John Berketa

Forensic odontology involvement in disaster victim identification

Forensic odontology is one of three primary identifiers designated by Interpol to identify victims of mass casualty events. Forensic odontology is involved in all five phases—Scene, Postmortem, Antemortem, Reconciliation and Debrief. Forward planning, adequate funding, international cooperation and standardization are essential to guarantee an effective response. A Standard Operation Procedure should be utilized to maximize quality, facilitate occupation and health issues, maintain security and form a structure to the relief program. Issues that must be considered in the management of the forensic odontology component of disaster victim identification are given in “Appendix 1”. Each stage of the disaster, from initial notification to debrief, is analyzed and a comprehensive checklist of actions suggested.

Radiographic Recognition of Dental Implants as an Aid to Identifying the Deceased

Abstract:  This study was undertaken to determine if dental implants can be radiographically differentiated by company type to aid forensic identification of the deceased. Recognition of dental implants on intraoral radiographic images was assessed in a blind study using a radiographic examination guide to highlight differences between dental implants. Inter‐ and intra‐examiner comparisons were conducted and a computer program (Implant Recognition System®) was evaluated to see whether it improved the accuracy of implant recognition. The study found that dental implants could be radiographically differentiated by company type. The Implant Recognition System® in its current form was of little benefit for radiographic assessment of dental implants for forensic odontologists. Prior knowledge of implant types, with a McNemar’s statistical value of 92.9, proved to be most significant in identification.

Maximizing postmortem oral-facial data to assist identification following severe incineration

PurposeThis paper reviews the literature for methods of maximizing the postmortem oral-facial information available for a comparison to be made for identification following an incident resulting in incineration.MethodA search was initially instigated utilizing PubMed, Scopus, and Google Scholar, with further library searches and correspondences among peers around the world leading to a comprehensive review of the literature.ConclusionMaximizing postmortem dental evidence in a severe incineration event requires correct recognition and recording of dental data. Odontologists should attend the scene to facilitate this recognition. The information should be documented, photographed, and stabilized before retrieval. Wrapping, padding, and further support of the remains during transportation to the examination mortuary will aid this process. Examination at the mortuary requires further photography, complete charting, and radiographic examination of any dental material available, as well as awareness of other possible medical evidence, to enable identification of the human remains.

Disaster victim identification: quality management from an odontology perspective

The desired outcome of the victim identification component of a mass fatality event is correct identification of deceased persons in a timely manner allowing legal and social closure for relatives of the victims. Quality Management across all aspects of the Disaster Victim Identification (DVI) structure facilitates this process. Quality Management in forensic odontology is the understanding and implementation of a methodology that ensures collection, collation and preservation of the maximum amount of available dental data and the appropriate interpretation of that data to achieve outcomes to a standard expected by the DVI instructing authority, impacted parties and the forensic odontology specialist community. Managerial pre-event planning responsibility, via an odontology coordinator, includes setting a chain of command, developing and reviewing standard operating procedures (SOP), ensuring use of current scientific methodologies and staff training. During a DVI managerial responsibility includes tailoring SOP to the specific situation, ensuring member accreditation, encouraging inter-disciplinary cooperation and ensuring security of odontology data and work site. Individual responsibilities include the ability to work within a team, accept peer review, and share individual members’ skill sets to achieve the best outcome. These responsibilities also include adherence to chain of command and the SOP, maintenance of currency of knowledge and recognition of professional boundaries of expertise. This article highlights issues of Quality Management pertaining particularly to forensic odontology but can also be extrapolated to all DVI actions.

The utilization of incinerated hip and knee prostheses for identification

PurposeThe aim of this study was to test various methods of retrieving number data from hip and knee implants from cremated human remains and to validate our findings by cross referencing our results with the national joint replacement registry.MethodImplants were collected from the remains of individuals who had donated their bodies to science following routine planned cremation. A number of different chemical and physical methods to expose the implant numbers on cremated implants to the point that they were legible were tested. The retrieved data on the implants was referred to the Australian Orthopaedic Association National Joint Replacement Registry to identify the individuals, and the names were cross-referenced from the original list of donors.ResultsIt was possible to retrieve sufficient data from cremated implants to track the name of the recipient of implants if they were placed following the formation of the registry. Both wet and dry paper (1200 size and without moisture), and fine grade steel wool (used in antique restoration), were successful in removing the oxidized layer from implants. With hip implants, it was discovered that the best area to retrieve clear readable information is inside the ball head or at the end of the neck as this area is protected from oxidation during incineration.ConclusionIncinerated or cremated hip and knee implants may be used to assist in the identification of a decedent following careful treatment, in conjunction with national joint revision registries and company data.

A study of osseointegrated dental implants following cremation.

BACKGROUND The comparison of dental morphology and restorative work for human identification has been well documented. This case study involved documentation of osseointegrated and clinically restored dental implants following cremation. METHODS The mandible and the maxilla were excised from a head containing implants and cremated. The remains were retrieved, digital and radiographic images were taken and elemental analysis undertaken. The brand of implants was identified utilizing web based search engines. A prosthodontist, known to commonly use this implant system, was approached to ascertain possibilities that matched the data given. RESULTS Following cremation the implants were identified and a prosthodontist was able to identify the deceased. Two implants in the maxilla had dehiscences on their buccal surfaces, which could not be detected by periapical radiographs. CONCLUSIONS Dental implants osseointegrated and restored with a prosthetic superstructure were recognizable following severe incineration. It was possible to trace back the identity of the unknown victim to a prosthodontist. Bone dehiscences discovered in this study highlighted how two-dimensional radiographs may not reveal lack of bone support.

Cochlear implants in the forensic identification process

PurposeDecedents who are severely decomposed, skeletonized or incinerated present challenges for identification. Cochlear implants aid hearing and bear unique serial numbers that can be used to assist with identification of bodies that are not visually identifiable. The purpose of this paper was to highlight companies that have or had manufactured cochlear type implants and demonstrate the appearance of the implants to assist crime scene investigators, pathologists, anthropologists and odontologists.MethodInvestigation of cochlear implants was conducted on the internet and companies were contacted for information regarding their implants.ResultsThe functional appearance of a cochlear implant is explained, brands of implants are tabulated and pre and post-incineration images are presented.ConclusionThe prevalence of cochlear implants is predicted to increase, thus they are likely to become relevant to the identification process. Company brand and serial markings can be retrieved from post-incineration implants making them a valuable aid in identification when other identifiers that may be present are not useful because they are heat-sensitive.

Locard's Principle of Exchange, Dental Examination and Fragments of Skin

The transfer of materials between victim and perpetrator was first reported by Locard in the nineteenth century. While in recent years DNA testing has been very successful in matching biological material from crime scenes to perpetrators, the following cases demonstrate that other more time‐honored methods remain useful. Two cases of lethal assault are reported where the victims had bitten their assailants resulting in fragments of the perpetrators’ skin being wedged between their teeth which were discovered during post mortem oral examinations. As the fragments were able to be matched to injuries in the perpetrators, identification was established prior to confirmatory DNA testing. In case 1 a criminal conviction for manslaughter resulted, and in case 2 the identity of the assailant was confirmed. Examination of a properly exposed and illuminated oral cavity may provide useful evidence in assault cases. These cases represent an unusual dental variant of Locards principle.

Dentures in dementia: the oral health management of patients in institutional care

The recent article by Langlois and Byard reporting on the death of a patient with a lower denture impacted in the oropharynx [1] stimulates thoughts on how this situation could have been prevented. The needs for dentures, either partial or full, are obvious to promote mastication and to provide an important aesthetic appearance. However, the need to routinely care for these prostheses is quite often neglected. Retained dentures trap food debris, creating an environment for denture stomatitis and hyperplasia [2]. For this reason dental associations recommended that dental prostheses are removed, cleaned, and left out overnight to allow the mucous membranes of the mouth to recover [3]. As well as improving the health of the patient’s mucosa, the nocturnal removal has the added benefits of decreasing the incidence of halitosis, decreasing the incidence of uncomfortable ulcerations, and allows the dentures to be checked for possible fractures, missing teeth, broken wires (on partial dentures), and impaction. Patients in institutional care may not be capable, either physically or mentally, of caring for their dentures. Nursing staff could supervise their removal (or in the case of incapacitated patients remove their dentures for them) before bedtime for cleaning and soaking overnight. This protocol has been recommended [4], but the unpleasantness of handling patients’ dentures and the reluctance of the patients to go without their prostheses while sleeping has seen this recommendation ignored [5]. I suggest that if patients do not want their dentures left out at night they, or their guardians, must sign a statement indicating their wishes. The awareness and education that some thought needs to be given to this decision might lead to a better quality of life for denture wearers.

Stabilisation of dental structures of severely incinerated victims at disaster scenes to facilitate human identification

Fatalities due to fire events such as bushfires, domestic and industrial fires and vehicle accident related incineration, leave victims with limited prospects of being accurately identified. Due to their morphology and anatomical position teeth are uniquely protected in incineration cases and via comparison to dental records often provide the only scientifically valid means of identification. However, extreme heat and direct exposure to flame can render the teeth extremely fragile and vulnerable to damage and loss especially during collection and transportation to the mortuary. Here we highlight the advantages of forensic odontology assistance at the scene of such events and discuss techniques and protocols applied to actual cases in which these processes were used to facilitate the identification of incineration victims.