[The crucial role of forensic odontology in the IDF].

Israel's recent military engagements have been asymmetric in nature, defining the captivity of a solider as the enemy's' strategic achievement. Casualty care during war, is a delicate mission, requiring the collaboration of 3 distinct corps - the medical corps, chaplaincy corps and the adjutant corps. In this article, we will review the crucial role forensic odontologists play in the identification of casualties. In addition to biometric identification which is carried out through DNA analysis, fingerprint co-matching and forensic odontology, the forensic battalion of the medical corps investigates the cause of death, delivering crucial information to different branches of the military.

Análise morfoestrutural de biomateriais para auxílio no processo de identificação humana / Morphostructural analysis of biomaterials for assistance in the human identification process

O objetivo do estudo foi avaliar as alterações de biomateriais restauradores e protéticos submetidos a temperaturas elevadas para o estabelecimento de parâmetros físicos que auxiliem nos casos de identificação humana em corpos carbonizados. A amostra do estudo experimental in vitro foi composta por 40 corpos de prova dividida em quatro grupos: GI (corpos de prova de cimentos de iônomero de vidro químico), GII (amálgamade prata), GIII (resina composta híbrida) e GIV (liga de cobre alumínio). Os corpos de prova foram submetidosa temperaturas de 300°C, 500°C, 700°C e 900°C. Após a incineração, os biomateriais foram submetidos a análises macroscópicas sobre as modificações de estrutura, coloração, forma e estabilidade dimensional e os dados analisados pela Análise de Variância e teste de Dunn (p<0,05). Os dados obtidos demonstraram em relação à radiopacidade uma diferença estatisticamente significante para as médias de densidade radiográfica no GI entre as temperaturas 700°C e 900°C; GIV entre as temperaturas 300°C e 900°C; 500° e 900°C. O GII atingiu seu ponto de fusão à 700ºC com aspecto pulverulento e lojas isoladas de mercúrio a 900°C. O GIII apresentou mudança estrutural nas temperaturas à 700°C e 900°C. No GIV não se constatou modificações relevantes. Assim, pode-se coligir que a resina composta micro hibrida e o amálgama apresentam severas alterações morfoestruturais enquanto o ionômero de vidro e o cobre alumínio não sofrem mudanças significativas em suas características originais. As alterações sofridas pelos materiais fornecem dados relevantes para o auxilio no processo de identificação humana de corpos carbonizados.

The aim of this study was to evaluate the changes of restorative and prosthetic biomaterials subjected to high temperatures for the establishment of physical parameters that assist in cases of charred bodies in human identification. The sample of the experimental in vitro study was composed by 40 specimens divided into 4 groups: GI (specimens of cements of ionomer of chemical glass), GII(silver amalgam), GIII (hybrid composite resin) and GIV (copper alloy aluminum). The specimens were subjected to temperatures of 300°C, 500°C, 700°C and 900°C. After incineration the biomaterials were submitted macroscopic analysis on changes of structure, color, shape and dimensional stability and all data were analyzed by ANOVA and Dunn’s test (p <0.05). Regarding the radiopacity there was statistically significant difference for the mean radiographic density in GI temperatures within 700°C and 900°C; GIV temperatures within 300°C and 900°C, 500°C and 900°C. The GII has reached its melting point at 700ºC with powdery appearance and isolated stores of mercury at 900°C. The GIIIhad structural change at 700°C and 900°C. In GIV it not observed significant changes. Thus, one cangather that the micro hybrid composite resin and amalgam exhibit severe morpho structural changes while the glass ionomer aluminum and copper does not undergo significant changes in their original characteristics. The changes undergone by materials provide relevant data to aid in the identification process of human bodies charred.

Utilização de imagens tridimensionais da cavidade sinusal frontal provenientes de tomografia computadorizada de feixe cônico para a identificação forense / Usage of tridimensional cone beam computed tomography imaging of the frontal sinus for human identifications in Forensic Scienses

A unicidade da cavidade sinusal frontal é um importante fator para a identidade humana. O uso de registros de imagens dessa cavidade para a identificação forense é amplamente difundido, sendo uma metodologia secundária segundo a INTERPOL. Recentes avanços nas tecnologias de imagem permitiram o registro de imagens tridimensionais dessa cavidade. Nosso objetivo foi validar a metodologia proposta por Beaini et al. (2015), padronizando critérios para a obtenção de imagens tridimensionais da cavidade sinusal frontal com tomografia computadorizada de feixe cônico e avaliando a capacidade desses dados para a identificação humana. Para tanto, utilizamos um banco de imagens tomográficas de 200 pacientes randomizados e analisados por três observadores. As imagens foram exportadas em formato DICOM e submetidas a dois processos de segmentação distintos e sobreposição tridimensional. Realizou-se a metodologia descrita para estabelecer a identificação entre pacientes randomizados. Os resultados mostraram que há uma diferença significativa entre os processos de segmentação, sendo mais indicada a técnica de segmentação manual. A metodologia proposta por Beaini et al. (2015) foi validada e um total de 166 pacientes foram identificados. O volume da cavidade sinusal possui um elevado potencial de identificação com uma probabilidade aproximada de 85% para determinar o gênero dos indivíduos.

The uniqueness of the frontal sinus cavity is an important factor for establishing human identity. The usage of imaging records of this cavity for human identity is a secondary methodology according to the INTERPOL protocols. Recent advances in imaging technologies have enabled the three-dimensional imaging records of this cavity. Our goal was to validate the methodology proposed by Beaini et al. (2015), by developing standardized criteria for the use of cone beam computed tomography three-dimensional images of the front sinus and evaluating the ability of these data for human identification. The aim of this study was to investigate a total of 200 imaging records from randomized patients that were analyzed by three observers. Images were exported in DICOM format and underwent two distinct segmentation processes and a three-dimensional overlap. The Beaini et al. (2015) technique was applied to establish identification of the randomized patients. My results showed a significant difference between both segmentation processes, with manual segmentation showing the best results. Beaini et al. (2015) technique was validated and a total of 166 patients were identified. The volume of the sinus cavity has a high identification probability with a rough probability of 85% to determine the sex of individuals.

Comportamiento del color de discos y restauraciones en resina compuesta sometidos a altas temperatura con fines forenses / Performance of color of discs and restorations in composite resin subject to high temperatures to forensic purposes

El objetivo de este estudio fue determinar el comportamiento del color de discos y restauraciones en resina compuesta sometidos a altas temperaturas con fines forenses. Para ello se realizó un estudio descriptivo de naturaleza pseudoexperimental in vitro que describió los cambios colorimétricos que ocurrieron en 75 discos y 75 dientes restaurados en resina compuesta (Z100 3M-ESPE®), confeccionados en cinco colores (A1, A2, A3, A3.5 y B2), al ser sometidos a la acción de altas temperaturas, con el propósito de establecer parámetros cualitativos a partir del cambio de color de utilidad forense. Los resultados obtenidos permitieron explicar los cambios de color por espectrometría, de tal forma que una resina compuesta, a 200 oC, pierde brillo y matiz; a 400 oC, pierde brillo, matiz y saturación; y a 600 oC, 800 oC y 1.000 oC gana brillo y pierde matiz y saturación. Así, no existieron diferencias significativas en las coordenadas de color L* a* b* al comparar los discos con los dientes restaurados. En conclusión, la interpretación visual del cambio de color y las coordenadas de color L* a* b* a través del uso de un espectrofotómetro puede constituirse en un método comparativo de bajo costo y de aplicación forense al momento de identificar el tipo y el color de un material restaurador en un cadáver o en restos humanos quemados, carbonizados o incinerados, para obtener marcadores positivos durante el cotejo ante mórtem-post mórtem, y estimar la temperatura máxima alcanzada durante la exposición (AU)

The objective for this study was to determine the color behavior of discs and composite resin restorations subjected to high temperature for forensic purposes. For this, a descriptive study of pseudo-experimental nature was made, to describing in vitro colorimetric changes that occur on the surface of 75 disks and 75 class I composite resin restorations (Z100 3M-ESPE®) made in five colors (A1, A2 , A3, A3.5 and B2), when subjected to the action of high temperatures (200 oC, 400 oC, 600 oC, 800 oC y 1,000 oC); in order to set parameters from the color change that can be applied to the forensic dental identification methods in the case of bodies or human remains burnt, charred or incinerated. The color changes can be explained by spectrometry. A composite resin subjected to 200 oC loses brightness and hue; to 400 oC wins brightness, hue and saturation; to 600 oC, 800 oC and 1,000 oC lost brightness, hue and saturation. No significant differences in the color coordinates L * a * b * to compare discs with the restored teeth, so the test bodies were suitable to test with the commercial composite resin system ESPE® 3M-Z100. In conclusion, the visual interpretation of color change and the L * a * b * color coordinates through the use of a spectrometer becomes a comparative forensic method application inexpensive when identifying the type and color a restorative material in a human remains burnt, charred or incinerated, to obtain positive markers for the antemortem-postmortem comparison and estimate the maximum temperature reached (AU)

Mass Fatality Incidents and the Role of the Dental Hygienist: Are We Prepared?

PURPOSE: Dental hygienists can fill critical roles during mass fatality incidents in the area of disaster victim identification, providing much needed support to forensic odontologists. The purpose of this paper is to bring awareness that research is needed to assess current dental hygiene programs, continuing education opportunities and the type of approach being used to develop and implement pedagogy in the forensic specialty area, specifically mass fatality preparedness and response for the dental hygienist. Because of the threat of terrorism in the U.S. and natural disasters like hurricanes, the need to prepare dental professionals in disaster response and fatality management is real. The authors' recommendations are to incorporate training in the areas of risk management and infection control in the mortuary setting, antemortem and postmortem records comparison, safe usage of portable radiographic equipment, and proper radiographic technique for the deceased victim. Disaster victim identification training in these areas is necessary for the accurate, efficient and dignified identification of disaster victims while minimizing errors and increasing responder safety. The dental hygiene professional can assist disaster mortuary response efforts in a way that leverages multidisciplinary teams, if effective training programs are implemented.

Evaluación de diferentes métodos de estimación de edad por desarrollo de la dentición en restos humanos esqueletizados de entre 0 y 6 meses / Evaluation of different methods for estimating age using developing teeth in skeletonized human remains between 0 and 6 months old

Introducción. Este trabajo tiene por objeto evaluar la aplicabilidad y precisión de 4 métodos para estimar la edad por el desarrollo de la dentición en el período posnatal temprano. Material y métodos. Para la realización de este estudio se seleccionó una muestra constituida por 25 individuos de ambos sexos, sin evidencias de enfermedades y con edades documentadas entre 0 y 6 meses posnatales. Se estimaron las edades dentales mediante la utilización de los trabajos de Moorrees et al. (1963a; b), Lunt y Law (1974), Ubelaker (1978) y AlQahtani et al. (2010) y se compararon las edades estimadas con la edad cronológica documentada para cada individuo de la muestra. Resultados. Los resultados mostraron que el método de Moorrees no es adecuado para el período de edad analizado dado no permitió estimar la edad del total de los individuos de la muestra y las edades estimadas presentan diferencias significativas con las edades cronológicas documentadas. Los métodos de Lunt y Law y Ubelaker son poco precisos y el método de AlQahtani es el que arrojó mayor exactitud respecto de la edad cronológica documentada. Conclusiones. A partir de los resultados se llegó a la conclusión de que los métodos gráficos son de muy fácil aplicación sin detrimento de la precisión que pueden conseguir en la estimación, y que el método de AlQahtani es el que presenta mayor precisión y exactitud en el rango etario analizado (AU)

Introduction. This work aims to assess the applicability, accuracy and precision of four methods for estimating age by tooth development in the early postnatal period. Material and methods. To perform this study a sample of 25 individuals of both sexes, with no evidence of pathology and documented ages from 0 to 6 postnatal months was selected. Dental ages were estimated using reference data from Moorrees et al. (1963), Lunt and Law (1974), Ubelaker (1978) and AlQahtani et al. (2010). Estimated and chronological documented ages were compared. Results. The results showed that the Moorrees et al. method is not suitable for the targeted age group as it was not possible to estimate the age of all individuals in the sample and the estimated ages had significant differences with documented chronological age. Lunt and Law and Ubelaker methods are vague and AlQahtani et al. method is more accurate. Conclusions. On the basis of the results it is concluded that graphical methods are easily applied without loss of accuracy and that the most accurate and precise method is by AlQahtani et al (AU)

Estimación de la edad dental mediante el desarrollo del tercer molar en una muestra de venezolanos, empleando una base de datos hispánica de Texas / Dental age estimation based from third molar development in a Venezuelan sample, using a Texas Hispanic database

Introducción. El presente trabajo tuvo como propósito comparar la edad dental estimada mediante el desarrollo del tercer molar de venezolanos y la obtenida utilizando una herramienta computacional con una base de datos hispánica de Texas. Material y métodos. Esta investigación fue de tipo retrospectiva y observacional. Se evaluaron ortopantomografías de 169 individuos de ambos sexos, con edades entre 12-20 años. Se calculó la edad dental por el método de Demirjian et al. (EDD), la edad dental por el tercer molar (ETM) utilizando los estadios de maduración de Demirjianet al., la edad dental por el software UT-Age con ancestro hispánico (UTH) y desconocido (UTD). Resultados. Las diferencias de media entre las variables evidenciaron una subestimación de la edad cronológica (EC) con relación a la EDD y ETM desde los 16 años, en ambos sexos. Las edades calculadas por el UT-Age sobreestimaron la edad en la mayoría de los grupos etarios. Al comparar la ETM con la UTH y la UTD, se observó una consistente sobreestimación de la edad. Considerando la media de la diferencia entre la EC y las edades estimadas, se observó que la EMT presentó la menor diferencia (varones 0,195 p = 0,225; mujeres 0,220 p = 0,276) cuando se comparó la ETM con las edades calculadas por el software, la UTH mostró la menor diferencia (varones -0,980 p = 0,001; mujeres -0,805 p = 0,001). Conclusión. La edad estimada mediante el UTH fue más próxima a la edad real que la obtenida por el UTD (AU)

Introduction. The purpose of this study was to compare the dental age estimated by the development of the third molar in Venezuelans with the age obtained using a computational tool with a Texas Hispanic database. Materials and methods. Retrospective observational stury. 169 ortopantomographs of Venezuelan individuals of both sexes, aged 12-20, were evaluated. Dental age was calculated by using the Demirjian et al. method (DAD), third molar dental age (TMA) using the stages of maturation of Demirjian et al., as well as the UT-Age software which includes Hispanic(UTH) and unknown (UTU) ancestress. Results. The mean differences between the variables showed an underestimation of the chronological age (CA) in relation to the DAD and TMA of 16 years in both sexes. The ages calculated by the UT-Age, overestimated age in most age groups. By comparing the TMA with UTH and UTU, there was a consistent overestimation of age. Considering the mean of the difference between the CA and the estimated ages, it was observed that the TMA had the lowest difference (p = 0.225 p = 0.195 males, females 0.220 p = 0.276). When TMA ages were compared with the one calculated by the software, UTH showed the smallest difference (p = 0.001 p = -0.98 males, females -0.80 p = 0.001). Conclusion. The estimated age using UTH was closer to the real age than the one obtained with UTD (AU)

A auditoria odontológica nos serviços de saúde suplementar / Dental auditing in supplementary health care services

O sistema de saúde no Brasil vem sofrendo grandes transformações. Em virtude da saúde pública não ter condições de atender as necessidades da população, junto ao baixo poder aquisitivo da população para custear de forma direta seus tratamentos, foi institucionalizado o sistema de saúde suplementar, que complementa o serviço de saúde público. Com a crise no mercado odontológico provocada pelo excesso de profissionais, muitos cirurgiões-dentistas,passaram a trabalhar em parceria com as operadoras de planos de saúde (OPS), na expectativa de aumentar a clientela. Essa parceria promove reorganização acelerada e irreversível do setor, em que a relação entre paciente e cirurgião-dentista é intermediada pela OPS. Objetivo: demonstrar por meio de atualização de literatura a importância da auditoria nos serviços de saúde bucal oferecidos pelas OPS, destacando o papel do auditor técnico como gestor de saúde, exprimindo sua função educadora e não fiscalizadora ou punitiva. Considerações finais: devido ao crescimento das OPS, regulação do setor através da lei 9656/98 e código de defesa do consumidoras OPS passaram a desenvolver instrumentos de avaliação da qualidade dos serviços prestados, dentre eles, a auditoria odontológica. Entretanto, este novo modelo de exercer a prática odontológica, tem trazido conflitos para os profissionais que desconhecem a importância do auditor nos serviços de saúde bucal. As ações dos serviços de auditoria são pautadas por princípios éticos-legais e baseadas em evidências que fundamentam a prática odontológica, além disso representa segurança adicional para o beneficiário através do controle de qualidade a que seu tratamento é submetido...

The health care system in Brazil is undergoing large transformations. Due to the public health care system's inability to attend to the needs of the whole population, together with the general population's inability to pay for needed treatment out of pocket, the supplementary health care system was created to augment the public system. With the crisis in the dental industry caused by the excess of dental professionals, many dentists began partnering with health care plan operators (HPO) with the hope of expanding their clientele. These partnerships encourage an accelerated and irreversible reorganization in the industry, where the relationship between patient and dentist is mediated by the HPO. Objective: to demonstrate via a review of the most recent literature the importance of the practice of auditing the oral-health services offered by the HPOs, highlighting the role of the technical auditor as health manager, focusing on its educational function and not fiscal or punitive. Final remarks: due to the growth of the HPOs, regulation of the sector via the law 9656/98 and the consumer-defense code, the HPOs started to develop tools to evaluate the quality of the performed services, amongst them, the dental audit. Nevertheless, this new model for the dental industry has given rise to problems for dental professionals that are unaware of the importance of the auditor in relation to oral health services. The actions of the auditing services are regulated by legal and ethical principles and based on fundamental data from dental practice. Beyond that, they add additional assurance for patients via quality control and ensuring their treatment is submitted...

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.

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.

The Danish Disaster Victim Identification effort in the Thai tsunami: organisation and results.

Following the December 2004 tsunami in Thailand experts from many countries, including Denmark, went to Thailand to help with identification work. The Interpol system for Disaster Victim Identification (DVI) was employed for the identification of the many casualties. This paper describes the work of the Danish teams in Thailand from the 30th December 2004 until the 6th June 2005. The investigation covers all Danes reported missing directly after the tsunami in Thailand on the 26th December 2004 and who were later found deceased, or, in one case, never recovered. The AM and PM forms were reviewed retrospectively and the relevant information compared. Forensic odontology alone was responsible for 70.3% of identifications, and in two more cases (5.4%) the identification was established using a combination of odontology and fingerprint information. Fingerprints were used to establish identity in 8 cases (21.6%). DNA-typing was only used in one identification, in combination with fingerprinting data. Only one Danish victim was not identified. This review of the 37 Danish cases confirms that odontological examination yielded the most identifications, fingerprint data much fewer, and DNA was only used to a small extent, due to organisational problems with the examination and because the initial samples were of inferior quality.

Aspectos éticos e legais dos documentos emitidos pelos cirurgiões-dentistas e que compõem o prontuário

Documentos odontológicos são diariamente elaborados, redigidos e arquivados pelos cirurgiões-dentistas na prática consentânea do dentista, e todos eles devem fazer parte do prontuário, contribuindo assim para o correto registro de todas as interações...

Percepção dos cirurgiões dentistas de uma cidade de médio porte no norte de Minas Gerais, a respeito dos aspectos ético-legais do prontuário odontológico

É de fundamental importância para todos que exercem a odontologia o conhecimento e aplicação das normas éticas e legais referentes à elaboração e manutenção da documentação relativa ao atendimento dos pacientes em consultórios...

Prontuário odontológico e sua utilização em perícias de identificação humana

O prontuário odontológico é uma fonte de informação imprescindível que pode ser utilizada como evidência pericial em casos de identificação humana...

Análise de websites de cirurgiões-dentistas quanto aos aspectos éticos e legais relativos à publicidade e propaganda

Atualmente a internet tem sido usada pelos cirurgiões-dentistas como ferramenta de marketing para seus clientes. Nesse caso, as regras pertinentes à propaganda convencional também devem ser obedecidas no ambiente virtual...

Forensic odontology, part 3. The Australian bushfires - Victoria state, February 2009.

This paper aims to demonstrate the stages in the disaster victim identification of those who lost their lives in the Australian bushfires that raged across the state of Victoria in February 2009. Communities were damaged or destroyed leaving families distressed and homeless, and as the number of deaths increased the Disaster Victim Identification (DVI) teams were activated, with plans evolving to deal with this emergency. The identification process was challenging due to many factors, such as the dangers and difficulties involved in body recovery and the charring and commingling of remains. It would take several months of careful work to identify the dead using a multidisciplinary approach. The impact of this incident will have long-lasting consequences for the families and communities involved. At the time of writing all but one of the 173 victims had been identified, mostly by dental methods: quite remarkable when only small fragments of the dental structures remained in many cases. This article is based on the author's personal experience working to assist the organised and experienced Australian Dental DVI Team.

Forensic odontology, part 2. Major disasters.

We have only to look back over the last 12 months to realise that time and time again, an incident occurs where there are mass fatalities. These incidents have instant and long-lasting impact on families, communities and sometimes whole countries. The aim of this paper is to emphasise the need for an efficient and sensitive response to assist in the identification of victims of such incidents and the necessity for trained team responses. Many countries now have Disaster Victim Identification (DVI) teams that are multi-disciplinary, and plans and protocols in place in readiness. The paper can only hope to give a brief overview of the disaster situation for the reader: whole books have been written on this topic. The forensic odontologist has a major role in disaster incidents when there are accurate and available antemortem dental records.

A importância da correta elaboração do prontuário odontológico: [revisão] / The importance of the correct preparation of dental records: [review]

Introdução: o prontuário odontológico é o conjunto de toda documentação obtida durante o tratamento odontológico. Manter esses registros completos e atualizados demonstra eficiência técnica-administrativa do profissional, além de servir como objeto de proteção civil e de instrumento de consulta em casos de identificação humana. Objetivo: revisar a literatura, destacando a importância da elaboração, preenchimento e arquivamento do prontuário odontológico sob os aspectos jurídicos, éticos e administrativos. Conclusões: o prontuário odontológico é de extremo valor ao cirurgião dentista, sendo que esta documentação deve ser confeccionada de forma correta e detalhada, possuindo assim um registro escrito de informações do paciente sempre com a assinatura do mesmo, concordando com tudo que foi relatado e realizado.

Introduction: the clinical record is the set of all documents obtained during the dental treatment. Keeping these records complete and updated shows technical and administrative efficiency by the professional, besides it serves as an object of civil and professional protection of information tool in cases of human identification. Aim: to review the literature and to highlight the importance of preparing, completing and filing the dental records in legal, ethical and administrative matters. Conclusion: the clinical records is of extreme value to the dentist, and this documentation must be made in a correct and detailed way so they give a written record of the patient information always having his signature agreeing with all reported and performed proceedings.