Journal of Forensic Odonto-Stomatology最新文献

Introduction: Orthodontic treatment in cleft lip and palate and craniofacial anomalies is complex and requires a multidisciplinary approach. There are often multiple possible treatment plans. To properly explain and discuss the various options, such as management of frequently missing incisors or the choice between orthognathic surgery and dental compensation, assessment of burden of treatment must be made and adequately communicated to the patients and families.

Patients and methods: 105 patients affected by cleft lip and palate and craniofacial anomalies were retrospectively collected and divided into two groups. The first group included patients whose orthodontic diagnosis involved missing elements, where treatment could be either space closure or space opening. The second group included patients with skeletal discrepancies, who could be treated with dental compensation ​or with orthognathic surgery. For all patients of both groups two different virtual treatment plans with the Clin Check® software were developed, corresponding to the different treatment possibilities. Clinical aspects which might have influenced treatment choice, such as treatment time, need for extractions, need for prosthetic replacements and need for cooperation were quantified. Logistic regression and Fisher exact test were applied to assess which aspects of treatment led patients to one of the different binary solutions.

Results: Length of treatment was not an aspect which differed between choices, while the need for high cooperation and need for tooth extractions were. The clear explanation and visual description of advantages and disadvantages of a treatment, seem to help patients in the selection of the expected solution in terms, not only of final occlusal and aesthetic result, but also in terms of burden of care. Though far from sufficient, the visual tool aids patients and families to take an "informed" decision, with significant legal inferences. Embracing these principles is essential to meet legal standards and foster trust, helping patients make well-informed decisions that align with their personal values and clinical needs. This approach not only respects patient autonomy but also reduces the risk of non-compliance, emotional strain, and potential legal issues, ultimately leading to better therapeutic outcomes and stronger clinician-patient relationships.

Forensic odontology is one of INTERPOL's three primary identifiers for Disaster Victim Identification (DVI). Forensic dental identification relies on the availability of antemortem dental radiographs, such as orthopantomogram (OPG), dental cone beam computed tomography (CBCT) scanned images, bitewing, and periapical (PA) views. These antemortem dental radiographs are used for comparison with postmortem dental radiographs. However, there are other types of non-dental medical radiographs that also capture dental structures. These medical radiographs are proven to be useful in forensic dental identification. This Queensland case series highlights the importance of non-dental radiographic images for the purpose of forensic dental comparison including the first published forensic dental identification involving comparison of a postmortem computer tomography (PMCT) multiplanar reformat (MPR) image with non-dental antemortem radiography. This case series also highlights the benefits of a collaborative working relationship between the forensic odontologist, forensic pathologist, police, and Coroner, in antemortem data collection.

Background: Training in dental age estimation (DAE) is inconsistent in undergraduate dental curricula. This study aimed to assess the impact of a structured teaching intervention on the inter-rater agreement and accuracy of undergraduate students using the Demirjian staging method.

Material and methods: Eighteen dental students with no prior training in forensic odontology assessed seven panoramic radiographs using Demirjian's method during a pre-teaching session. This was followed by a 90-minute lecture led by a qualified forensic odontologist, which included a presentation, interactive discussion, and practical demonstration of the Demirjian staging system. The same radiographs were re-evaluated by the students two weeks later. Inter-observer agreement was assessed using Fleiss' Kappa, while accuracy was determined by comparing the students' staging results to those of the primary observer.

Results: Initial inter-observer agreement was moderate (κ = 0.45), increasing to substantial agreement (κ = 0.76) after the teaching session. Overall, accuracy improved from 46% to 73% post-teaching. The highest improvement was seen in the incisors, which improved from 48% to 92%.

Conclusion: A brief, structured teaching session substantially improved dental students' reliability and accuracy in DAE. Integrating targeted forensic odontology education into the undergraduate dental curriculum is essential, as even brief instructional interventions can yield notable improvements in both staging consistency and accuracy.

Forensic odontology (FO) is grounded in a well-established historical framework, necessitating adherence to minimum standards to ensure quality on an international scale. Nonetheless, these standards frequently fail to account for the considerable variability in challenges, resources, and practices at the national or local levels. The Dominican Republic, the second-largest nation by area after Cuba in the Antilles and the second-largest by population after Haiti, has exhibited one of the highest economic growth rates in Latin America and the Caribbean. However, it also faces complexities and challenges due to population movement and rising crime rates. The enactment of new legislation and the establishment of institutions, such as the National Institute of Forensic Pathology "Doctor Sergio Sarita Valdez" (INPFSS), signify their contributions to the advancement and modernization of the Judiciary and Public Health through service, education, and forensic research. This article presents the work undertaken by the FO department during autopsies conducted at the INPFSS between 2000 and 2024, highlighting the strengths, weaknesses, and opportunities for improvement that the service has identified as challenges, striving to align with global standards while consistently considering local realities and resources. We assert that the FO procedures at the INPFSS are distinctive, at least within the Latin American context, as they genuinely contribute to illustrating not only current practices but also potential enhancements aimed at advancing Dominican forensic work in accordance with global standards.

Portable handheld radiograph devices are increasingly common in forensic odontology, particularly in postmortem dental examinations. However, concerns remain regarding radiation exposure to operators handling these devices in mortuary settings. This study aimed to assess the radiation dose to the lens of the eye and fingers of the operator that is exposed to radiation from the NOMAD™ Pro handheld Radiograph. The radiation exposure on the operator of a dental portable handheld radiograph device in the dental postmortem procedure was monitored from March 2020 to February 2021. NanoDot™ OSL Dosimeters (Landauer, IL, USA) were positioned near the eyes and fingers of the operator to estimate the radiation dose. The dosimeters were then analysed using the LAUNDER's MicroStar reader and corrected based on the background reading and calibration parameters. Data from 80 procedures were analysed with the equivalent yearly doses for eyes and fingers were estimated and compared to the International Commission on Radiological Protection (ICRP) recommended limits. Results showed that the annual dose estimation for the lens of the eyes was 1.34 (range 0.56-6.57) mSv/yr while the fingers were 1.52 (range 0.40-5.51) mSv/yr. Radiation exposure to the fingers was slightly higher than exposure to the eyes but remained within requirements of the ICRP dose limits. In conclusion, even though portable radiograph equipment is useful in forensic odontology, operators only receive safe and low levels of radiation exposure. The continuous safe use of these devices in postmortem dental examinations is ensured by appropriate monitoring and adherence to safety procedures.

Accurate age classification using mandibular third molar radiographs is crucial for legal and forensic applications. This study evaluated different methods for classifying age as under or over 18 years in a Thai population. We compared three approaches: (i) a traditional human-based method using a modified Demirjian classification adapted for mandibular third molars, (ii) an end-to-end deep learning model in which a convolutional neural network (CNN) directly predicts age group, and (iii) a human-defined feature extraction approach, where a CNN estimates tooth developmental stages that are subsequently used for age classification. The dataset included 3,407 images of individuals aged 14-23 years. The results indicated that the traditional human-based method achieved high specificity (0.99) and a strong Bayes' post-test probability (0.99), but it exhibited low sensitivity (0.45). In comparison, the end-to-end deep learning models showed higher sensitivity (0.65 to 0.74) than the traditional method, along with a specificity of 0.91 to 0.95 and Bayes' post-test probability of 0.93 to 0.95. The human-defined feature extraction approach, which used developmental stages for age determination, achieved an accuracy of 0.88 to 0.92 in developmental stage classification. For age classification, the models demonstrated higher specificity (0.95 to 0.97) and Bayes' post-test probability (0.95 to 0.97) than the end-to-end deep learning method, along with sensitivity ranging from 0.51 to 0.56. Our results indicate that although traditional methods excel in specificity, the human-defined feature extraction approach provides a balanced solution with high specificity and interpretability, suggesting its potential value in clinical practice for age estimation.

This study evaluates the performance of a curvature-based 3D dental comparison method - the keypoint pipeline - for forensic identification, assessing the effects of standardised blunt force trauma on human dentitions. The dental arches in ten human jaw specimens (five maxillae, five mandibulae) were scanned using two intraoral 3D scanners before and after exposure to controlled blunt trauma delivered via a drop tower mechanism applying approximately 3154 Newton of force. Trauma outcomes were documented through high-speed video, digital photography, and 3D scanning. Post-trauma scans were processed using the keypoint pipeline, which quantifies dental surface similarity by comparing curvature signatures. An all-vs-all comparison was conducted between pre- and post-trauma scans, including cross-scanner evaluations. Despite consistent trauma application, fracture patterns varied by jaw type, with mandibular fractures typically occurring in the frontal plane in the side segments and maxillary fractures in the sagittal plane in the midline suture. The keypoint pipeline successfully scored 92.5% of the true matches to be the best matching comparison, even in the presence of significant structural damage and tooth displacement. Matching pairs yielded lower dissimilarity scores (mean: 0.55) compared to mismatches (mean: 0.78), indicating that curvature features were sufficiently preserved post-trauma. These findings support the integration of curvature-based 3D dental surface analysis into forensic odontology workflows, particularly in disaster victim identification scenarios involving blunt force trauma.

The aim of this study was to evaluate the linear and volumetric measurements of the frontal sinus (FS), using cone beam computed tomography (CBCT) scans, for a discriminatory analysis of gender, age and facial skeletal pattern in a Brazilian population. A total of 300 CBCT scans were analyzed, measuring the height, width, length and volume of the FS. The measurements were divided into groups: sex, age (<20 to >40 years and >40 years) and facial skeletal pattern classes I, II and III. The function values in the centroid group were 0.675 for male and -0.292 for female. A rule was established indicating that if the value of D is greater than 0.19, the sample will be classified as male. The results showed a significant difference in women, who had significantly lower volume, width and depth than men (p-value<0.001, 0.003 and <0.001 respectively). No significant differences could be observed between the age and facial skeletal pattern groups. The results suggest that the FS measures of volume, height, width and depth have moderate discriminatory power for predicting gender in a Brazilian population. In conclusion, the results show that the FS has potential for determining gender, but the accuracy of the method and its applicability for analyzing age and facial skeletal pattern were limited in our population.

Fractures of the mandibular angle following surgical extraction of the third molar occur at an incidence ranging from 0.0034% to 0.0075%. The low incidence and the data present in the literature reveal how legal claims based on late mandibular fractures from third molar extractions are unlikely, being an uncommon clinical condition. The present case investigates the causal relationship between the fracture of the mandibular angle and the intervention of extraction of a dental element 3.8 in conditions of semi-inclusion and the possible hypothesis of dental malpractice. About two weeks after the extraction, the patient felt a noise like that produced by shattering glass, followed by severe and sudden pain along the area of the left mandibular joint and numbness. The following day, the patient underwent an orthopantomogram performed by the same medical team that carried out the operation in question, with an incorrect diagnosis of dislocation of the condyle, which is to be treated with muscle relaxants and anti-inflammatories. Upon further radiological investigations performed by different operators, it is concluded that the patient is suffering from a "fracture of the left mandibular angle". The patient, therefore, reported and sued the dentists for the crime of negligent personal injury who had extracted element 3.8. From medical history, clinical examination, and documentation produced by the patient, it can be said that the extraction of element 3.8 was necessary as the pericoronary sac had caused an untreatable periodontal lesion at the distal root of the 3.7. From a medico-legal point of view, it was established that the extraction maneuvers may have caused the fracture of the mandibular angle, but it can be excluded professional responsibility in the criminal field of the medical team that carried out the res judicata intervention, since the fact in itself represents a known complication of the extraction of mandibular third molars.