Hrvoje Brkić

Dental age estimation using Demirjian and Willems methods: Cross sectional study on children from the Former Yugoslav Republic of Macedonia

To evaluate applicability of Demirjian and Willems methods for calculating dental age of children in the Former Yugoslav Republic of Macedonia we analyzed panoramic radiographs of 966 children (485 female and 481 male, aged 6-13 years) treated at the University and Community Dental Clinics in Skopje using four Demirjian methods and a Willems method for determining dental ages. Intra-rater and inter-rater agreement of mineralization stages were 0.86 and 0.82, respectively. All methods significantly overestimated dental age when compared to the chronological age (p<0.001). In males, the lowest overestimation was shown using Willems method (0.52±0.87 years), followed by Demirjian methods from 1976 using PM1, PM2, M1, M2 teeth (0.69±0.92 years) and using I2, PM1, PM2, M2 teeth (0.80±0.98 years). The greatest overestimation were shown using Demirjian methods using 7 teeth from 1976 (0.92±0.99 years) and method from 1973 (1.06±1.07 years). In females, the lowest overestimation was shown using Willems method (0.33±0.83 years) than the Demirjian method using PM1, PM2, M1, M2 teeth (1.00±1.01 years), following methods from 1976 using 7 teeth (1.03±1.01 years) and I2, PM1, PM2, M2 teeth (1.12±0.96 years). The greatest overestimation was for method from 1973 using 7 teeth (1.17±0.98 years). Willems method was the most accurate while Demirjians methods for dental age calculation are not suitable on children from the Former Yugoslav Republic of Macedonia.

Odontological identification of human remains from mass graves in Croatia.

Abstract This paper reports the results and methods of dental identification of 1000 human remains exhumed from mass graves in Croatia up to July 1998. Personal identification of the victims was performed at the Department of Forensic Medicine and Criminology at the School of Medicine in Zagreb. A forensic odontologist participated in the identification process by carrying out the dental identification. A total of 824 victims were positively identified, while 176 victims remained unidentified. Dental identification based on available dental antemortem data was achieved in 25% of the cases. Dental identification based on dental charts was achieved in 35%, on x-rays in 15%, on photographs of teeth in 22%, on interviews in 18%, and on confirmation by odontologists in 10% of the cases. Teeth, in combination with anthropological parameters, age, sex and height, as well as other specific characteristics such as tattoos, personal identification cards, clothes, jewellery and DNA, were helpful for identification of 64% of the victims, but the significance for the identification was not dominant. Only in 11% of the cases was identification achieved by other relevant means and teeth not used at all. Identification procedures in Croatia will continue until another 1700 people who are still missing or kept as prisoners of war since the aggression on Croatia in 1991 are found and/or identified.

Dental identification of war victims from Petrinja in Croatia

Abstract In this paper the authors report their experiences and problems encountered in the identification of war victims from Petrinja in Croatia. Soon after Croatian forces regained Petrinja in 1995, four mass graves were discovered from which the bodies of 46 civilians, 38 males and 8 females, were recovered. Identification of the victims was performed at the Department of Forensic Medicine and Criminology at the School of Medicine in Zagreb. A forensic odonto-stomatologist from the Department of Dental Anthropology of the School of Dental Medicine at the University of Zagreb participated in the identification process by carrying out dental identifications. A total of 27 victims (59%) were identified, while 19 (41%) are at present still unidentified. Identification by supportive and anthropological evidence (e.g. sex, age, height, personal documents, dress, jewellery) was achieved in 43% of cases, while identification based only on dental records was achieved in 16%. The most useful dental characteristics for the purpose of identification were fixed and removable prosthetic appliances for oral rehabilitation. The reason for the low number of dental identifications was the lack of antemortem dental data which could be compared with postmortem dental records.

Cameriere's third molar maturity index in assessing age of majority

Estimation of chronological age of an individual is one of the main challenges in forensic science. Legally to be able to treat a person as a minor or an adult, it is necessary to determine whether their age of majority (if they are older or younger than 18, in most countries). Methods for estimating age are especially important when an individual in question lacks personal documents or other means of identification. As the dental age differs in various populations, the aim of this study was to evaluate applicability of third molar method for assessing age of majority in Croatia. Camerieres third molar maturity index (I3M) value of 0.08, measured by the open apices of the teeth, was verified in sample of 1336 panoramic images aged between 14 and 23 years. Chronological age gradually decreased as I3M increased in both genders. Males showed statistically significant advanced maturation when I3M was between 0.0 and 0.3 value. The results indicate that the sensitivity of the test for 0.08 value was 84.3% (95%CI 80.6%, 87.5%) for females and 91.2% (95%CI 88.7%, 93.1) for males. Specificity was 95.4% (95%CI 92.5%, 97.5%) and 91.9% (95%CI 88.8%, 94.3%). The proportions of accurately classified males were 88.8% and that of females 91.5%. The estimated post-test probabilities, of individuals, in other word the probability that a Croatian individual with an I3M<0.08 is 18 years or older is 94.5% for females, and 96.5% for males. With high accuracy, the third molar maturity index should be used as a determinant of the age of majority in Croatia.

Characteristics of the craniofacial complex in Turner syndrome

OBJECTIVE To identify characteristics of the craniofacial complex in Turner syndrome (TS) patients from Croatian population, to investigate the interrelationship among craniofacial variables and to assess their correlation with age. DESIGN Cephalometric analysis was carried out on lateral cephalograms of 36 TS patients, aged 10-33 years. Cephalograms of 72 age-matched healthy females with class I occlusion served as control. RESULTS Logistic regression analysis sorted out two variables as predictors of TS: shorter posterior cranial base length (sella-basion) and reduced mandibular prognathism angle (sella-nasion-supramentale). Sixty-four percent of TS patients and 92% of the controls were classified correctly. After exclusion of the variable sella-nasion-supramentale, three variables were significant predictors of TS: shorter sella-basion, larger cranial base angle (nasion-sella-basion) and shorter subspinale-basion distance. Retrognathic position of the jaws in TS subjects was not correlated with the shape of the cranial base. Correlations with age revealed lack of maxillary longitudinal growth with persistent retrognathism and posterior rotation along with reduced mandibular growth. CONCLUSION Shorter posterior length and increased cranial base angle along with bimaxillary retrognathism were characteristics of TS patients. Results indicated that deficiency of the X chromosome genes had a direct influence on all three anatomic parts - cranial base, maxilla and mandible - causing irregular growth.

Periodontal diseases at the transition from the late antique to the early mediaeval period in Croatia

OBJECTIVE We tested the hypothesis that the transition from the late antique to the early mediaeval period in Croatia had a negative impact on the periodontal health. METHODS 1118 skulls were examined for dental calculus, alveolar bone resorption, fenestrations, dehiscences and root furcation involvement. RESULTS The prevalence of teeth with calculus varied from 40.7% in the LA sample of continental parts of Croatia to 50.3% in the LA sample of Adriatic Croatia. The prevalence of alveolar bone resorption ranged between 21.2% in the EM sample from continental Croatia and 32.3% in the LA sample from Adriatic Croatia. The prevalence of individuals with alveolar bone dehiscences varied from 8.6% in the LA sample from continental Croatia up to 15.0% in the EM sample from Adriatic Croatia. The prevalence of individuals with alveolar bone fenestrations varied from 21.5% in the LA sample from Adriatic Croatia up to 36.2% in the LA sample from continental Croatia. The prevalence of individuals with exposed root bifurcations or trifurcations varied from 9.0% in the EM sample from Adriatic Croatia up to 20.7% in the EM sample from continental Croatia. Statistically significant differences were found between samples. CONCLUSION The transition from the late antique to the early mediaeval period in Croatia did not have a negative impact on periodontal health. Studies of periodontal health of ancient populations should be performed to provide a better and more reliable reconstruction of living conditions in the past.

Shape of the craniofacial complex in patients with Klinefelter syndrome.

The shape and size of the craniofacial complex in 35 adults with Klinefelter syndrome (47,XXY) were analyzed cephalometrically and compared with 60 control males. Twenty-four angular and 18 linear measurements were obtained for each subject. The results showed that the 47,XXY males were different from the controls in several areas of the craniofacial skeleton. Most of the differences were located in the cranial base and the cranial base angle (p < 0.02). The length of the maxillary base was greater (p < 0.05) and more prognathic (p < 0.01) in the study group. The mandible was also longer and more prognathic (p < 0.01).

Orthodontic anomalies and malocclusions in Late Antique and Early Mediaeval period in Croatia

OBJECTIVE Malocclusions are relative infrequently analysed in bioarchaeological investigations and if investigated the samples are very small. This research provides analysis of orthodontic anomalies of even 1118 individuals from the Late Antique (LA) and Early Mediaeval (EM) period. Aims were to describe the prevalence of orthodontic anomalies in this historical period and to analyse which orthodontic anomalies are best suitable for bioarchaeological investigations. METHODS 1118 skulls were examined for anomalies of tooth number, tooth displacement (rotation, malposition, diastema and crowding) as well as for malocclusions. RESULTS The prevalence of hypodontia in the LA was 41.02% and 30.61% in the EM sample. Tooth displacement was noticed in 15.63% individuals from the LA and in 12.42% individuals from EM. About 26% of the LA sample and 7.19% of the EM sample were affected with tooth crowding and the difference was statistically significant. CONCLUSION Orthodontic anomalies affecting only one tooth or group of teeth are more suitable for examination in bioarchaeological investigations than orthodontic features requiring presence of both jaws and all or almost all teeth. Clinical investigation protocols and methodology should be adopted for bioarchaeological researches and international standards and recommendations should be established for this kind of investigation on skeletal remains.

Occlusal plane orientation in Klinefelter syndrome (47, XXY males)

Occlusal plane position was analysed cephalometrically in 35 Klinefelter adults (47,XXY) and compared with 60 eugnath control males (46,XY). The significantly smaller angles between the occlusal plane and the cranial base (NSL-OLs) and between the occlusal plane and the Frankfort horizontal plane (Fr-OLs) were obtained in 47,XXY males (P < 0.01), while the angles between the maxillary base and the occlusal plane (NL-OLs) and between the Campers line and the occlusal plane (Camp.-OLs) were not significantly different (P > 0.05) from the control group. Significantly smaller angles between the occlusal plane and the cranial base (NSL-OLs) and between the occlusal plane and the Frankfort horizontal plane (Fr-OLs) in Klinefelter males are attributed to the hereditary influence of an extra X chromosome on the smaller growth of the cranial base and the greater growth of the lower border of the mandible. Although the maxilla was also shifted forward in XXY males in relation to the cranial base it was not enough to compensate for the hereditary influence, due to the greater growth of the lower border of the mandible and the smaller cranial base in 47, XXY males, on the inclination of the occlusal plane to the Frankfort horizontal plane and the cranial base. The forward shift of the maxilla was sufficient to compensate for the inclination of the occlusal plane in 47, XXY males to the maxillary base and the Campers line (P > 0.05).

Carabelli's trait in Croatian populations over 1800 years.

Examination and comparison of the morphological features of tooth crown in archaeological and recent samples can be difficult due to the different levels of tooth wear seen both within and between populations. These differences make the comparison of frequency data for Carabelli trait problematic. The aim of the present study is to detect the frequency and degree of expression of Carabellis trait in Croatian populations from late antiquity to recent times and to use these data as supplementary evidence of complex population migration. A total of 1287 individuals from the late antiquity, medieval, early modern and modern periods were examined. Correlation between the presence of Carabellis trait and tooth crown size was tested. The results of our analyses show that the frequency of Carabellis trait is significantly greater in the early modern period (51.3%) and in the 21st century (43.1%) than in the late antiquity (20.4%) and medieval periods (23.4%). These results are consistent with historical evidence of migration and population change in the territory of present-day Croatia throughout the almost 1800 years covered by this study. The results also provide additional evidence for the complex nature of population change in the transition from the late antiquity to the early medieval period.