area to total tooth area from canine radiographs. Patients in their 30-40s were examined at a dental outpatient clinic for the prevention or treatment of adverse events associated with the use of bisphosphonates to prevent steroidal osteoporosis, and radiographs were obtained. The pulp and tooth areas were measured and the estimated age was determined using regression formulas calculated from the canine teeth of the general study subjects of Japanese. The mean absolute error between the estimated ages and the chronological ages of the patients was 19.24 years for the upper canines and 17.69 years for the lower. Moreover, the root mean square error was 23.18 years for the upper canines and 20.00 years for the lower. The estimated ages were far from the actual ages of the steroid users. When estimating an unidentified individual's age, if the patient has pulp chamber constriction that is inconsistent with other forensic physical findings, this information may assist in predicting their medical background.

The age estimation of skeletal remains still represents a central issue not only for the reconstruction of the so-called "biological profile," but mostly for the palaeodemographic investigation. This research aims at verifying the feasibility of the adult age estimation method developed on living people by Pinchi et al. (2015 and 2018), for estimating the age at the death of 37 subjects from ancient populations found in two different Italian necropolis of archaeological interest (Mont'e Prama and Florence, X-IX century B.C and V-VI century A.D respectively). The method is conservative and based on a geometrical approximation of dental volumes of the upper central left incisors on CBCT scans. The statistical distribution of the age and errors followed the Bayesian approach proposed by Sironi et el. (2018) applying the "a priori" values according to the estimates/classification obtained with anthropological methods (morphological). Results show higher accuracy for Mont'e Prama remains than for the Florentine sample due to the different characteristics of the two ancient populations (estimates varying from 18.4 up to 28.7 years with a maximum error of 6,14 years for Mont'e Prama, and from 15.88 up to 43.37 years with a minimum error of 1 year up to a maximum error of 7,85 years for Florence). The method proposed and validated on modern living people can represent a reliable tool for estimating the age of ancient human remains with a significant palaeodemographic value for archaeologists/anthropologists. Mont'e Prama sample could be defined as a homogenous group of males aged around 20-30 years, probably warriors, soldiers, or athletes; Florentine sample as an inhomogeneous group of males and females from different families buried all together in a small area out of the city due to the probable occurrence of a special healthy emergency in the city.

The great advances in diagnostic and therapeutic skills of most sectors of medicine and dentistry have led to an increasingly greater demand from patients for accuracy, attention and diligence by healthcare workers. Dentistry is one of the branches most frequently involved in claims for damages from malpractice, especially in those sectors that are particularly costly and of significant aesthetic value. Aim of the study was to compare data of malpractice claims with those of other Authors to identify similarities and/or differences in the results and to increase epidemiological knowledge in the area of dental malpractice. This work is a descriptive study performed analyzing medical malpractice claims in which one of the Authors was nominated as court professional expert advisor from 2018 to 2022 in two of the biggest courts in Campania: Naples and Santa Maria Capua Vetere. Findings of great interest were the greater involvement of the pros-thetic and implant-prosthetic sector, the significant recurrence of clinical records deficiency and the high prevalence of claims made by female subjects. Also, there was a greater incidence of emergent damage confronted to the non-pecuniary personal injury (biological damage).

This study aims to compare the accuracy of Demirjian's and Cameriere's methods in determining adult age at the 18-year threshold using mandibular third molars in the Thai population. Panoramic radiograph images of 504 healthy subjects aged between 14 and 23 years were retrospectively collected. The developmental stages of mandibular third molars were evaluated using Demirjian's method, while the maturity index of mandibular third molars (I3M) was assessed using Cameriere's method. Comparing the development of the left and right mandibular third molars, slight differences were observed: the left side developed 0.06 stages faster (p = 0.01) and had an I3M 0.01 higher (p < 0.01). For the 18-year age threshold, Demirjian's Stage H demonstrated a specificity of 1.00 for both sexes on the left mandibular third molar, and 0.97 for males and 1.00 for females on the right. I3M < 0.08 yielded specificities of 0.84 for males and 0.93 for females on the left, and 0.82 for males and 0.91 for females on the right. Reducing the cut-off to I3M < 0.02 improved specificity to 1.00 for both sexes on the left side, and 0.96 for males and 1.00 for females on the right. Notably, using Demirjian's Stage H and I3M < 0.02, the probability of being over 18 years was 1.00 for females on both sides, and 0.96 for males on the left and 1.00 on the right. Our study recommends using an I3M cutoff of <0.02 for adult age assessment in the Thai population, as it achieves high specificity comparable to Demirjian's Stage H, with effective differentiation of adults.

Objectives: The study aims to evaluate the pulp-to-tooth area ratio in permanent maxillary central incisors, lateral incisors, and canines for age estimation using three-dimensional cone beam computed tomography images.

Methods: Hundred cone-beam computed tomography (CBCT) images of patients aged between 12-70 years were retrospectively studied using NNT Viewer software version 13. Pulpal and teeth area were evaluated with the "area tool" in the acquired images in all three planes, and the pulp-to-tooth area ratio (PTR) was calculated with the measurements obtained. The reproducibility of intra-observer bias using paired t-tests was calculated.

Results: The coefficient of correlation (r) values of maxillary central incisors with age are -0.54, -0.623, and -0.50 in the axial, sagittal, and coronal planes respectively. The r values of maxillary lateral incisors are -0.05, -0.52, and -0.25 in the axial, sagittal, and coronal planes. The coefficient of correlation values (r) of maxillary canine with the age is -0.53, -0.62, and -0.49 in the axial, sagittal, and coronal planes. A strong correlation between chronological age and PTR in multiple sections of the maxillary incisors and canines (p-value <0.05) was observed.

Conclusion: The permanent maxillary central incisor and canine yielded promising results in predicting age. The predicted age derived by mid-sagittal sections was closer to the chronological age than the axial sections, which had the least predictability.

The activity of a dentist reveals itself in numerous aspects, and its regulation is determined by the Deontological Code of the Dental Association, which contains a set of rules that dentists are obliged to follow in the exercise of their profession. The regulation of this activity goes beyond following these precepts because, in the legal relationship that is established whenever an agreement is made with a patient to carry out the treatment deemed appropriate, a series of duties and obligations begin for each party, translated into a reciprocal contract, in which the non-compliance of one of them may result in a legal claim. The objective of this study was to research most court decisions delivered in this century, in Portugal, regarding the activity of dentists when faced with patient claims and to outline a framework that better allows us to understand the regulation of this activity within the scope of the contracts established with them. This includes identifying the patients' sex, the judicial instance, the area of dentistry, the location of the injury, the type of liability, the characterization of the obligation, the basis of responsibility, the alteration of biological assets, and the outcome of the action while also not neglecting the identification of trends and jurisprudential evolutions, should they arise. A survey of judgments from the Portuguese Superior Courts was carried out, which focused on decisions from the Supreme Court of Justice, Court of Appeal of Porto, Court of Appeal of Lisbon, Court of Appeal of Coimbra, Court of Appeal of Guimarães, and Court of Appeal of Évora. To understand the judgments analyzed in this study, a brief approach to various legal concepts and institutions of interest was conducted. A summary characterization of the factual basis of the injured party's claim and the legal framework applied, as well as subsequent decisions by higher courts regarding the activity of dentists, was also elaborated. It was impossible to identify any relationship between the field of dentistry and the characterization of the obligation and the basis of responsibility, nor between the outcomes of the actions and these two parameters mentioned. This is likely due to the small sample size, which, although limited, represented all available published superior court decisions in Portugal related to the proposed topic, and because there were different decisions for similar and identical factual situations due to the various scientific and social conceptions adopted by the courts being susceptible to other interpretations.

The life-altering effects of criminal trials necessitate providing reliable methods to distinguish adults (≥18) from minors (< 18). The present study aims to evaluate the accuracy of the third molar maturity index (I3M) introduced by Cameriere et al. (2008) in distinguishing adults from minors in the Iranian population. Panoramic radiographs of 800 Iranian individuals (400 males and 400 females) aged 14-23 were evaluated. The cut-off value of I3M=0.08 was analysed to determine whether the individual is younger or older than 18. All male or female subjects with I3M above 0.7 were below 18 years old. The cut-off value of 0.08 showed a sensitivity of 80.83% and 63.33% and a specificity of 88.12% and 93.12%, respectively, in males and females. The positive predictive values were 91.08% and 93.25%, and the negative predictive values were 75.40% and 62.87%, respectively, for males and females. The Bayes' post-test probability was 94% for females and 92% for males. 83.75% of males and 75.25% of females correctly classified as adults or minors. The most remarkable error rate occurred at 18 years old (67.5 % in females and 57.5% in males). By ROC curve analysis, the population-specific cut-off values of I3M 0.097 for males, 0.116 for females, and 0.099 regardless of sex, were acquired, which improved the sensitivity of discrimination between adults and minors (86.3%, 73.8%, and 78.1 %, respectively). The results showed that I3M is a reliable method for distinguishing between minors and adults in the Iranian population. This method provides a higher accuracy level in identifying individuals under 18 years old. Population-specific I3M cut-off values increased accuracy, sensitivity, and NPV, especially for females. The I3M method produced better results in diagnosing adult males than adult females and a higher accuracy level in identifying individuals under 18.

Background: Forensic age estimation is a procedure which utilises many methods to estimate the age of both living and deceased individuals, including those who have died in natural disasters or man-made catastrophes. The pattern and closure of spheno-occipital synchondrosis (SOS) fusion, along with subchondral ossification of the mandibular condyle, can be used to estimate age.

Aim and objectives: This study aims to estimate age using computed tomographic (CT) images of spheno-occipital synchondrosis fusion (SOS) and mandibular condylar cortication (MCC), and to correlate these findings with chronological age.

Materials and methods: The present study included 435 CT images of individuals aged 10-25 years. SOS fusion was assessed using a four-stage system, and MCC was assessed bilaterally using a three-stage system on the sagittal plane. Data on fusion stages and cortication types were entered along with chronological age, and then statistically analysed.

Results: SOS fusion stage 2 occurred at similar age in males (19.82 ± 2.67 years) and females (19.23 ± 2.93 years). Earlier fusion of other stages was observed in females by a mean age of 2 years. MCC was completed 1 year earlier in females, with statistically significant differences (p ≤ 0.001). When comparing cortication types and different fusion stages, only type II cortication showed statistically significant differences compared to different fusion stages (p ≤ 0.001).

Conclusion: Mandibular condylar cortication (MCC) and spheno-occipital synchondrosis (SOS) fusion were positively correlated with chronological age, suggesting that these parameters can be used as an adjunct method for age estimation.

Estimating the post-mortem interval (PMI) of human remains based on the histomorphology of dental pulp parameters is promising, but available evidence is scarce and sometimes contradictory without a scientific model. The aim of the study is to characterise the histomorphological changes of dental pulp associated with the decomposition of human remains by a qualitative and quantitative approach. The main aim is to establish a correlation based on post-mortem (PM) dental pulp histomorphology and the PMI, and whether pulp degradation could be an available medico-legal tool for PMI estimation beyond the first week after death (late PMI). The eligible sample consisted of 27 sound teeth from 16 healthy patients aged 16 to 72 years due to orthodontic or oral surgery treatment, to create PMI's simulating the death of the subject as the time elapsed from tooth avulsion. Data collected from patients (sex, date of birth, tooth position, date and hour of the avulsion, date and hour of pulp extraction) were anonymised in accordance with the requirements of Faculty of Dental Medicine of the University of Lisbon. The sample was divided into 9 groups of 3 teeth according to different PMI sets from T0 (baseline) up to 2 weeks (T0, 7, 12, 24, 36, 48, and 72 hours, 1 and 2 weeks). All the dental samples were stored at room temperature up to the time of pulp extraction and then prepared with haematoxylin and eosin stain. High-resolution microscopy was performed to obtain histological images. An operator performed the qualitative evaluation of blood vessels, collagen fibres, and the extra-cellular matrix (ECM) in PM pulps and measured the variation in cells/nuclei density by counting 6 different ROIs (Regions of Interest) for each pulp manually and automatically (quantitative analysis). Qualitative results showed that the degeneration of dental pulp appears 7 hours after death but histological changes in vessels, fibres, and ECM in PM dental pulp are characterised by high variability, consequently it is not possible to generalise the results for early PMIs. Quantitative measurements proved that cell count cannot be standardised due to the presence of superimposed layers of cells and nuclei fragmentation. Odontoblasts did not demonstrate evidence of cellular or nuclear lysis up to 14 PM suggesting their applicability in late PMIs. Future research will focus on late PMIs and different techniques of tooth preparation.

Background: Tooth wear is a non-pathological loss of hard tissues on the incisal and occlusal tooth surface. In archaeology, the loss of dental tissue through attrition is associated with living opportunities and habits, availability, characteristics and methods of food preparation. In forensics, tooth wear is used to estimate the dental age on cadavers.

Material and methods: For this study, we used an archaeological sample from two sample collections. In this study, tooth wear was compared in archaeological samples of well-preserved maxilla and mandible specimens (n=392) from Croatian coastal and continental populations from Late Antiquity (LA) and the Early Middle Ages (EMA). The computer system VistaMetrix 1.38 was used to analyse the abrasion and attrition of hard dental tissues. The Shapiro-Wilk and chi-square tests were performed for categorical data to test the difference between two historical periods and two geographical locations, while the Kruskal-Wallis test was performed for continuous data.

Results: There was a statistically significant difference in the proportion of tooth wear in total teeth area (P < 0.001) when comparing continental and coastal Croatia in LA and coastal Croatia between LA and EMA (P = 0.006 and P < 0.001, respectively). Samples from coastal Croatia from the LA period had the lowest percentage of tooth wear with a median of 8.35%, while samples from coastal Croatia from the EMA had the highest percentage of tooth wear with a median of 18.26%. Our results generally show greater tooth wear in the EMA period in male subjects.

Conclusion: The results of the tooth wear research obtained with the Vista Metrix software can contribute to the study of life circumstances and changes that the analysed population has experienced in its historical development.