Prevalence of abnormalities seen on orthopantomograms performed for forensic age estimation in unaccompanied minor asylum seekers.

OBJECTIVES: Evaluate the prevalence of radiological anomalies on orthopantomograms (OPT) performed as part of forensic age estimation in unaccompanied minors. METHODS: This is a retrospective study conducted on 208 OPT examinations requested by a magistrate. These OPTs were interpreted independently by two readers to establish the number of missing teeth (MT), presence of dental fillings (DF), and dental anomalies (DA). The presence of radiolucent (RL), radiopaque, and mixed lesions was also assessed. RESULTS: Most radiologic anomalies were RL, detected on 41% and 39% of the subjects evaluated for R1 and R2, respectively, with a mean of 1.3 ± 2.4 (1-16) and 1.1 ± 2 (1-13) RL lesions per subject. Among the RL identified, the majority were dental (70% for R1 and 65% for R2), all of which had a suspected infectious origin. Among readers, 43% and 41% of the subjects evaluated presented MT, 21% and 15% presented DF, and 22% and 20% presented DA for R1 and R2, respectively. The inter- and intra-observer reproducibility for OPT classification was considered excellent (Kappa = 0.84, 95% CI 0.78-0.90, and Kappa = 0, 95, 95% CI 0.86-0.99). DISCUSSION: There was a non-negligible prevalence of radiological anomalies in OPT studies performed for forensic age estimation. Most of these lesions were suspected to be infectious in origin, potentially requiring medical care. This constitutes an ethical dilemma inherent in the judicial expertise injunction requiring a limited specific response. CLINICAL RELEVANCE STATEMENT: This study highlights a non-negligible prevalence of supposedly infectious radiological abnormalities. The restricted possibility for the legal expert to declare these abnormalities raises ethical and medical questions. KEY POINTS: • Orthopantomograms can be performed as part of forensic age estimation. • Results indicate the majority of radiological anomalies detected on OPTs were of suspected infectious origin. • These findings give rise to ethical and medical questions about the way in which these forensic examinations are carried out.

Applicability of Cameriere's third molar maturity index on orthopantomograms and computed tomography scans from a French population.

Cameriere developed a method on orthopantomograms (OPG) to assess adult age of 18 years based on the relationship between age and the third molar maturity index I3M. The aim of this study was to evaluate whether Cameriere's method could be applied to computed-tomography scans (CT-scans) from a population of French juveniles and young adults and compare the results obtained from OPG of the same individuals. Our sample comprised 200 examinations that had been performed at the radiological department of a French University hospital between 2007 and 2020. Each patient had received an OPG and a cranial CT scan for medical purposes, and we used a similar adaptation of I3M based on OPG to determine the I3M based on CT scans. Due to exclusion criteria, our final sample comprised 71 OPGs and 63 CT scans. Based on the 71 OPGs, there was concordance between chronological age and estimated age, with a sensitivity of 78.57%, a specificity of 89.47%, and a misclassified rate of 18.03% based on tooth 38, and a sensitivity of 78.79%, a specificity of 91.67%, and a misclassified rate of 17.78% based on tooth 48. Our results based on CT scans presented concordance between chronological age and estimated age for tooth 38 described by a sensitivity of 77.78%, a specificity of 94.12%, and a misclassified rate of 16.98%. The concordance between chronological age and estimated age based on 48 had a sensitivity of 75.00%, a specificity of 93.75%, and a misclassified rate of 19.23%. The > 90% ICC indicate an excellent similarity between measurements of teeth 38 and 48 based on OPGs and CT scans. This study has revealed the applicability of the Cameriere's method to calculate the I3M based on CT scans from a French population. The results based on CT scans are similar to results based on OPGs from the same individuals.

Forensic International Dental Database (FIDBv2) for adult age-at-death estimation in multiple forensic contexts: Strengthening the operationalization of the Lamendin criteria in a global scope model.

The aim of this study is to validate the FIDBv2 online procedure for adult age-at-death estimation using root dentine translucency (RDT) and periodontal retraction (PR) of single-rooted teeth in a worldwide sample. The sample includes 4810 teeth of 2559 individuals from 16 countries of America, Europe and Asia. Bias and inaccuracy between documented (DA) and estimated ages (EA) were calculated. Pearson and Intraclass Correlation Coefficients were computed to assess the strength of agreement between pairs of data, while Kolmogorov-Smirnov Z was used to evaluate the statistical significance of the differences. The percentages of correctly estimated cases within different age ranges were obtained to find trends in the reliability of the results. Most of the biases (-4.61-1.31 years) and inaccuracies (4.81-9.72 years) are low. The dispersion of EA increases with age and almost all the DA-EA correlations are above 0.75. DA-RDT and DA-PR correlations are positive, most of the former being high (0.74-0.91), and the latter being low (0.11-0.54). The highest percentages of correct estimations are identified for the ±7.5 and ±10 years ranges, and most comparisons of bias and inaccuracy between countries are non-significant. The high correlations between DA and EA suggest that the method is robust and reliable for a global application. Mean errors are low, with the best results found in the 30-69-year-old cohort. This research supports that the method is effective and accurate for age estimation in forensic contexts worldwide, thus reaffirming it is a generalizable procedure locally and internationally.

Teledentistry and Forensic Odontology: Qualitative Study on the Capacity of Implementation.

The postmortem identification of people without an identity is performed either by using DNA, dental charts, or fingerprints (until advanced decomposition prevents their study). The lack of forensic dentists who can conduct identifications lead us to reflect on the use of digital technology in this area. The aim of this study was to validate the organizational capacity of using teledentistry for the identification of bodies in a forensic medicine department. A mixed observational study was conducted on 55 cases between July 2020 and February 2021 in the Forensic Medicine and Thanatology Department of Montpellier University Hospital. The protocol was structured in five steps: an initial interview with the agent (a forensic autopsy technician/caregiver specialized in forensic medicine), regarding the idea they had in terms of using telemedicine in their daily practice; agent training in the telemedicine system; realization of a clinical examination using an intra-oral camera by the agent; data analysis by a dental surgeon; final interview with the agent. The study was conducted on 55 subjects. The average age was 54 years old, with more than two-thirds of the patients being male (69%). The videos had an average duration of 29 min. There was an increase in visit duration when rigidity was high; this was also the case when there were many dental specificities in the oral cavity. The quality of the videos was either good or excellent. This study showed that remote identification could be considered as a new non-invasive identification tool. Many features were analyzed to create a training guide for forensic institutes.

Age Estimation in 0-8-Year-Old Children in France: Comparison of One Skeletal and Five Dental Methods.

Age estimation in juveniles is a critical procedure in judicial cases for verification of imputability or for civil reasons when adopting children. Several methods based both on skeletal and dental growth have been performed and applied on different populations; nevertheless, few articles have compared different methods in order to test their reliability in different conditions and age ranges, and this is a clear obstacle in the creation of common guidelines for age estimation in the living. A comparison of five dental methods (Anderson, Ubelaker, Schour and Massler, Gustafson and Koch, Demirjian) and one skeletal method (Greulich a Pyle atlas) was performed on a population of 94 children aged between 0 and 8 years. Results showed that, whereas under 2 years all the methods have the same inaccuracy, over 2 years the diagram methods, such as Schour and Massler and Ubelaker's revised one, have a lower error range than the most frequently used Greulich and Pyle atlas and Demirjian method. Schour and Massler, Gustafson and Koch, and Ubelaker methods showed, respectively, a mean error amounting to 0.40, 0.53, and 0.56 years versus the 0.74 and 0.88 years given by Demirjian and the Greulich and Pyle atlas. An in-depth analysis of the potential of several methods is necessary in order to reach a higher adherence of age estimation with the complexity of growth dynamics.

Comparison of four skeletal methods for the estimation of age at death on white and black adults.

When analyzing human adult skeletal remains, it is often difficult to decide whether a single aging method will give a more reliable age estimation than a combination of methods. This study evaluates four macroscopic indicators for age estimation on 218 American White and Black individuals, ranging in age from 25 to 90 years of age, from the Terry collection. Individuals in the sample were selected to have a balanced race, sex, and age distribution. The following aging methods were applied to each skeleton by one experienced observer: the Suchey-Brooks (SB) pubic symphysis method, the Lovejoy auricular surface method, the monoradicular teeth Lamendin (LM) method, and the Iscan (IC) method for fourth ribs. The statistical study involved the evaluation of inaccuracy and bias (based on median age) for each age indicator and the combination of methods using Principal component analysis (PCA). Analysis was performed on the entire sample, then by race, then sex, and then age group (25-40 years, 41-60 years, and >60 years). PCA was the most accurate method for both racial groups when all age groups are analyzed together. When the sample was divided into age groups, SB was the most accurate for young adults (25-40 years) and LM was the most accurate for middle adults (41-60 years). After the age of 60, all methods are highly inaccurate, although IC gives the lowest inaccuracy. As regards bias, the study highlights the tendency of all methods to overestimate the age of young individuals and to underestimate in the older age group. No single skeletal indicator of age at death is ever likely to reflect accurately the many factors that accumulate with chronological age. In fact, one must use as many dental and skeletal indicators as possible. However, in order to maximize the potential of each method, in the final evaluation one should consider mainly the method or methods that have a higher accuracy for a particular age range.

Technical note: The two step procedure (TSP) for the determination of age at death of adult human remains in forensic cases.

This paper presents the principles and results of TSP (the two step procedure), a comprehensive (combined) method of age estimation in mature human skeletal remains. The first step consists of the examination of the pubic symphysis using the Suchey-Brooks system for a "pre-choice". Then for SBS phases I, II, III, (young adults up to about 40) the age estimate is given using the chronological interval corresponding to each phase. For SBS phase is IV, V or VI (mature adults, about 40 to 60), then (second step) the dental method of Lamendin (using single rooted tooth) will be applied alone. Both methods are fast, easy to learn and to use (requiring no preparation except cleaning soft tissues from the pubic bone) and are not expensive, making TSP usable by all pathologists or anthropologists in any Forensic unit. It is also of great practical use in mass disaster and mass grave situation. After 15 years of use, a literature review and four evaluation studies we confirm that TSP is more accurate than any single method for aging adults and at least as good as more complicated combined methods. Despite its advantages TSP is, like all other aging methods, not efficient in adults over 65 years of age.

An evaluation of statistical methods for the determination of age of death using dental root translucency and periodontosis.

Lamendin and colleagues (1992) proposed to assess age-at-death from root translucency and periodontosis. Several teeth from the same individual were included in their study. In our work, we evaluate the reliability of their formulas without introducing this bias. Our sample was constituted of 214 individuals (114 males and 100 women) selected from the Terry collection (U.S.A.). The R(2) between age and both indicators is equal to 0.33 and 0.08 (p < 0.001). Based on linear regression, the mean of standard error for individual age prediction was equal to 13.67 years, and the mean interval length is equal to 53.89 years. Multinomial logistic regression and Bayesian approach failed to give satisfactory results when classifying the individuals in age categories. Therefore, the use of root translucency and periodontosis may lead to incorrect age-at-death assessment, and it is thus necessary to complement this approach with other techniques to assess age-at-death.