Vilma Pinchi

Age estimation for forensic purposes in Italy: ethical issues

Age assessment in children and young adults is a relevant medicolegal issue due to the gradual increase of persons devoid of proper identification documents in European countries. Because of the illegal immigration and growing crime rates among children and adolescents, age estimation for forensic purposes is often required. The scientific research and the extensive experience of forensic experts in the last decades focused on the use of radiographic methods addressed to evaluate the degree of skeletal or dental development as the most accurate parameters to estimate the chronological age of children and adolescents. This paper analyzes the ethical issues related to age estimation procedures based on radiographic methods, showing how the ethical principles of beneficence, nonmalevolence, justice, and autonomy may be guaranteed during the execution of the age assessment in forensic practice. The procedure might be conducted in accordance with international guidelines and protocols, though they need a higher homogenization and standardization. A strong collaboration between various scientific societies of professionals (forensic odontologists, forensic pathologists, forensic anthropologist, radiologists, pediatricians, and psychologists), who have been involved in age estimation for years, is needed to reach this goal.

Probabilistic Classification of Age by Third Molar Development: The Use of Soft Evidence

Abstract:  This study introduces a method to classify individuals according to an age threshold, given sex and third molars’ dental maturity measured on the Demirjian scale by expressing uncertainty on dental evidence (soft evidence). We introduced a procedure to learn the parameters of the Naïve Bayes model, and we discussed two classification rules. The model was estimated and tested on 559 Italians aged 16–22. Two experts provided the dental evaluations, and the model was estimated for each of them. We evaluated the coherence of the evidence provided by the experts. Some indexes have been proposed to evaluate the effectiveness of the models, emphasizing how the experts’ ability and the technology affect the results. We introduced two benchmarks, one based on the sample distribution per sex and age: in this case, probability of correct classification increases 22% and the proportion of false adults impressively decreases 80.2%; the other benchmark, obtained by simulating hard evidence, shows how the use of soft evidence increases the proportion of correct classification 3.1% and decreases the crucial proportion of false adults about 20%. Similarly, the proportion of false minors decreases about 5.3%.

Trends in endodontic claims in Italy.

According to the scant data available in the literature, endodontic claims are common among dental professional liability cases and the second most common type of claim. This study aimed to describe the characteristics of endodontic claims in Italy and the most frequently disputed errors, and the discussion below includes consideration of ethical and medico-legal aspects thereof. We retrospectively analysed 120 technical reports written on cases of professional malpractice in endodontics in the last 5 years. The complainant patients were males in 22.5% of the cases, while females made up the remaining 77.5%. In the dentist sample, male operators were more often involved in litigation cases (80%) than female operators. The most frequently claimed technical errors were: lack of a complete filling of root canal/s (71.7%), the perforation of tooth structure (12.7%), extrusion of sealing materials beyond the apex of the tooth (9.6%) and the fracture of an endodontic instrument (5.9%). In 1.7% of cases it was found that the expert did not make any errors performing the endodontic therapy. In only very few cases (2.7%) no therapy was considered necessary, while the most common therapeutic solution involved in endodontic misconduct was tooth extraction (53.0%). In many cases the dentist preferred to extract the endodontically undertreated tooth and substitute it prosthetically rather than trying to re-treat it. The discrepancy between the total number of cases examined and those that eventually go to court leads us to believe that the majority of endodontic malpractice cases are resolved in out-of-court settlements.

Padova Charter on personal injury and damage under civil-tort law Medico-legal guidelines on methods of ascertainment and criteria of evaluation

Compensation for personal damage, defined as any pecuniary or non-pecuniary loss causally related to a personal injury under civil-tort law, is strictly based on the local jurisdiction and therefore varies significantly across the world. This manuscript presents the first “International Guidelines on Medico-Legal Methods of Ascertainment and Criteria of Evaluation of Personal Injury and Damage under Civil-Tort Law”. This consensus document, which includes a step-by-step illustrated explanation of flow charts articulated in eight sequential steps and a comprehensive description of the ascertainment methodology and the criteria of evaluation, has been developed by an International Working Group composed of juridical and medico-legal experts and adopted as Guidelines by the International Academy of Legal Medicine (IALM).

Techniques of dental DNA extraction: Some operative experiences

This study presents and discusses the possibility of multiple dental DNA extraction at different times using an endodontic technique. We chose a mixed sample of twenty teeth (decayed, filled, different kinds of teeth, etc.) and performed two different accesses to the pulp cavity to collect samples of dental tissue useful for DNA extraction. The Identifiler(®) and Minifiler(®) kits were used respectively for the first and second genetic analysis. The researchs most relevant findings are the possibility of successfully repeating dental DNA extractions, and that a dental element can be considered as a DNA source that can be reused even after prolonged time elapses. The studys results document a simple and efficient methodology for dental identification based on the choice of dental elements, endodontic techniques and the use of the Minifiler(®) kit for genetic analysis.

Probabilistic age classification with Bayesian networks: A study on the ossification status of the medial clavicular epiphysis

In the past few decades, the rise of criminal, civil and asylum cases involving young people lacking valid identification documents has generated an increase in the demand of age estimation. The chronological age or the probability that an individual is older or younger than a given age threshold are generally estimated by means of some statistical methods based on observations performed on specific physical attributes. Among these statistical methods, those developed in the Bayesian framework allow users to provide coherent and transparent assignments which fulfill forensic and medico-legal purposes. The application of the Bayesian approach is facilitated by using probabilistic graphical tools, such as Bayesian networks. The aim of this work is to test the performances of the Bayesian network for age estimation recently presented in scientific literature in classifying individuals as older or younger than 18 years of age. For these exploratory analyses, a sample related to the ossification status of the medial clavicular epiphysis available in scientific literature was used. Results obtained in the classification are promising: in the criminal context, the Bayesian network achieved, on the average, a rate of correct classifications of approximatively 97%, whilst in the civil context, the rate is, on the average, close to the 88%. These results encourage the continuation of the development and the testing of the method in order to support its practical application in casework.

Whiplash-Associated Disorders: Clinical and medico-legal guidelines on the methods of ascertainment

The manuscript presents the International Guidelines developed by the Working Group on Personal Injury and Damage under the patronage of the International Academy of Legal Medicine (IALM) regarding the Methods of Ascertainment of any suspected Whiplash-Associated Disorders (WAD).The document includes a detailed description of the logical and methodological steps of the ascertainment process as well as a synoptic diagram in the form of Flow Chart.

An unusual case of incaprettamento.

Incaprettamento is a ritual strangulation that represents a method of homicide typical of the Italian Mafia. While the victim is in the prone position, he/she is bound by one end of a rope, creating a slipknot around the throat, while the other end is used to tie the limbs behind the back. Forensic investigations reveal that in most cases, the binding of the extremities and the positioning of the victim are carried out after death due to others means and are intended to hold somebody in contempt and to punish betrayers. When the victim is tied while alive, the death is caused by self-strangulation because it is impossible to maintain the legs in this forced position. Here, we describe in detail a case with a lot of similarities to incaprettamento, although we define it as atypical because of the unusual methods of the actual binding and the circumstances in which death occurred. In fact, the investigation of the crime scene, the external and internal findings, and the histologic examination result show that this is a crime of passion.

Age estimation by assessment of pulp chamber volume: a Bayesian network for the evaluation of dental evidence

PurposeThe present study aimed to investigate the performance of a Bayesian method in the evaluation of dental age-related evidence collected by means of a geometrical approximation procedure of the pulp chamber volume. Measurement of this volume was based on three-dimensional cone beam computed tomography images.MethodsThe Bayesian method was applied by means of a probabilistic graphical model, namely a Bayesian network. Performance of that method was investigated in terms of accuracy and bias of the decisional outcomes. Influence of an informed elicitation of the prior belief of chronological age was also studied by means of a sensitivity analysis.ResultsOutcomes in terms of accuracy were adequate with standard requirements for forensic adult age estimation. Findings also indicated that the Bayesian method does not show a particular tendency towards under- or overestimation of the age variable. Outcomes of the sensitivity analysis showed that results on estimation are improved with a ration elicitation of the prior probabilities of age.

Comparison of the diagnostic accuracy, sensitivity and specificity of four odontological methods for age evaluation in Italian children at the age threshold of 14 years using ROC curves

The age threshold of 14 years is relevant in Italy as the minimum age for criminal responsibility. It is of utmost importance to evaluate the diagnostic accuracy of every odontological method for age evaluation considering the sensitivity, or the ability to estimate the true positive cases, and the specificity, or the ability to estimate the true negative cases. The research aims to compare the specificity and sensitivity of four commonly adopted methods of dental age estimation – Demirjian, Haavikko, Willems and Cameriere – in a sample of Italian children aged between 11 and 16 years, with an age threshold of 14 years, using receiver operating characteristic curves and the area under the curve (AUC). In addition, new decision criteria are developed to increase the accuracy of the methods. Among the four odontological methods for age estimation adopted in the research, the Cameriere method showed the highest AUC in both female and male cohorts. The Cameriere method shows a high degree of accuracy at the age threshold of 14 years. To adopt the Cameriere method to estimate the 14-year age threshold more accurately, however, it is suggested – according to the Youden index – that the decision criterion be set at the lower value of 12.928 for females and 13.258 years for males, obtaining a sensitivity of 85% and specificity of 88% in females, and a sensitivity of 77% and specificity of 92% in males. If a specificity level >90% is needed, the cut-off point should be set at 12.959 years (82% sensitivity) for females.