Use of Images for Human Identification in Forensic

7/24/2019 Use of Images for Human Identification in Forensic

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RadiolBras0&CC4arLA.r8-&D&E7"&3F",C "&3C"CC),4H-M !ol'gioBrasileirodeRadiologiaeGiagn


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!arvalhoSPetal0

of the (.). *ational +ibrary of

'edicine%, available at

www.ncbi.nlm.nih.govpub-med, and

Bireme $egional 'edicine +i-brary, a

specialized database of the an-

&merican ealth /rganization%, specifi-

cally at the databases 'edline, +ilacs,)ci0+/ and 1ochrane, available at www.

bireme.br, utilizing the following terms as

descriptors in ortuguese! radiologia,

odontologialegal,identificaohumana2

and in 0nglish! radiology, forensic den-

tistry and human identification.

For the systematic literature review,

the following inclusion criteria were

consid-ered! 3% the articles should have

been pub-lished in the period between

3445 and 67752 6% the subject of the

article should relate to the study object2

8% a clear objec-tive and fidelity to thestudy developed2 9% the article should be

based on previous lit-erature2 :%

conclusion in accordance with the study

findings.

#he articles selection was based on

compatibility with the study structure and

methodology. ;ata reported in previous

studies were recovered considering the

pro-duction recorded on the above

mentioneddatabases.

& total of 9: articles were found on

theabove mentioned databases and thosein-cluded in the present literature review

wereselected according to the already

men-tioned inclusion criteria2 and after

method-ological analysis 34 articles were

utilized.

HUMANIDENTIFICATION

ANDDENTISTRY

#he activity of the dental surgeon in

the forensic environment is assured by

the per-tinent federal regulation, the

+aw *o. :.7amination of dental remains,e>tending

to several areas such as anthro-pology,

genetics, biochemistry, forensic

ballistic, thanatology and forensic

trauma-tology, radiology, computing and

images mi>ing, and is regulated by a

pertinent fed-eral law(4)

.

Forensic dentistry is present in pro-

cesses of post-mortem human identifica-

tion from the early procedures $general

identification% comprising estimation of

age and se>, determination of ethnic group,

s"in color and other personal characteris-

tics such as height and diagnosis of s"in

spots or fluids present or originating from

the oral cavity, or even in the definition of

time and cause of the death, to the irrefut-

able possibility of individual identifica-tion

(2).

#he contribution of forensic dentistry in

this field can be measured on innumerable

scientific reports(59)

and quantified includ-

ing by persons unaware of the dentistry

terminology and forensic sciences, li"e in

the case of the victims of the #&' airplane

crash occurred in )?o aulo, ), Brazil, in

344=, where the media highlighted the rel-

evance of identification procedures(2)

.

In the meantime, the two major airplane

crashes in Brazil can be mentioned, the first

one occurred in )eptember 677=, involv-

ing a @/+ airlinesA airplane, causing the

death of 3:9 people, and the second one,in

uly 6775, involving a #&' airplane

where 344 people died. In both accidents

the application of different techniques of

forensic identification was necessary to

individualize the victims, including dental

identification.

owever, besides clinical e>amination

and dental records, forensic dentistry can

also utilize radiological images in pro-

cesses of identification. #hus, the analysisofdental records in conjunction with ante-and

post-mortem radiographies became an

essential tool in processes of human iden-

tification.

&dditionally, since the second half of

the eighties, with the development of infor-

mation technology and the consequential

introduction of computed radiology, the

technique has been refined, offering higher

accuracy in the identification, even in

toothless individuals, and in the determina-

tion of age(10)

.

FORENSICANTHROPOLOGYAND

UTILIZATIONOFIMAGES:

HISTORY

istorically, the application of radiol-

ogy in forensic sciences was introduced in

3-ray dis-

covery by oentgen, to demonstrate the

presence of lead bullets inside the head ofa

victim(11)

. )chCller(12)

proposed the pos-


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sibility of utilizing radiological images

of the facial sinuses for

identification pur-poses.

Following this study, many others

werepublished and, finally, 1ulbert

D +aw(13)

reported the first complete

radiological identification.

)ingleton(14)

employed this technique

for identification of corpses in a

massive disaster.etersen

(15)reported a fire in the

otel afnia, occurred in

1openhagen, ;en-mar", in 3458,

with 8: deaths. 0ight den-tal surgeons

collaborated with the identifi-cation

team, performing visual, photo-

graphic and radiographic e>aminations

of all the victims, recording detailed

data ofpost-mortem odontograms and

completing their wor" with a

comparison and evalua-tion of ante-

mortem information with the

preliminary post-mortem data

collected. #he identification of 59E

of the victimswas achieved as a result

of the dentists team collaborative

wor".

essler D emble(16)

demonstrated

the role of forensic dentistry in the

identifica-tion of &merican victims of

the /peration ;esert )torm. &mong6:3 e>aminations for dental

recognition, 699 allowed the in-

dividualization and positive

identification of the victims. )uch

e>aminations were facilitated by the

availability of a record with

panoramic radiographic images of the

majority of the persons involved in

theoperation2 the cases that could not

be iden-tified were just those that did

not presentprevious dental records.

azebroucq et al.(1)

have described

two cases where the identification was

based on osteotomy of ma>illas and

mandibles, whose specimens were

individually sub-mitted to panoramic

radiography, with the images being

compared with ante-mortemradiographic

images recorded by the of-fices of the

surgeon dentists of the victims.

&ccording to the authors, this technique,besides providing complete information

for identification, allows the assessment

of thedental age in children.

&ustin D 'aples(!)

have described a

study evaluating the accuracy of methods

of images superimposition in the identifi-

cation of un"nown human s"ulls. In this

study, the authors have tried to

investigate the accuracy of the method

without refer-ring dental records, and

could conclude

"&I RadiolBras0&CC4arLA.r8-&D&E7"&3F",C


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Useof images forhuman identification inforensicdentistry

that, even without dental data. images su-

perimposition can be successfully per-

formed, provided there are at least two

ante-mortem radiographic images $frontal

and lateral views%.

&ndersen D Genzel(6)

, through ante-

mortem and post-mortem simulations,haveevaluated the capacity of individual

iden-tification by analyzing conventional

bitew-ing films and radiographic

subtraction.Based on a scoring system $3

H eliminated,6 H possible, 8 H li"ely, 9 H

certain%, threeobservers have analyzed

each case indi-vidually and classified

the radiographicimages ta"ing two to 36

individual charac-teristics into

consideration. #he authorsassert the

validity of this technique for hu-man

individual identification, provided itis

applied in compliance with strict criteria.

/liveira et al.(1!)

have developed a study

evaluating the possibility of a radiological

study of the lumbar spine determining a

correct identification of an individual, de-

spite the changes associated with aging.

#he sample included =7 pairs of lumbar

spine radiographic images that were

mi>edup so two e>perienced

radiologists couldput them bac"

together by comparing thevertebrae of

each pair for similarities anddifferences

in anatomical details. 1orrectpairing ofradiographs of the whole samplewas

achieved by both observers and the

statistical analysis demonstrated a good-

to-perfect interobserver agreement,

conclud-ing that the comparison

between radio-graphic images of lumbar

spine can deter-mine a correct

identification of individuals,

despite changes associated with aging.

dontic treatment, intraradicular and intra-

coronal posts and dental prostheses(2022)

.

'any studies also highlight the rel-

evance of radiography in human identifi-

cation through comparative methods

utiliz-ing patterns of trabecular bone,

frontal si-nuses and ma>illas, dentalradiographic images and cephalometry

and increasedfingers length(20"21"2325)

.

CON#ENTIONALRADIOGRAPHY

#he identification technique utilizing

conventional radiography is based on the

comparison between ante-mortem images

recorded in dental offices and centers

withpost-mortem radiographic images.

'uch information can be obtained

from theseimages.

#his method allows the observation of

anatomical characteristics such as coronal

shape and size, pulp anatomy, positioning

and shape of the alveolar bone crest, be-

sides unique and individual

characteristics resulting from dental

treatments(10)

.

DIGITALRADIOGRAPHY

(ntil recently, the greatest part of den-

tal restoration materials was metal and

therefore radiopaque. eculiarcharacteris-tics of every restoration

could be easilyobserved on

conventional radiography.owever,

the process of identificationbased on

conventional radiography becamemore

difficult because of the disseminationof

prophylactic dental treatments and the

consequential, significant reduction in the

incidence of cavities, particularly in

devel-oped countries(10)

.

&t the same time, the spectacular

devel-opment of microelectronics and

informa-tion technology in association

with the decrease in costs of

computational equip-ment has allowedthe development of morepowerful and

reliable techniques for com-parison of

radiological images with appli-cation in

forensic dentistry(10)

.

Innumerable variations of digital radi-

ology techniques can be found in the

litera-ture, but, essentially, the method

comprises the following steps! 3%

radiographic imagesdigitization with the

aid of a scanner(26)

, video camera(2)

or,

yet with images acqui-sition directly from

a >-ray system coupled with a computer

with monitor, printer and 1;-/'

recorder2 6% images processing through

an appropriate software, allowing

comparisons based either on images su-

perimposition(2)

, interposition(26)

or sub-

traction(2)

.

#hese modern techniques allow an ac-

curate analysis of the spatial relations of

teeth roots and supporting structures on

ante- and post-mortem images(29)

. #here

are softwares with resources for images

rota-tion, translation and scaling,

facilitating thecorrect alignment betweenante- and post-mortem radiographs

without the necessity of new

e>posures(2!)

. It is important to ob-serve

that differences in the geometry be-tween

radiographs represent the main fac-tor of

error in this type o technique, and the

above mentioned correction is essential to

reduce the noise resulting from the

processof image subtraction(2)

.


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UTILIZATIONOF

IMAGESINFORENSIC

DENTISTRY

In cases where the identification of a

corpse is required, radiographic images of

the deceased can be obtained and

compared with any ante-mortem

radiographic image of the presumed

person(1!)

.

#he following anatomical details can

beadopted as parameters! shape of teethand roots, missing and present teeth,

residual roots, supranumerary teeth,

attrition or abrasion, coronal fractures,

sign of bone reabsorption resulting

from periodontal disease, bone

pathology, diastemas, cavi-

ties shapes and lines, dental cavities, endo- 1igure"0Utilizationof conventional radiographyforhumanidentification0

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COMPUTEDTOMOGRAPHY

1onventional, two-dimensional orthree-dimensional computed tomography

$1#% is a useful imaging method in the

pro-cess of human identification, and

presentsinnumerable advantages in this

field as compared with the traditional

radiographicprojection. Firstly, because

this method is free from the problem of

structures super-imposition beyond the

plane of interest, and also for allowing

the visualization of small differences of

density(30)

.

&dditionally, 1# presents other

advan-tages, such as images

segmentation - animportant resource in cases where internalpoints must be evaluated

-, easy images manipulation, imaging quality with e>cel-lent color scale and

transparency, obtentionof volume, area and both angular and lin-ear measurements(31)

.

&n ante-mortem 1# image provides information which can be utilized in the

construction of a post-mortem facsimileimage, considering that craniometric pointscan

be precisely located and measurementscan be accurately performed(31)

.

Besides, the film includes a completedescription of the radiological protocol,


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1igure&0Utilizationof computedtomographyforhumanidentification0

with the positioning of the patient, angu-

lation, slice thic"ness, ", e>posure

time,

symmetry, border outline, and number

andpresence of septa and cells are

compared on

majority of investigators in this field.

)chCller(3)

has reported the frontalsinuses

size of the visual field, etc. *ame, age

andse> of the patient, as well as name

of the

ante-mortem and post-mortem radio-

graphic and tomographic images.

uniqueness, a characteristic that has also

been testified by other authors(13"23"39"40)

.

assisting physician, name of the hospital,

type of scanner utilized and other relevant

information are also included.

Individually, the films indicate the

imaging plane and slice thic"ness.

1urrently, slice thic"nessesas low as 3.7

mm can be obtained(32)

.

&nthropologically, 1# has been

utilizedin the study of s"ulls(32"33)

and

also, in theforensic conte>t, as an

additional resourcein processes of

identification(34)

. &ddition-ally, studies

have demonstrated the appli-cability of

facial reconstruction by meansof 8; 1#

for the purposes of individual

identification(31)

.

IDENTIFICATION$Y

FRONTALSINUSESPATTERN

#he observation of the frontal sinuses

pattern is already a well-established tech-

nique of individual identification in

foren-sic anthropology. ariations in size,

shape,

#he frontal sinuses are not present at

birth(35)

and start developing between the

second and third years at a rudimentary

level

(23)

, but, according to Bensimon D0loit

(36), these structures cannot be radio-

logically detect before the age of si>

years. #he development of the frontal

sinuses isfaster in the puberty, and is

complete around the 67 years of age

when the growth stops according to a

consensus among allthe authors studies.

)tudies report that, statistically, the

fron-tal sinuses are larger in men than in

women,and in women the upper borders

of the fron-tal sinuses are deeper(13"339)

.

&lso, otherfactors may affect the regular

anatomy ofthefrontal sinuses in adultindividuals, as fol-lows! fractures,

traumas, surgeries, diseases,mucoceles

and some enlargement in elder

individuals, all of them of rare

incidence(30)

.

#he frontal sinus configuration is pecu-

liar to each individual, as reported by the

GENERALIDENTIFICATION

THROUGHRADIOLOGY

In cases where previous records are

not available for comparison, an

alternativestrategy is the obtention of

the largest amount of information about

the deceased in order to construct a

profile as an aid to personal

identification(19)

.

Identification of gender based on the

dental anatomy and cephalometric radiog-

raphy, as well as the determination of eth-

nic groups are described by )assouni(24)

.

&lthough radiology plays an invaluable

role in the differentiation between human

and animal bones through the analysis ofthe bone tissue density

(1), its contribution

to the determination of age can be much

more significant.

;uring life, the bone tissue develops

from ossification centers and mature to a

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Useof images forhuman identification inforensicdentistry

complete development. #his process is

continuous and is completely finished

with the epiphyseal fusion. #his

development is followed-up and studied

by radiological methods in order to

establish a chronology, allowing the age

estimation. #he relation-ship betweenbone and chronological ages depends on

variables related with the indi-vidual

organism and with the environment2 this

e>plains the higher or lower error rate,

depending on the method utilized(1)

.

)assouni(24)

has reported the wide

diver-sity of methods for age estimation

based on the chronology of the third

molar eruption, dentition development

and sutures. &lso, other parameters

which contribute to the age estimation

through the teeth evaluation can be

mentioned, as follows! deciduous

eruption, crown and root mineralization,

tooth areapulp chamber area ratio, dental

erosion.

#hese measurements of changes

relatedto the age of dental tissues

present verygood results in general

identification, con-sidering that teeth are

less susceptible tonutritional, hormonal

and pathologicalchanges, particularly

in children. )o, ageestimation in

children can be based on theanalysis of

the developmental stages of thedentalelements in the permanent dentition

observed on panoramic radiographic im-

ages and classified according to the table

of dental mineralization chronology(10)

.

/n the other hand, age estimation in

adult individuals can be achieved by

radio-logical determination of the

reduction in size of the pulp cavity

resulting from a sec-ondary dentin

deposition, which is propor-tional to the

age of the individual(10)

.

#he physico-chemical analysis of the

bone demonstrates an increased carbonate

deposition with aging. &lso, an increased

decalcification is observed with the

conse-quential decrease in bone

density.#here are morphological

characters on some bonesthat should be

analyzed separately. )o, an atrophic

mandible related to dental loss

corresponds to a characteristic suggestive

of an aged individual(1)

.

Gith aging, cranial sutures ossify

$synostosis% and disappear, therefore this

is a parameter to be ta"en into

consideration in age estimations. )o,

radiology plays an e>tremely significant

role in age estima-tions focusing on

epiphyseal ossification

centers whose investigation results in

higher reliability(1)

.

CONCLUSIONS

Innumerable radiological techniques

can be utilized as an aid in humanidentifi-cation, including the

determination of se>, ethnic group and

mainly age. owever, the application of

any of the mentioned tech-niques

depends on the availability of a pre-vious

image record for comparison. )o, it is

very important that records of radiologi-

cal images acquired during treatments are

"ept by health care professionals.

#he analysis of ante-mortem and post-

mortem radiographic and tomographic

images has become an essential tool in

pro-cesses of human identification in the

field of forensic dentistry, especially

with the refinement of techniques and

adoption ofnew technologies.

Gith the availability of a variety of ra-

diological methods, the forensic dentistry

practitioner can opt for the method that

best meet the requirements for a

successful identification, focusing on a

careful appli-cation of the technique

and an accurate interpretation of

collected data.

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3. anrell . /dontologia legal D antropologia

fo-rense. 3J ed. io de aneiro! @uanabara

oogan26776.

6. /liveira *, ;aruge 0, @alv?o +11, et al. 1on-

tribuiK?o da odontologia legal para a identifica-

K?o Lpost-mortemM. ev Bras /dontol. 344


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forensic dentistry. ;ent 1lin *orth &m.

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identification of victims of the L*oronicM

disaster. &m oent-genol adium #her.

34:32==!85:H

al.&pports de la radiologie pour

lAidentificationmTdico-lTgale des corps! une

technique nouvellede radiographie des

ma>illaires. adiol. 3448259!=53H9.

3perimental

study. Fo-rensic )ci Int. 6773233:!3=:H4.

6=. Good 0, #ai 11, Blen"insop B, et al.

;igitized slice interposition in forensic dental

radiographic identification. &n in vitro study.

&m Forensic'ed athol. 344923:!57H


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!arvalhoSPetal0

used to reproduce antemortem film position.

Fo-rensic )ci. 3444299!973H9.

64. Good 0, ir" *, )weet ;. ;igital dental

ra-diographic identification in the pediatric,

mi>edand permanent dentitions. Forensic

)ci. 3444299!437H=.

87. eichs . Yuantified comparison of frontal si-

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tomography.Forensic )ci Int. 34482=3!393H=

8 and the

paranasal sinuses. In! aje" ', editor.

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",C RadiolBras0&CC4arLA.r8-&D&E7"&3F",C

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