Research Progress of Age Estimation Based on the Demirjian's Method.

ABSTRACT: In recent years, individual age estimation has gained increasing attention in forensic practice. Common age estimation methods mainly use developments of teeth and bones. Compared with bones, teeth are stronger and are highly resistant to external factors, therefore plays an important role in age estimation. Demirjian's method is one of the most commonly used methods to evaluate dental age and has been widely used in many countries. In this paper, the accuracy of its application in different populations is reviewed. It is found that compared with the chronological ages, most of the estimated ages are overestimated. By combining research results of many scholars and by analyzing, it can be assumed that this situation may be related with race, region, sex, etc.

Epidermis and Enamel: Insights Into Gnawing Criticisms of Human Bitemark Evidence.

Critics describe forensic dentists' management of bitemark evidence as junk science with poor sensitivity and specificity and state that linkages to a biter are unfounded. Those vocal critics, supported by certain media, characterize odontologists' previous errors as egregious and petition government agencies to render bitemark evidence inadmissible. Odontologists acknowledge that some practitioners have made past mistakes. However, it does not logically follow that the errors of a few identify a systemic failure of bitemark analysis. Scrutiny of the contentious cases shows that most occurred 20 to 40 years ago. Since then, research has been ongoing and more conservative guidelines, standards, and terminology have been adopted so that past errors are no longer reflective of current safeguards. The authors recommend a comprehensive root analysis of problem cases to be used to determine all the factors that contributed to those previous problems. The legal community also shares responsibility for some of the past erroneous convictions. Currently, most proffered bitemark cases referred to odontologists do not reach courts because those forensic dentists dismiss them as unacceptable or insufficient for analysis. Most bitemark evidence cases have been properly managed by odontologists. Bitemark evidence and testimony remain relevant and have made significant contributions in the justice system.

Bite-Mark and Pattern Injury Analysis: A Brief Status Overview.

Bite marks are one component of forensic investigation requiring subjective interpretation for determining unknown source evidence to a putative suspect. Recent scrutiny has lead to questions about the scientific validity of patterned evidence, bite-mark analysis in particular, and its role in judicial proceedings. This article discusses some issues that persist in forensic circles and the difficulties surrounding the field of bite-mark analysis that inherently must employ human subjectivity in its execution of duty.

Imaging in forensic radiology: an illustrated guide for postmortem computed tomography technique and protocols.

Forensic radiology is a new subspecialty that has arisen worldwide in the field of forensic medicine. Postmortem computed tomography (PMCT) and, to a lesser extent, PMCT angiography (PMCTA), are established imaging methods that have replaced dated conventional X-ray images in morgues. However, these methods have not been standardized for postmortem imaging. Therefore, this article outlines the main approach for a recommended standard protocol for postmortem cross-sectional imaging that focuses on unenhanced PMCT and PMCTA. This review should facilitate the implementation of a high-quality protocol that enables standardized reporting in morgues, associated hospitals or private practices that perform forensic scans to provide the same quality that clinical scans provide in court.

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.

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 challenges and effects of globalisation on forensic dentistry.

This paper deals with the challenges faced by forensic dentists in a world in which globalisation has become a reality. People travelling across the globe on a daily basis become victims of violent crime, terrorist attacks, human displacement, natural and man made disasters. This has forced colleagues in the profession to participate in joint operations exposing inadequacies which need urgent attention. Forensic dentists practise in isolation creating their own rules and regulations oblivious to the greater global community. No international protocols exist for the many procedures practised by the profession. Possible solutions to the complex problems are offered. These include co-operation with colleagues around the globe while striving for the highest levels of quality control, standardisation, reliability, impartiality, reproducibility and ethical accountability.

Developmental dental anomalies and their potential role in establishing identity in post-mortem cases: a review.

Teeth may provide useful forensic evidence owing to features like uniqueness, stability and comparability. Moreover, the human dentition is heterodont, i.e. all the teeth have different morphology - incisors, canines, premolars and molars. There are sometimes deviations from normal morphology, such as the presence of extra teeth, variation in their shape and size eg the presence of an extra cusp, fractured crown/root, Carabelli's cusp, peg laterals, transpositions, fusion, etc. These differences can help forensic personnel identify bodies, especially where other methods of identification like facial features, fingerprints or DNA typing cannot yield satisfactory results as in cases of badly decomposed bodies, burnt remains, mass disasters, etc. Identification from dentition is based on the direct comparison of post-mortem dental profiles with ante-mortem dental records of the deceased. This article aims to review these developmental and morphological dental traits and their role in post-mortem identification.

Bite Mark Analysis in Foodstuffs and Inanimate Objects and the Underlying Proofs for Validity and Judicial Acceptance.

Even though one of the first bite mark cases was Doyle v. State in 1954 (a bitten cheese case), the research has focused on bite marks inflicted in human skin. As published Papers, Case Reports, or Technical Notes can constitute precedents which are relied upon in making the legal arguments and a considerable amount of case law exists in this area, we present a systematic review on bite mark analysis in foodstuffs and inanimate objects and their underlying proofs for validity and judicial acceptance according to Daubert rulings. Results showed that there is vulnerability in these procedures, and it is essential to demand for focus scrutiny on the known error rates when such evidence is presented in trials. These kinds of bite marks are well documented; however, there has been little research in this field knowing that the protocols of analysis and comparison are the responsibility of the forensic odontologists.

Role of forensic odontology in the identification of victims of major mass disasters across the world: A systematic review.

BACKGROUND: Forensic odontology (FO) is regarded in the literature as one of the most reliable and economical scientific methods for victim identification in mass disasters (MDs). The present paper systematically reviews the role of forensic odontologists in various global MDs. METHOD: A comprehensive search of the literature databases (PubMed, Medline, SCOPUS, Web of Science and Google Scholar), along with cross-referencing published peer-reviewed articles, was conducted. The search included full texts, abstracts or titles, had no inclusion year limit (searched until September 2017) and was limited to the English language. Keywords included a combination of 'Forensic odontology', 'Dental records', 'Victim identification', 'Natural mass disaster', 'Criminal mass disaster', 'Accidental mass disaster' and 'Victim disaster'. RESULTS: Of the included disasters (20), 12 (57.14%) were accidental, 5 (23.80%) natural and 3 (19.04%) were criminal. The maximum number of victims was associated with the Japan tsunami (15892), followed by the Thailand tsunami (4280) and the Estonia ferry disaster (852). A total of 23654 victims were reported, of which 20569 (86.96%) were positively identified. Reports from 17 MDs included the use of FO in victim identification [3025 (14.70%) cases]. In addition, 1094 victims (5.31%; from 7 papers) were identified using FO in combination with other methodologies. The highest percentage of victims was identified using FO following the Kentucky air crash (47; 100%), followed by the Newark air crash (38; 76%), the Nepal air crash (10; 71.42%), the France air crash (56; 65.88%), the Australian bushfire (14; 63.63%), and the Estonia ferry disaster (57; 60.63%). CONCLUSION: FO has played a significant role in victim identification in several MDs around the world. The success of FO-based identification is heavily dependent on the availability of ante-mortem records from general dental practitioners. Hence, adequate knowledge about FO and appropriate dental record keeping among general dental practitioners are critical.

Development and evaluation of online education to increase the forensic relevance of oral health records.

BACKGROUND: Human identification can be reliably established by dental comparison; success is significantly impacted by inadequate ante-mortem information. Previous Australian research revealed suboptimal recording of features important for forensic dental identification and compliance with Dental Board of Australia guidelines. We hence created and evaluated an online education programme aimed at improving oral health practitioner recording. METHODS: An interactive learning module (ILM) was constructed and released to three focus groups representing practitioners with varying experience levels: Australian Society of Forensic Odontology members, third year dental students and the wider dental community. Pre- and post-participation perceptions were recorded, with percentage, mean, broad agreement, standard deviation and statistical significance between responses determined. RESULTS: Improved recognition of importance of record keeping, knowledge, confidence, skill and motivation to learn was seen following ILM interaction. This was particularly significant for students, participants with 3-5 years of experience in their current occupation and those whose highest level of education was achieved in Australia. CONCLUSIONS: The ILM increased self-reported awareness, understanding and attitude of participants with different levels of case note recording experience; this can improve recording practises and aid forensic dental identification if utilized in undergraduate teaching and as a continuing professional development tool for dental practitioners.

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.

Guidelines in forensic odontology: legal aspects.

The task of the forensic dentist is ruled by an obligation to be diligent and prudent. If guidelines should exist which are recognised by the dental forensic community, they will probably be used to judge his work, even if guidelines are only considered as recommendations. The questions to be answered are: who issued these guidelines and are they conform to evidence-based forensic odontology.

Problem-based analysis of bitemark misidentifications: the role of DNA.

The dental literature concerning bitemark methodology is surprisingly thin and sorely lacking in rigorous scientific testing. Contra to this fact, the bitemark legal caselaw is surprisingly strong and is used as a substitute for reliability testing of bite mark identification. In short, the Judiciary and the Prosecutors have loved forensic odontologists. This paper will focus on the author's participation as a Defense expert over the last seven years in over 50 bitemark prosecutions and judicial appeals. This sampling will act as an anecdotal survey of actual bitemark evidence. Certain trends regarding methods and reliability issues of odontologists will be discussed. Several of these cases have been later judicially overturned due to DNA analyses after the defendants were originally convicted. These diagnostic misadventures are being vocally discussed in the US media by news and legal investigators who are asking hard questions. The forensic dentistry community, however, is curiously silent. What actions are necessary by the profession to improve this assault on the 52-year tradition of bite mark identifications in the United States?

Major incident response: collecting ante-mortem data.

The Asian tsunami of 26 December 2004, which devastated coastal parts of more than 10 countries in and around the Indian Ocean caused over 200,000 casualties. People from more than 58 nationalities were amongst the victims and subsequently an international effort for disaster victim identification (DVI) was set up, coordinated by Interpol. DVI teams from more than 20 countries took part in the identification process which, because of the complexity of the situation, had to be conducted in an internationally agreed upon procedure. Standard operating protocols of post-mortem (PM) procedures were established for fingerprinting, forensic pathology, forensic odontology and DNA profiling and were crucial in the quality of the entire DVI process of the quickly decomposing bodies. A very important and underestimated part of the DVI process is the gathering of the ante-mortem (AM) data of the persons reported missing in their home countries. In the wake of this tsunami event it appeared to be even more problematic as entire families had died and information was difficult to obtain. As dentistry proved to be the most valuable identification mean--up to 85% of the cases--the AM dental records proved to be crucial elements for DVI. Standard operating protocols (SOP) were again established as to who, where, when and what information had to be collected by the dentists by the AM teams abroad. Transcribing the AM dental information by experienced forensic odontologists was another crucial element in the whole identification procedure as the information had to be loaded into the DVI System International (Plass Data, Holbaek, Denmark) for comparison with incoming PM data. The Interpol DVI Standing Committee thus recommends that forward planning, adequate funding, international cooperation and standardisation are essential to guarantee an effective response to any major mass disaster of this kind in the future.

Dental age estimation, quality assurance and age estimation of asylum seekers in Norway.

The historical development of age estimation and the different techniques are presented. Also it is important to separate individuals below 20 years where tooth development can be used and those above 20 years of age where regressive changes must be used and where the visual assessment may be more important. The recommendations for quality assurance from the International Organization for Forensic Odonto Stomatology (IOFOS) is discussed and also the problems of quality assurance on an international level. Suggestions for changes in these recommendations are presented. Finally the Norwegian dental age estimation project in asylum seekers who claim to be below 18 years of age is described.

The barriers to achieving an evidence base for bitemark analysis.

Forensic dentistry is the union of two scientific disciplines, both of which are undergoing a renewed scientific rigor. In forensic science the advent of the Daubert ruling has required that judges assess the forensic value of 'expert testimony' ensuring that techniques, methodologies and practices are not only commonly accepted (as was the previous hurdle during the Frye era) but that error rates, assessment of reliability and validation studies are published to support their use. This new degree of judicial scrutiny has been mirrored in the field of dentistry itself, where organisations search and summarise randomised controlled trials in order to recommend best practice and devise clinical care pathways that are firmly grounded in proven scientific research. Despite the obvious drive from both of these professions, forensic dentistry, and in particular the sub-discipline of bitemark analysis, has been remarkably slow to address the obvious deficiencies in the evidence base that underpins this element of forensic science. Reviews of the literature reveal that the vast majority of published works are case reports, and very little primary literature exists. This paper reviews those studies that have assessed aspects of bitemark analysis including the crucial issue of the uniqueness of the human dentition; the application of transparent overlays and the application of statistical probabilities in bitemark conclusions. There are numerous barriers to undertaking high quality research in the field of bitemark analysis, the most important of which is the use of a gold-standard that is acceptable both in terms of diagnostic research but is also forensically relevant. If bitemark analysis is to continue to play a role in the judicial process then there is an urgent need for high quality studies that meet the levels of forensic and scientific scrutiny applied to other disciplines within the criminal justice system. Studies are required to determine not that the human dentition is unique, but how this asserted uniqueness is represented on human skin and other substrates. The error rates associated with the analysis of bitemarks are required on a procedural level as well as an individual practitioner basis and scales and interpretative indices of bitemark severity and forensic significance should be validated and introduced into common use.

Lessons learned from large-scale comparative dental analysis following the South Asian tsunami of 2004.

The aim of this study was to examine the quality of the ante-(AM) and postmortem (PM) dental data that were submitted for entry into the PLASS data system in Phuket, Thailand, following the Boxing Day (December 26) Tsunami, 2004. The investigators were two forensic odontologists who were part of the New Zealand Disaster Victim Identification team that worked at Wat Yang Yao morgue and at the Information Management Center in Phuket. Our findings underline the usefulness of dental data in human identification, but point to a number of significant sources of error. Of the 78 PM records received, only 68% of radiographs and 49% of photos confirmed the accompanying dental charting. This underlines the value, particularly of photographs of the dental arches, in quality control. It also points to a large error component, which may have been due to inexperience of the operators, fatigue, poor conditions in the temporary morgue, or the problem of tooth-colored fillings. Of the 106 AM records received, 62% were of unacceptable quality and 64% were either not accompanied by radiographs or had poor quality radiographs. These results indicate that AM data collection ideally needs to be collated and checked by a forensically trained dentist(s) in the country of origin.

Good bite mark evidence: a case report.

Bite mark analysis is unquestionably the most difficult, and contentious, work undertaken by forensic odontologists. Each injury must be assessed to determine if it was made by human or animal teeth, if the quality of the evidence allows presentation to a Court of Law, and if the pattern can be reasonably compared to a suspect dentition. Many injuries examined by forensic odontologists do not meet these criteria. A case is presented in which a Victim Statement could be corroborated, with evidence of good probative value.