clinical case - Dental and Medical Problems

clinical case - Dental and Medical Problems

clinical case
Dent. Med. Probl. 2013, 50, 4, 486–490
ISSN 1644-387X
© Copyright by Wroclaw Medical University
and Polish Dental Society
Agnieszka Przystańska1, A, B, D, E*, Mariusz Glapiński2, A, B, D, E*, Tomasz Kulczyk3, B, D, F,
Dorota Lorkiewicz-Muszyńska4, A, B, E
Forensic Odontology in Practice: the Role of Prosthethic
Dental Treatment in Personal Identification
Praktyka odontologiczno-sądowa: rola uzupełnień protetycznych
w procesie identyfikacji osobniczej
Department of Anatomy, Poznań University of Medical Sciences, Poland
Oral Rehabilitation Clinic, Poznań University of Medical Sciences, Poland
3
Department of Biomaterials and Experimental Dentistry, Poznań University of Medical Sciences, Poland
4
Department of Forensic Medicine, Poznań University of Medical Sciences, Poland
*Authors contributed equally to this work.
1
2
A – concept, B – data collection, C – statistics, D – data interpretation, E – writing/editing the text,
F – compiling the bibliography
Abstract
Personal identification by dental means is one of the most effective methods used in medico-legal practice, especially when dealing with victims of natural disasters, fires and traffic accidents. The aim of a postmortem examination is to collect odontological (including surgical, prosthetic and orthodontic) data significantly relevant for
identification purposes. It is important not only to determine the type of prosthetic treatment, but also to provide
detailed descriptions of materials and methods of construction. Thorough knowledge of dental techniques and
prosthetic treatment allow us to ascertain the time and place of the treatment. Prosthetic components, in addition
to all other material culture, can be very useful in the dating of the remains. The post mortem investigation results
of the individual odontological profile of the victim, saved and documented in a special form are then compared
with the available antemortem data of missing persons (Dent. Med. Probl. 2013, 50, 4, 486–490).
Key words: forensic odontology, personal identification.
Streszczenie
Identyfikacja osobnicza za pomocą danych odontologicznych jest jedną z najskuteczniejszych metod stosowanych
w praktyce medyczno-sądowej szczególnie w przypadku identyfikacji ofiar katastrof naturalnych, pożarów oraz
wypadków komunikacyjnych. Pośmiertne badanie odontologiczne ma na celu zebranie jak największej liczby
danych o znaczącej przydatności dla procesu identyfikacji w tym śladów leczenia chirurgicznego, protetycznego
i ortodontycznego. Dla potrzeb identyfikacji ważne jest nie tylko określenie rodzaju uzupełnienia protetycznego,
lecz przede wszystkim szczegółowy opis materiału i metody wykonania. Znajomość technik protetycznych i metod
leczenia umożliwia określenie czasu, a często także miejsca wykonania uzupełnienia. Elementy protetyczne, obok
ujawnionych wszelkiego rodzaju przedmiotów kultury materialnej, mogą okazać się bardzo przydatne podczas
datowania szczątków. W wyniku badania powstaje zapisany w postaci formularza i udokumentowany zdjęciami rentgenowskimi indywidualny profil odontologiczny ofiary, który jest następnie porównywany z dostępnymi
danymi zażyciowymi osób zaginionych (Dent. Med. Probl. 2013, 50, 4, 486–490).
Słowa kluczowe: odontologia sądowa, identyfikacja osobnicza.
Personal identification by dental means is one
of the most effective methods used in medico-legal practice when significant mechanical damage,
advanced post mortem changes, charring, or frag-
mentation of the body makes the victim’s identification using other methods impossible. Odontological methods have an efficiency rate of 92% [1]
making them particularly useful in identifying
487
Forensic Odontology in Practice
victims of natural disasters, fires and transport accidents (such as airplane crashes).
Odontological analysis is also performed in archaeological findings and accidental recoveries
of skeletonized human remains from, for example,
excavations. The examination starts with data collection and the evaluation of evidence regarding their
usefulness in the identification process. The presence of an anthropologist or forensic odontologist at
the scene is important to thoroughly search the site
where the remains were found and to possibly secure the loose parts as single teeth, bony fragments
or dentures. Every single detail, even the smallest, can
be crucial for personal identification. One should also remember to securely attach every piece of evidence found to the bony material for further analysis.
Sending a skull and mandible without loose teeth or
dentures is inadmissible and may lead to wrong conclusions. Also, attempts to stick or bond loose elements are inadvisable and should only be made by
a qualified and experienced forensic odontologist.
Post mortem Examination
The preliminary forensic odontological evaluation, such as selection of evidence (ex. separation of
animal material) begins at the scene and is then continued in the laboratory. The aim of a post mortem
examination is to collect odontological (including
surgical, prosthetic and orthodontic) data significantly relevant for identification purposes. It is conducted in the following steps [2]:
1. Quantitative analysis of the dental status.
2. Assessment of teeth location.
3.Evaluation of morphological characteristics
of individual teeth.
4. Dental pathologies.
5. Dental records.
6. Radiographic and photographic documentation.
Fig. 1. Example of prosthetic dental treatment (bridge)
in post mortem investigation
Ryc. 1. Przykład uzupełnień protetycznych (most)
w badaniu pośmiertnym
Evaluation of Prosthetic
Dental Treatment
The precise description of every trace of dental treatment, surgical, prosthetic and orthodontic
is of great practical importance [3]. The prosthetic treatment is crucial in the personal identification of victims over the age of 40 years [4]. Usually, the first to be described are fixed elements,
such as crowns, bridges, intraradicular elements,
and implants (Fig. 1), although a detailed investigation of personal identification of fire victims in
Scandinavian countries revealed the latter are the
least likely to be found across all age groups [4].
For identification purposes, not only the determination of the restoration type is important, but
first and foremost, a detailed description of materials and methods of construction. Thorough knowledge of dental techniques and prosthetic treatment allows us to ascertain the specific time and
place of the treatment. Prosthetic components, in
addition to all other material culture, can be very
useful in the dating of the remains. Andersen et
al. [4] found that removable dentures (complete
and partial) were present in 12% of all fire victims over the age of 35 years. Edentulous jaw occurs in over 50% of people over 40 years [5], thus the
probability of wearing dentures increases in victims along with their age. The removable dentures
require a detailed evaluation regarding the material and technique used. The precise description of
the dentures is essential for both handwritten and
computer-aided form filling (Figs. 2, 3) [6].
Example 1. Case history: among the remains
a complete upper denture that correlates with maxil­lary parameters and profile of the investigated
skull. This is a complete, caoutchouc denture with
porcelain teeth. The element of the sucker attaching
the denture to the palate is visible. Dentures of this
type had been used from the interwar period to the
end of the 50s (Fig. 4).
Information concerning materials used for
dental restorations is very important in the identification process. The presence or lack of dental treatment as well as the number and quality of dentures can be an indicator of socioeconomic status, or at least the place of origin [7]. Also
the material used (gold, porcelain, composite, steel),
may provide an additional source of information
about the victim. Unusual examples of treatment
may be an indicator of place of residence [8]. For
example, crowns and bridges in the anterior region
made of gold are frequently observed in citizens of
Russia and the former Soviet Union (Fig. 5).
Also significant is the fact that restorations
are always clearly visible on X-ray images, facili-
488
A. Przystańska et al.
Fig. 4. Denture with the element of the sucker
attaching to the palate found within the remains
Ryc. 4. Proteza z elementem po przyssawce mocującej
do podniebienia znaleziona przy szczątkach
Fig. 2. Example of prosthetic dental treatment (denture) in post mortem investigation
Ryc. 2. Przykład uzupełnień protetycznych (proteza)
w badaniu pośmiertnym
Fig. 5. Example of gold prosthetic dental treatment in
post mortem investigation
Ryc. 5. Przykład uzupełnień protetycznych
wykonanych ze złota w badaniu pośmiertnym
Fig. 3. Example of prosthetic dental treatment (denture) in post mortem investigation
Ryc. 3. Przykład uzupełnień protetycznych (proteza)
w badaniu pośmiertnym
tating comparative analysis of available ante mortem dental records. It should be noted that all fixed
and removable restorations are prepared individually for each patient in the dental technical laboratory and are usually well described in the patient’s
dental records making them a valuable source
of information for comparative analysis. In some
countries, it is customary to mark the dentures
with the laboratory symbol or initials of the doctor; however, the prevalence of this kind of technology is negligible [9, 10].
489
Forensic Odontology in Practice
Table 1. Case 1. Post mortem odontologial record.
Tabela 1. Przypadek 1. Dane stomatologiczne uwzględnione w badaniu pośmiertnym
missing ante mortem
18
28
missing ante mortem
missing ante mortem
17
27
missing ante mortem
porcelain-fused-to-metal crown connected by me- 16
tal bar to crown on tooth 12
26
missing ante mortem
missing ante mortem
15
25
missing ante mortem
missing ante mortem
14
24
porcelain-fused-to-metal crown with ball attachment
missing ante mortem
13
23
present, crown fracture, caries
present, porcelain-fused-to-metal crown connected by metal bar to crown on tooth 16
12
22
present, caries D present, sound
11
21
present, tooth coloured filling M
present, sound
41
31
present, sound
present, sound
42
32
present, sound
present, sound
43
33
present, caries D
present, tooth coloured filling MO
44
34
present, caries OD
porcelain-fused-to-metal crown connected by me- 45
tal bar to crown on tooth 48
35
missing post mortem
missing ante mortem
46
36
missing ante mortem
missing ante mortem
47
37
missing ante mortem
porcelain-fused-to-metal crown connected by me- 48
tal bar to crown on tooth 45
38
missing ante mortem
Comments:
Tartar. Regression of alveolar process of mandible from tooth 34 toward tooth 45 (from 2 mm to 4 mm). Between teeth 38
and 35 atrophy of alveolar process following tooth loss, bone remodeling due to the prosthetic treatment.
Prosthetic restorations:
Maxilla: teeth 12 and 16 porcelain fused to metal (PFM) crowns connected by the bar with ball attachments on the top of
the bar placed in position 15 (patrix). Tooth 24 PFM crown with ball attachment placed on distal (patrix). Crowns 12, 16,
24 grinded for clasps; partial skeletal denture, acrylic saddles, acrylic artificial teeth. Elastic rings in matrices.
Mandible: teeth 45 and 48 porcelain fused to metal (PFM) crowns connected with the bar with ball attachments on the
top of the bar placed in position 47 (patrix). Tooth 35 PFM crown with ball attachment placed on distal (patrix) – tooth
is missed – deduction based on the skeletal denture construction; partial skeletal denture, acrylic saddles, acrylic artificial
teeth, lingual surface made of metal alloy. Elastic rings in matrices.
Forensic Odontological
Record
All the information gathered from a post mortem odontological examination is saved in a special format.
Example 2 (Table I). All around the world, in
order to identify the victims of disasters, special
Interpol forms [11] (pink for post mortem examination and yellow for the ante mortem) are used.
Completing the form is not easy; it requires some
experience and knowledge of abbreviations and
symbols. Because of the potential for mistakes and
the possibility that dental practitioners might be
involved in the identification of victims (not only
forensic odontologists) in the area, it is important
for every dentist to have an opportunity to read
and complete the form prior to going on duty.
Conclusions
The post mortem investigation results of the
individual odontological profile of the victim,
saved and documented in a special form, is then
compared with the available ante mortem data of
missing persons (medical and dental records, radiological documentation, gypsum casts, wax bites).
Prosthetic components, in addition to disclo­
sing any kind of material culture can be very useful
in dating the remains. Dentures provide valuable
information about the victim, especially when the
medical records are reliable and contain all the details necessary for identification. Recently, it has
been suggested that prosthetic restorations can be
marked using chips [12] containing basic information about the contractor (who keep records of patients), or the patient. The usefulness of such a solution would be invaluable.
490
A. Przystańska et al.
References
[1] Schuller-Götzburg P., Suchanek J.: Forensic odontologists successfully identify tsunami victims in Phuket,
Thailand. Forensic Sci. Int. 2007, 204–207.
[2] Przystańska A., Lorkiewicz-Muszyńska D., Łabęcka M.: Individual characteristics of the dentition and their
contribution in odentification of disaster victims. [In:] Security of public health in environmental emergency. Advances in research methodology. Jerzy Konieczny (ed). Poznań–Łódź–Inowrocław, Garmond Oficyna Wydaw.
2012, 427–436 [in Polish].
[3] Valenzuela A., Martin-de las Heras S., Marques T., Exposito N., Bohoyo J.M.: The application of dental
methods of identification to human burn victims in a mass disaster. Int. J. Legal Med. 2000, 113, 236–239.
[4] Andersen L., Juhl M., Solheim T., Borrman H.: Odontological identification of fire victims-potentialities and
limitations. Int. J. Leg. Med. 1995, 107, 229–234.
[5] Radomska A., Michalak A, Gruszka K, Ciurla A, Bożyk A., Borowicz J.: Analysis of missing teeth in selected group of patients of Lubelskie. Poradnik Stomatologiczny 2011, 11, 186–188 [in Polish].
[6] Martinez-Chicon J., Valenzuela A.: Usefulness of forensic dental symbols and dental encoder database in forensic odontology. J. Forensic. Sci. 2012, 57, 206–211.
[7] Maupome G., MacEntee M.I.: Prosthodontic profiles relating to economic status, social network, and social support in aan elderly population living independly in Canada. J. Prosthet. Dent. 1998, 80, 598–604.
[8] Pretty I.A., Sweet D.: A look at forensic dentistry – part I: the role of teeth in the determination of human identity. Br. Dent. J. 2001, 190, 359–366.
[9] Bengtsson A., Olsson T., Rene N., Carlsson G.E., Dalbom U., Borrmaan H.: Frequency of edentulism and
idnetification marking of removable dentures in long-term care units. J. Oral. Rehabil. 1996, 23, 520–523.
[10] Richmond R., Pretty I.A.: Contemporaary methods of labelling dental prostheses – a review of literature. J. Forensic Sci. 2006, 51, 1120–1126.
[11] www.interpol.int/INTERPOL-expertise/Forensics/DVI-Pages/Forms, dostęp: 12. 11. 2012.
[12] Nuzzolese E., Marcario V., Vella G.D.: Incorporation of radio frequency identification tag in dentures to facilitate recognition and forensic human identification. Open Dent. J. 2010, 4, 33–36.
Address for correspondence:
Dorota Lorkiewicz-Muszyńska
Department of Forensic Medicine
Poznań University of Medical Sciences
Święcickiego Str 6
60-781 Poznań
Poland
Tel. +48 61 854 64 15
E-mail: [email protected]
Received: 30.09.2013
Revised: 31.10.2013
Accepted: 7.11.2013
Praca wpłynęła do Redakcji: 30.09.2013 r.
Po recenzji: 31.10.2013 r.
Zaakceptowano do druku: 7.11.2013 r.