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Role of Radiology in Forensic Dentistry

Role of Radiology in Forensic Dentistry


T Chandrasekhar, 2P Vennila

Professor and Head, Department of Oral Medicine and Radiology, Sri Ramakrishna Dental College and Hospital
Coimbatore, Tamil Nadu, India

Senior Lecturer, Department of Oral Medicine and Radiology, Sri Ramakrishna Dental College and Hospital
Coimbatore, Tamil Nadu, India

Correspondence: T Chandrasekhar, Professor and Head, Department of Oral Medicine and Radiology, Sri Ramakrishna
Dental College and Hospital, SNR College Road, Avarampalayam, Coimbatore-641006, Tamil Nadu, India

Forensic radiology is a specialized area of medical imaging utilizing radiological techniques to assist physicians and pathologists in matter
pertaining to the law. Postmortem dental radiographs are the most consistent part of the antemortem records that can be transmitted during
the forensic examination procedures. Pathologists regularly use radiographic images during the course of autopsy to assist them in identification
of foreign bodies or determination of death. Forensic radiology can be used in suspicious death or murder, in analysis of adverse medical
events, solving legal matters, to detect child abuse, drug trafficking, body identification and disease identification. Using the possibilities of
radiology, special characteristics of the internal structures of the dentomaxillofacial region can be revealed. We can also detect endodontic
treatments, healing extraction sockets, implants or even tooth colored restoration. Therefore, we can give answers to problems dealing with
identification procedures, mass disaster and dental age estimation.
Keywords: Radiology, Forensic dentistry, Victim identification.

Forensic dentistry (FD) deals with examination of dental
evidences with proper evaluation of dental findings. Forensic
dentistry is present in processes of postmortem human
identification from the early procedures (general identification)
comprising estimation of ethnic groups, skin color and other
personal characteristics, such as height and diagnosis of skin
spots or fluids present or originating from the oral cavity, or
even in the definition of time and cause of the death, to the
irrefutable possibility of individual identification. Radiology
has been used extensively in conventional dental identification
based on anatomy and by using comparison of maxillofacial
skeletal landmarks in antemortem and postmortem records.1
Application of radiology in forensic sciences was introduced
in 1896, just one year following the X-ray discovery by
Roentgen, to demonstrate the presence of lead bullets inside
the head of a victim.2 Schuller3 in 1921, proposed the possibility
of utilizing radiological images of facial sinuses for
identification purposes. Hazebroucq et al4 in 1993, described a
system for identification based on osteotomy of maxilla and
mandible which can also be used for age determination. Austin
and Maples5 (1994) have described a study for evaluating the
accuracy of methods of image superimposition and concludes
that with two antemortem radiographs (frontal and lateral view)
and without dental data, identification can be made.
Andersen and Wensel6 in 1995, through antemortem and
postmortem simulation, have evaluated the capacity of

individual identification by analyzing the conventional bite-wing

films and radiographic subtraction, based on scoring system
(1-eliminated, 2-possible, 3-likely, 4-certain).
In forensic radiology, identification process is characterized
by utilization of appropriate techniques and means to discover
identity, and can be developed by skilled technicians or
professionals with differentiated specific knowledge in areas
of biology and with appropriate techniques to achieve human
Identification is made by comparison of antemortem and
postmortem radiographs. Anatomical details like shape of teeth,
roots, supernumerary teeth, missing and present teeth, attrition,
abrasion, coronal fracture, signs of bone resorption resulting
from periodontal disease, bone pathology, diastemas, dental
cavities, endodontic treatment, interradicular and intracoronal
posts, implants, extraction socket and dental prostheses can be
used for identification.8
Accurate forensic dental identification requires point-bypoint comparison of set of intraoral radiographs, which can be
made as many as 18 to 21 images, in which all points of
comparison must match exactly or in which differences must
be explainable.9
Digital radiography, used for a decade or more by radiologists
in most hospitals, has become the solution of choice in mass

Journal of Indian Academy of Oral Medicine and Radiology, July-September 2011;23(3):229-231


T Chandrasekhar, P Vennila

disaster assisting forensic medical examiners to quickly identify

decedents. Digital radiography dramatically increases the
quality and timeliness associated with use of dental radiographs
in forensic dental victim identifications, particularly when
combined with computer-based dental chart matching software.
New digital X-ray system and portable X-ray tube heads allow
odontology team to work directly at the mass fatalities.
Onsite identification with the help of digital system is
especially advantageous when the body has been burned or
otherwise susceptible to damage during transit. Secure satellite
communication allows images to be relayed to the command
center. With digital dental X-ray technology, it is possible to
capture X-rays and compare them to existing digitalized dental
records much more efficiently.
When digital material is copied in a lossless format, a perfect
copy is created, so if important digital material is backed-up,
copied, or re-archived every 10 to 20 years using then-current
technology, digital information can be retained indefinitely in
original form.
Decreased turnaround, increased productivity, longevity,
practicality and flexibility makes digital radiography the system
of choice in mass disaster compared to conventional
Conventional, two-dimensional or three-dimensional computed
tomography (CT) is a useful imaging method in the process of
human identification, and presents innumerable advantages in
this field compared to traditional radiographic projection.
Firstly, because this method is free from the problem of
structures superimposition beyond the plane of interest and also
for allowing the visualization of small differences in density.
Other advantages are image segmentationan important
resource in cases where internal points must be evaluated, easy
image manipulation and quality with excellent color scale and
Anthropologically, CT has been utilized in the study of
skulls and also in the forensic context, as an additional resource
in the process of identification. Additional studies have
demonstrated the applicability of facial reconstruction by means
of 3D CT for the purpose of individual identification.12
CT and MRI techniques have been refined, offering higher
accuracy in identification, even in toothless individuals and in
determination of age. It can also be used in assessment of degree
of fitness of a weapon to a wound in cases of blunt force skull
injury and also assists in depicting pattern of postmortem skull
fractures. Micro-CT has been used in matching weapons to
wounds in sharp force injury cases.13
Radiographic examination of skeletal structure is a potentially
useful procedure for identification either in human remains or
in living persons. A combined use of the nasal septum deviation

patterns (straight, left, right, sigmoid, reverse sigmoid and rare

types) and frontal sinus patterns (aplasia, symmetry, left or right
dominant asymmetry in combination with the number of
lobulation) achieved a classification of at least 204 different
Radiographic Dental Implants Recognition for
Evaluation in Human Identification
Forensic dental identification is based on the morphological
comparison and matching of dental records. If no previous
papers are found, identification may be difficult. However,
morphological features of dental implant depicted on
radiographs may be used to develop a dental profile of the
individual and this can narrow the search to a smaller number
of individuals, or eliminate certain candidates by taking into
account the dental system employed. The matching of two sets
of radiographs is performed with postmortem periapical
radiograph of implant against the dental implants image of
various implant system stored in the archive.15
Dental Maturation Assessment by
Nollas Technique
Human dental growth and development have been recorded by
many ways. Abou El-Yazeed et al carried out a study to assess
the maturation of permanent dentition applying Nollas
technique on a group of panaromic X-ray films (186 boys and
192 girls) of Egyptian children within the age range of 6 to
15 years. The panaromic radiographs were used for evaluation
of tooth maturation on a scale from 0 to 10 (0Absence of crypt,
1Presence of crypt, 2Initial calcification, 3One-third of
crown completed, 4Two-third of crown completed, 5Crown
almost completed, 6Crown completed, 7One-third of root
completed, 8Two-third of root completed, 9Root almost
completed, open apex, 10Apical end of root is completed)
and the obtained data was statistically analyzed. Lower teeth
were found to be ahead of upper teeth in all age groups. Results
of maxillary and mandibular teeth including or excluding the
third molar gave similar values.16
Many radiological techniques are used as an aid in human
identification, including the determination of sex, ethnic group
and mainly age. However, the application of any of the
mentioned techniques depends on the availability of a previous
image record for comparison. So, it is very important that
records of radiological images acquired during treatments are
kept by health care professionals.
As criminology and law enforcement are advancing to keep
up with a spiraling crime rate, forensic radiology has emerged
as a specialized aspect of the investigations, and its potential in
crime solving must be used and expanded to benefit all of

Role of Radiology in Forensic Dentistry

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Journal of Indian Academy of Oral Medicine and Radiology, July-September 2011;23(3):229-231