Ademir Franco

Applicability of Willems model for dental age estimations in Brazilian children

Several studies described tooth development as a reliable pathway for age estimations. Depending on the considered life span, the dental age indicators vary. In children, combinations of developing teeth provide the best information about age. In sub adults third molar mineralization is almost exclusively considered. The aim of this study was, firstly, to verify the Willems model in a Brazilian sample. Secondly, to observe differences between the Willems model and a new developed Brazilian model. Thirdly, the information of permanent teeth (PM) and third molar (TM), development was combined for age estimation in children. A sample of 1357 panoramic radiographs of Brazilian males (M) and females (F), with age between 5 and 23 years was collected. The technique of Gleiser and Hunt modified by Kohler (1955) [34] was applied for third molar staging in the entire sample. The Demirjian staging technique was used on the mandibular left permanent teeth (except third molars) of all individuals from 5 to 15 years. Kappa and weighted Kappa statistics were performed to verify inter- and intra-observer reliabilities. Based on the obtained Demirjian scores the Willems model was verified. Next the data were split to develop a new Brazilian model based on the Willems method and to verify the established model. The accuracy in age prediction between the Willems model and the new Brazilian model was compared. Additionally, regression models including PM, TM and PM plus TM information were compared. The Kappa and weighted Kappa statistics revealed high agreement between observers (0.88 Kappa; 0.93 weighted Kappa). The differences between predicted and chronological age for the verified Willems model were expressed in mean errors of -0.17 and -0.38 year for F and M respectively. The differences in mean error between the new developed Brazilian model and the Willems model were 0.02 (F) and 0.20 (M) year. The regression models combining PT and TM information provided only in the age range between 14 and 15.99 years a small decrease in root mean squared error (0.2 year) in females. The new developed Brazilian model provided similar age predicting performances as the Willems et al. model. Added TM was only providing more accurate age estimations in the ages of 14 and 15 year in F.

Feasibility and validation of virtual autopsy for dental identification using the Interpol dental codes

Virtual autopsy is a medical imaging technique, using full body computed tomography (CT), allowing for a noninvasive and permanent observation of all body parts. For dental identification clinically and radiologically observed ante-mortem (AM) and post-mortem (PM) oral identifiers are compared. The study aimed to verify if a PM dental charting can be performed on virtual reconstructions of full-body CTs using the Interpol dental codes. A sample of 103 PM full-body CTs was collected from the forensic autopsy files of the Department of Forensic Medicine University Hospitals, KU Leuven, Belgium. For validation purposes, 3 of these bodies underwent a complete dental autopsy, a dental radiological and a full-body CT examination. The bodies were scanned in a Siemens Definition Flash CT Scanner (Siemens Medical Solutions, Germany). The images were examined on 8- and 12-bit screen resolution as three-dimensional (3D) reconstructions and as axial, coronal and sagittal slices. InSpace(®) (Siemens Medical Solutions, Germany) software was used for 3D reconstruction. The dental identifiers were charted on pink PM Interpol forms (F1, F2), using the related dental codes. Optimal dental charting wasxa0obtained by combining observations on 3D reconstructions and CT slices. It was not feasible to differentiate between different kinds of dental restoration materials. The 12-bit resolution enabled to collect more detailed evidences, mainly related to positions within a tooth. Oral identifiers, not implemented in the Interpol dental coding were observed. Amongst these, the observed (3D) morphological features of dental and maxillofacial structures are important identifiers. The latter can become particularly more relevant towards the future, not only because of the inherent spatial features, yetxa0also because of the increasing preventive dental treatment, and the decreasing application of dental restorations. In conclusion, PM full-body CT examinations need to be implemented in the PM dental charting protocols and the Interpol dental codes should be adapted accordingly.

The uniqueness of the human dentition as forensic evidence: a systematic review on the technological methodology

The uniqueness of human dentition is routinely approached as identification evidence in forensic odontology. Specifically in bitemark and human identification cases, positive identifications are obtained under the hypothesis that two individuals do not have the same dental features. The present study compiles methodological information from articles on the uniqueness of human dentition to support investigations into the mentioned hypothesis. In April 2014, three electronic library databases (SciELO®, MEDLINE®/PubMed®, and LILACS®) were systematically searched. In parallel, reference lists of relevant studies were also screened. From the obtained articles (nu2009=u20091235), 13 full-text articles were considered eligible. They were examined according to the studied parameters: the sample size, the number of examined teeth, the registration technique for data collection, the methods for data analysis, and the study outcomes. Six combinations of studied data were detected: (1) dental shape, size, angulation, and position (nu2009=u20091); (2) dental shape, size, and angulation (nu2009=u20094); (3) dental shape and size (nu2009=u20095); (4) dental angulation and position (nu2009=u20092); (5) dental shape and angulation (nu2009=u20091); and (6) dental shape (nu2009=u20091). The sample size ranged between 10 and 1099 human dentitions. Ten articles examined the six anterior teeth, while three articles examined more teeth. Four articles exclusively addressed three-dimensional (3D) data registration, while six articles used two-dimensional (2D) imaging. In three articles, both imaging registrations were combined. Most articles (nu2009=u20099) explored the data using landmark placement. The other articles (nu2009=u20094) comprised digital comparison of superimposed dental contours. Although there were large methodological variations within the investigated articles, the uniqueness of human dentition remains unproved.

Prevalence of bifid mandibular canals in panoramic radiographs: a maxillofacial surgical scope

PurposeThe present study aims to estimate the prevalence of bifid mandibular canals in patients treated at the Dental Clinic of the Federal University of Paraná, Brazil.MethodsThe sample consisted of 3,024 panoramic radiographs from male (nxa0=xa01,155) and female (nxa0=xa01,869) patients (mean age 30xa0years). An experienced radiologist analyzed the panoramic radiographs according to the study of Langlais et al. (J Am Dental Assoc 110:923–926, 1985), which classifies bifid mandibular canals into four different types.ResultsSixty patients (1.98xa0%) presented bifid mandibular canals. Specifically, 50 patients revealed bifid mandibular canals type I, while 10 patients revealed bifid mandibular canals type II. All the variations were unilateral. In addition, statistically significant results were not observed for gender distribution.ConclusionThe present findings indicate a low prevalence of morphologic alterations of the mandibular canal in the studied population. However, the present outcome highlights the clinical relevance of investigating the radiologic morphology of the mandibular canal prior to surgical interventions.

Human identification through the patella—Report of two cases

The human identification process is often performed by the comparison between acquired post-mortem (PM) fingerprints, dental patterns, or DNA sample with ante-mortem (AM) databases. However, in some special situations alternative sources of human identifiers reveal valuable part as forensic tools. In this context, medical records of surgical interventions and morphological bone traits are useful in the anthropological environment, specifically for the PM examination of skeletal remains. The present study reports two cases of positive human identifications by the comparative analysis between AM and PM radiographic medical records of surgically treated human patella. The present outcome highlights the importance of storing and updating medical records in order to aid human identification processes in special forensic situations.

Three-dimensional analysis of the uniqueness of the anterior dentition in orthodontically treated patients and twins

Dental uniqueness can be proven if no perfect match in pair-wise morphological comparisons of human dentitions is detected. Establishing these comparisons in a worldwide random population is practically unfeasible due to the need for a large and representative sample size. Sample stratification is an option to reduce sample size. The present study investigated the uniqueness of the human dentition in randomly selected subjects (Group 1), orthodontically treated patients (Group 2), twins (Group 3), and orthodontically treated twins (Group 4) in comparison with a threshold control sample of identical dentitions (Group 5). The samples consisted of digital cast files (DCF) obtained through extraoral 3D scanning. A total of 2.013 pair-wise morphological comparisons were performed (Group 1 n=110, Group 2 n=1.711, Group 3 n=172, Group 4 n=10, Group 5 n=10) with Geomagic Studio® (3D Systems®, Rock Hill, SC, USA) software package. Comparisons within groups were performed quantifying the morphological differences between DCF in Euclidean distances. Comparisons between groups were established applying One-way ANOVA. To ensure fair comparisons a post-hoc Power Analysis was performed. ROC analysis was applied to distinguish unique from non-unique dentures. Identical DCF were not detected within the experimental groups (from 1 to 4). The most similar DCF had Euclidian distance of 5.19mm in Group 1, 2.06mm in Group 2, 2.03mm in Group 3, and 1.88mm in Group 4. Groups 2 and 3 were statistically different from Group 5 (p<0.05). Statistically significant difference between Group 4 and 5 revealed to be possible including more pair-wise comparisons in both groups. The ROC analysis revealed sensitivity rate of 80% and specificity between 66.7% and 81.6%. Evidence to sustain the uniqueness of the human dentition in random and stratified populations was observed in the present study. Further studies testing the influence of the quantity of tooth material on morphological difference between dentitions and its impact on uniqueness remain necessary.

Dental age estimation in Brazilian HIV children using Willems’ method

The notification of the Human Immunodeficiency Virus (HIV) in Brazilian children was first reported in 1984. Since that time more than 21 thousand children became infected. Approximately 99.6% of the children aged less than 13 years old are vertically infected. In this context, most of the children are abandoned after birth, or lose their relatives in a near future, growing with uncertain identification. The present study aims to estimate the dental age of Brazilian HIV patients in face of healthy patients paired by age and gender. The sample consisted of 160 panoramic radiographs of male (n: 80) and female (n: 80) patients aged between 4 and 15 years (mean age: 8.88 years), divided into HIV (n: 80) and control (n: 80) groups. The sample was analyzed by three trained examiners, using Willems method, 2001. Intraclass Correlation Coefficient (ICC) was applied to test intra- and inter-examiner agreement, and Student paired t-test was used to determine the age association between HIV and control groups. Intra-examiner (ICC: from 0.993 to 0.997) and inter-examiner (ICC: from 0.991 to 0.995) agreement tests indicated high reproducibility of the method between the examiners (P<0.01). Willems method revealed discrete statistical overestimation in HIV (2.86 months; P=0.019) and control (1.90 months; P=0.039) groups. However, stratified analysis by gender indicate that overestimation were only concentrated in male HIV (3.85 months; P=0.001) and control (2.86 months; P=0.022) patients. The significant statistical differences are not clinically relevant once only few months of discrepancy are detected applying Willems method in a Brazilian HIV sample, making this method highly recommended for dental age estimation of both HIV and healthy children with unknown age.

Improving traditional dental autopsies in postmortem examinations of intraoral gunshot wounds

Despite the recent advances in the post-mortem forensic examinations, some medico-legal institutes are limited in accessing improved technological facilities, hampering an optimal autopsy. Specifically in developing countries, high-cost imaging devices are not afforded, making necessary the development of alternative autopsy techniques. In parallel, in dental autopsies muscle stiffness is often observed lacking mouth opening. This situation is specifically worse in cases of intraoral firearm injuries, in which detailed description of the detected wounds must be reported post-mortem. Based on this context, the present study aims to illustrate two cases of intraoral firearm injuries, in which the dental autopsies were performed considering a conservative and alternative technique for the improvement of mouth opening. Both cases provided optimal results, indicating the new approach as a valuable tool for dental autopsies.

Uniqueness of the anterior dentition three-dimensionally assessed for forensic bitemark analysis

The uniqueness of the human dentition (UHD) is an important concept in the comparative process in bitemark analysis. During this analysis, the incisal edges of the suspects teeth are matched with the bitemarks collected from the victims body or crime scenes. Despite playing an essential part to exclude suspects, the UHD contained in the involved incisal tooth edges remains an assumption on bitemark level. The present study was aimed, first, to investigate three-dimensionally (3D) the UHD within different quantities of dental material from the incisal edges; second, to test these outcomes in a bidimensional (2D) simulation. Four-hundred forty-five dental casts were collected to compose 4 study groups: I - randomly-selected subjects, II - orthodontically treated subjects, III - twins and IV - orthodontically treated twins. Additionally, 20 dental casts were included to create threshold groups on subjects from whom the dental impressions were taken at 2 different moments (Group V). All the dental casts were digitalized with an automated motion device (XCAD 3D® (XCADCAM Technology®, São Paulo, SP, Brazil). The digital cast files (DCF) were integrated in Geomagic Studio® (3D Systems®, Rock Hill, SC, USA) software package (GS) for cropping, automated superimposition and pair-wise comparisons. All the DCF were cropped remaining 3xa0mm (part 1), 2xa0mm (part 2) and 1xa0mm (part 3) from the incisal edges of the anterior teeth. For a 2D validation, slices of 1xa0mm, not including incisal edges (part 4), were also cropped. These procedures were repeated in Group V, creating specific thresholds for each of the study parts. The 4 study groups were compared with its respective threshold using ANOVA test with statistical significance of 5%. Groups I, II and III did not differ from the corresponding threshold (Group V) in all study parts (pxa0>xa00.05). Scientific evidence to support the UHD was not observed in the current study. Bitemark analysis should not be disregarded but considered carefully when the suspects present similar dental alignment and morphology, such as in orthodontically treated subjects and twins, respectively.

Clinically Detectable Dental Identifiers Observed in Intra‐oral Photographs and Extra‐oral Radiographs, Validated for Human Identification Purposes

Screening the prevalence and pattern of dental identifiers contributes toward the process of human identification. This research investigated the uniqueness of clinical dental identifiers in photographs and radiographs. Panoramic and lateral cephalometric radiographs and five intra‐oral photographs of 1727 subjects were used. In a target set, two observers examined different subjects. In a subset, both observers examined the same subjects (source set). The distance between source and target subjects was quantified for each identifier. The percentage of subjects in the target set being at least as close as the correct subject was assessed. The number of molars (34.6%), missing teeth (42%), and displaced teeth (59.9%) were the most unique identifiers in photographs and panoramic and lateral cephalometric radiographs, respectively. The pattern of rotated teeth (14.9%) was the most unique in photographs, while displaced teeth was in panoramic (37.6%) and lateral cephalometric (54.8%) radiographs. Morphological identifiers were the most unique, highlighting their importance for human identifications.