Ronald Schulz

Comparative study on the effect of ethnicity on wisdom tooth eruption

The current knowledge base for evaluating the influence of ethnic origin on wisdom tooth eruption is still inadequate. We therefore analyzed and compared the chronology of wisdom tooth eruption in three ethnic populations—German, Japanese, and black South African—based on evidence from 2,482 conventional orthopantomograms. The investigated German population ranked in the middle in terms of the age of wisdom tooth eruption. The black South African population was the fastest and the Japanese population the slowest in terms of reaching the respective eruption stages. Population-specific reference data should be used when evaluating wisdom tooth eruption for the purpose of forensic age estimation.

Studies in use of the Greulich–Pyle skeletal age method to assess criminal liability

In recent years, skeletal age determination has become increasingly important for determining the age of live subjects as part of criminal investigation. The most widely used method worldwide to determine skeletal age is the Greulich-Pyle atlas method. The present study examines the suitability of the Greulich-Pyle method given the particular requirements of forensic age estimates. It is a retrospective analysis of 649 hand radiographs originally taken from persons aged between 1 and 18 years, separately for each sex. If the Greulich-Pyle method is used exclusively, it can be claimed with a probability of 95% that a young man has reached the age of 14 years and thus the age of criminal liability if his skeletal age is at least 15.5 years. In the case of female subjects, even if they are estimated as being 16.0 years old, it cannot be asserted with a probability of 95% that they have reached the age of 14. To reduce the margin of error of age estimates, determining the skeletal age should always go hand in hand with a physical examination to determine indications of sexual maturity and a dental examination to record dental status. The reference values given in the present study can be applied to members of all ethnic groups for age estimate purposes. If the person under examination has a different socio-economic status, the expert performing the age estimate should address this issue in his expert opinion and discuss the possible effects that might have on the age diagnosis.

Influence of the examiner’s qualification and sources of error during stage determination of the medial clavicular epiphysis by means of computed tomography

Computed tomography (CT) of the medial clavicular epiphysis has been well established in forensic age estimations of living individuals undergoing criminal proceedings. The present study examines the influence of the examiner’s qualification on the determination of the clavicular ossification stage. Additionally, the most frequent sources of error made during the stage assessment process should be uncovered. To this end, thin-slice CT scans of 1,420 clavicles were evaluated by one inexperienced and two experienced examiners. The latter did the evaluations in consensus. Two classification systems, a five-stage system and a substaging system for the main stages 2 and 3, were used. Prior to three of his six assessment sessions, the inexperienced examiner was specifically taught staging of clavicles. Comparison of the examiners’ results revealed increasing inter- and intraobserver agreements with increasing state of qualification of the inexperienced examiner (from κ= 0.494 to 0.674 and from κ= 0.634 to 0.783, respectively). The attribution of a not-assessable anatomic shape variant to an ossification stage was identified as the most frequent error during stage determination (n= 349), followed by the overlooking of the epiphyseal scar defining stage 4 (n= 144). As to the clavicular substages, classifying substage 3a instead of 3b was found to be the most frequent error (n= 69). The data of this study indicate that κ values must not be considered as objective measures for inter- and intraobserver agreements. Furthermore, a high degree of specific qualification, particularly the knowledge about the diversity of anatomic shape variants, appears to be mandatory and indispensable for reliable evaluation of the medial clavicular epiphysis.

Age estimation in U-20 football players using 3.0 tesla MRI of the clavicle.

BACKGROUND To guarantee equal chances for participants in U-20 football tournaments, it seems desirable to verify the ages given by players with questionable dates of birth. OBJECTIVE To study the potential use of 3.0 tesla MRI of the clavicle in estimating the ages of U-20 football players. METHODS The ossification stage of the medial clavicular epiphyses was evaluated prospectively in 152 male footballers in the age group from 18 to 22 years using 3.0 tesla MRI. RESULTS Average age increased with any higher degree of fusion. The only footballer with full ossification of the medial clavicular epiphyseal plate was 21.2 years old. CONCLUSIONS The presence of a fully ossified clavicular epiphyseal plate appears to provide evidence of completion of the 20th year of life. The results of the pilot study need to be verified in a larger number of cases.

Studies of the Chronological Course of Wisdom Tooth Eruption in a Black African Population

The importance of forensic age estimation in living subjects has grown over the last few years. In dental age estimation, tooth eruption is a parameter of developmental morphology that can be analyzed by either clinical examination or by evaluation of dental X‐rays. In the present study, we determined the stage of wisdom tooth eruption in 410 male and 106 female Black South African subjects of known age (12–26 years) based on radiological evidence from 516 conventional orthopantomograms. Four eruption stages were determined (no emergence, alveolar emergence, gingival emergence, complete emergence). Statistical scores were determined for the individual stages separately for both sexes. The data presented here can be utilized for forensic estimation of the minimum and most probable ages of investigated persons.

Reference study on the time frame for ossification of the distal radius and ulnar epiphyses on the hand radiograph

Hand radiographs from 554 male and 288 female subjects aged 10-30 years, which had been taken due to traumatological indications, were evaluated. A classification into five ossification stages was applied to assess the epiphyseal development of distal radius and distal ulna (1: epiphysis not ossified; 2: epiphysis ossified, nonunion of the epiphysis and metaphysis; 3: partial union of the epiphysis and metaphysis; 4: complete union of the epiphysis and metaphysis, epiphyseal scar visible; 5: complete union of the epiphysis and metaphysis, epiphyseal scar nondiscernable). It was established that male subjects with an ossification stage 4 of the radius or ulna and female subjects with an ossification stage 5 of the radius were at least 14 years old. The occurrence of ossification stage 5 of the radius proves that a male individual has reached the age of 18 years.

Sonographic examination of the apophysis of the iliac crest for forensic age estimation in living persons

The present study examines the applicability of ultrasound diagnostics in assessing the ossification processes of the apophysis of the Crista iliaca of the pelvis for the purposes of forensic age diagnostics in living persons. To this end, the apophyseal ossification stages were determined in 307 female and 309 male study participants aged between 10 and 25 years. In females, ossification stage I was identifiable at an age of 10.1 years at the earliest (x¯=11.8), ossification stage II at 11.2 years at the earliest (x¯=14.6), ossification stage III at 14.7 years at the earliest (x¯ =18.6), and ossification stage IV at 17.9 years at the earliest (x¯=22.7). In males, ossification stage I was observable from an age of 10.0 years (x¯=11.8), ossification stage II from 10.5 years (x¯=14.9), ossification stage III from 15.6 years (x¯=18.9), and ossification stage IV from 17.4 years (x¯=22.6). In forensic age estimation procedures in living persons, sonographic examination of the iliac crest apophysis makes it possible to minimise exposure of the individual to radiation in accordance with the existing legal basis for the use of X-rays on humans. In application areas with no legal basis to justify X-ray examinations, the accuracy of an age diagnosis can be improved by integrating skeletal maturity as a criterion.

Studies of the chronological course of wisdom tooth eruption in a German population

Forensic age estimation in living subjects has gained increasing significance in recent years. In dental age estimation, tooth eruption is a parameter of developmental morphology that can be analyzed by either clinical examination or by evaluation of dental X-rays. In the present study, we determined the stage of wisdom tooth eruption in 144 male and 522 female German subjects aged 12-26 years based on radiological evidence from 666 conventional orthopantomograms. The results presented here provide useful data on the age of alveolar, gingival, and complete emergence of the third molars in the occlusal plane that can be utilized for the forensic estimation of the minimum and most probable ages of individuals under investigation.

A web-based e-learning programme for training external post-mortem examination in curricular medical education

In Germany, the external post-mortem examination is considered a medical duty and may be performed by any licensed physician. Concerning legal medicine as a curricular subject in teaching medical students, the external post-mortem examination is regarded a core area. At the University of Müenster, 15 virtual cases of death have been developed by using the web-based Inmedea Simulator. The programme allows performing all relevant steps in executing a complete external post-mortem examination. A particular importance was attached to the aspect of training users in approaching the subject in a systematic way to interpret significant forensic findings correctly and to comprehend their medico-legal implications. The programme was used for the first time in the academic term of 2010/2011. The overall reception of the programme by the medical students resulted to be positive in a first evaluation.

Forensic age estimation in living subjects based on ultrasound examination of the ossification of the olecranon.

Radiation-free imaging procedures for the purposes of forensic age diagnosis are highly desirable, especially for children. With this in mind, the stage of ossification of the olecranon was prospectively determined in 309 male and 307 female healthy volunteers aged between 10 and 25 years, based on ultrasound. A four-stage classification system was used for this purpose. This stage classification system takes into account whether an isolated secondary ossification centre, an epiphyseal cartilage or an epiphysis which is completely fused with the diaphysis can be detected. The earliest observation of stage 2 was at 10.0 years in males and 10.1 years in females. Both findings are determined by the lower age limit of the sample and are thus not representative of the minimum age for ossification stage 2. Stage 3 was first noticed at age 13.5 years in males and 10.6 years in females. Stage 4 was first reached at age 13.7 years in males and 12.3 years in females. Hence, in our sample, ossification stage 3 can be seen as evidence that females have reached the age of 10 years and males the age of 13 years. In our sample, stage 4 provides evidence that a female individual has reached the age of 12 years. It was concluded that the results of our study should be validated using other samples.