Svrha rada: Željelo se izvijestiti o uspješnoj identifikaciji humanih ostataka na osnovi usporedbe arhivskih, dakle prijesmrtnih (AM) podataka i poslijesmrtnih (PM) endodontskih radiograma. Zbog toga je u tekstu istaknuto koliko je važno spremiti i čuvati dokumente u kliničkim arhivima. Prikaz slučaja: Nakon prometne nesreće dovezeno je neidentificirano tijelo. Odmah je obavljeno forenzično ispitivanje kako bi se ustanovio identitet stradale osobe. Kako u nacionalnoj bazi podataka nije bilo otisaka prstiju, u potrazi za prijesmrtnom (AM) dokumentacijom korišteni su radiogrami privatnih klinika dentalne medicine. Na kraju je poginula osoba identificirana na temelju analize obavljenih endodontskih terapija. Zaključak: Zubni radiogrami važni su kao pravno sredstvo koje podupire zahtjeve forenzičara u svakodnevnoj forenzičnoj praksi. U endodonciji su pak periapikalni radiogrami nezamjenjivi pri odgovarajućoj terapiji. U forenzici su ti radiogrami solidan izvor prijesmrtnih (antemortem – AM) podataka potrebnih za identifikaciju.Objective of work: The present study aims to report a case of successful human identification based on the comparison of ante-mortem and post-mortem records of endodontic treatment. Based on these, the legal value of storing and updating clinical records is highlighted throughout the text. Case report: An unknown body was recovered from a traffic accident site. Forensic examination was conducted in order to establish the identity of the victim. Based on the absence of ante-mortem fingerprint registration in the national database, the search for AM data was performed using periapical radiographic records from private dental clinics. A positive dental identification was achieved analyzing evidence of endodontic treatment. Conclusion: Dental radiographs play a valuable role as legal tools supporting the criminal demands on the daily forensic practice. Specifically in endodontics, periapical radiographs are essential for a proper treatment. In forensics, these radiographs represent a solid source of ante-mortem data for human identifications

Ademir Franco

Carlos Estrela

Fernando Fortes Picoli

Fernando Gomes Nunes

Rhonan Ferreira Silva

Acta Stomatologica Croatica

PubMed

Hrčak - Portal of scientific journals of Croatia

www.ascro.hr147Acta stomatol Croat. 2014;48(2):147-150.PRIKAZ	SLUČAJACASE REPORTRhonan Ferreira Silva1*, Ademir Franco2, Fernando Fortes Picoli3*, Fernando Gomes Nunes4, Carlos Estrela5Dentalna	identifikacija	endodontskim	radiogramima:	 prikaz	slučajaDental Identification Through Endodontic Radiographic Records: a Case ReportACTASTOMATOLOGICACROATICAwww.ascro.hrZaprimljen: 21. ožujka 2014.Prihvaćen: 22. svibnja 2014.Adresa	za	dopisivanjeRhonanFerreira SilvaFederal University ofGoiasAv. Universitaria, Esquinacom 1ª Avenida s/n, SetorUniversitarioPostalcode: 74605-220 Goiania, Goias, Brazil tel: 00 55 62 3209 6051rhonanfs@terra.com.brSažetakSvrha	rada:	Željelo se izvijestiti o uspješnoj identifikaciji humanih ostataka na osnovi uspored-be arhivskih, dakle prijesmrtnih (AM) podataka i poslijesmrtnih (PM) endodontskih radiograma. Zbog toga je u tekstu istaknuto koliko je važno spremiti i čuvati dokumente u kliničkim arhivima. Prikaz	slučaja:	 Nakon prometne nesreće dovezeno je neidentificirano tijelo. Odmah je obavljeno forenzično ispitivanje kako bi se ustanovio identitet stradale osobe. Kako u nacionalnoj bazi po-dataka nije bilo otisaka prstiju, u potrazi za prijesmrtnom (AM) dokumentacijom korišteni su radi-ogrami privatnih klinika dentalne medicine. Na kraju je poginula osoba identificirana na temelju analize obavljenih endodontskih terapija. Zaključak:	Zubni radiogrami važni su kao pravno sred-stvo koje podupire zahtjeve forenzičara u svakodnevnoj forenzičnoj praksi. U endodonciji su pak periapikalni radiogrami nezamjenjivi pri odgovarajućoj terapiji. U forenzici su ti radiogrami soli-dan izvor prijesmrtnih (antemortem –  AM) podataka potrebnih za identifikaciju. Ključne	riječiforenzična stomatologija; forenzična antropologija; stomatološka radiografija; autopsija; zubni karton1 Državno sveučilište Goias, Brazil. Forensic Odontology, Federal University of Goias, Brazil.2 Katoličko sveučilište Paraná, Brazil. Pontifícia Universidade Católica do Paraná, Brazil.3 Brazilsko stomatološko društvo State of Goias, Brazil. Brazilian Dental Association, State of Goias, Brazil.4 Paulista Sveučilište, State of Goias, Brazil. Paulista University, State of Goias, Brazil.5 Državno sveučilište Goias, Brazil. Federal University of Goias, Brazil.* Policijski forenzički ekspert, State of Goias, Brazil. Forensic Expert of the Scientific Police, State of Goias, Brazil.IntroductionCurrently, an increased trend of lawsuits is observed worldwide. Consequently, the correct registration of clinical procedures becomes more important over time (1). In odon-tology a detailed description of the treatment plan, practi-cal steps and post-treatment outcomes is essential to support the dentist against potential legal and ethical complaints (2). Moreover, the registration of dental treatment also allows for further comparative techniques in human identification cas-es (3,4). To sum up, the registered clinical data play an im-portant part both in the civil and criminal areas of the foren-sic environment. In this context, endodontics is a specific branch of odon-tology, which essentially depends on imaging exams (5). UvodDiljem svijeta neprestano se povećava broj zahtjeva u sudskim parnicama. Zbog toga je vrlo važno odgovarajuće dokumentirati kliničke postupke (1). Kad je riječ o dentalnoj medicini, potrebno je arhivirati detaljni plan terapije, karton s podatcima o provedenim postupcima i rezultate terapije ka-ko bi se postigla zaštita od mogućih pravnih postupaka i etič-kih primjedbi (2). Dokumentiranje postupaka u dentalnoj medicini omo-gućuje i primjenu komparativne tehnike u slučaju identifika-cije ljudi (3,4). Zato je vrlo važno arhivirati kliničke podatke jer mogu biti potrebni stručnjacima i civilnog i kriminali-stičkog područja forenzike. U tom kontekstu endodoncija je specijalistička grana dentalne medicine koja ovisi o radiološ-Dentalna identifikacija - prikaz slučaja148www.ascro.hrFerreira Silva i sur.kim nalazima (5). Radiogrami zuba najčešći su izvor prije-smrtnih (antemortem – AM) podataka potrebnih za iden-tifikaciju ljudi (6). Naime, ti se podatci mogu usporediti s poslijesmrtnima (postmortem – PM) (7,8). Usporedna iden-tifikacija ljudskih tijela obično se temelji na forenzičnim do-kazima, poput obavljenih terapija zuba i jedinstvene morfo-logije (5). Temeljem navedenoga, ovaj rad izvještava o identifikaciji ljudskog tijela usporedbom AM i PM endodontskih punje-nja te se ističe koliko je endodoncija važan i prijeko potreban dio forenzične znanosti.Prikaz	slučajaNepoznato ljudsko tijelo nađeno je 2005. godine na mje-stu gdje se dogodila prometna nesreća te je prevezeno u Pato-loški institut Medicinskog fakulteta u Goji, u Brazilu. Truplo je ondje bilo 30 dana kako bi ga preuzela rodbina. No nitko nije došao pa je ta poginula osoba pokopana kao nepoznata. U lijes su položeni i prikupljeni poslijesmrtni (PM) podatci radi eventualne naknadne identifikacije.Dental radiographs are the most common source of ante-mortem (AM) evidence for human identification (6). Once the AM data is obtained, the comparison with post-mortem (PM) data is enabled (7,8). The comparative human identi-fication is usually based on forensic evidence, such as dental treatments and unique morphology (5).Based on that, the present study reports a case of human identification through the comparison between AM and PM endodontic findings, highlighting the relevance of endodon-tics as an essential adjuvant to the forensic sciences. Case	reportIn 2005, an unknown body, recovered from a traffic ac-cident site, was referred to the Medico-Legal Institute of Goiania, Brazil. The body awaited in the institute for 30 days allowing the relatives to claim it. The relatives did not come forward, and the body was buried as an unknown person. Nevertheless, the PM data of the victim was properly regis-tered for possible human identification needs.Slika	1. Usporedba antemortem (A: 2001, B: 2004 i C: 2004) i postmortem (D: 2006) periapikalnih radiograma – vidi se endodontsko liječenje desnog drugog maksilarnog pretkutnjaka (15), pneumatizacija desnog maksilarnog sinusa u području kutnjaka i nedostatak desnog maksilarnog prvog kutnjaka (16).Figure	1 Comparison of ante-mortem (A: 2001, B: 2004 and C: 2004) and post-mortem (D: 2006) periapical radiographs, highlighting the endodontic treatment of the maxillary right second pre-molar (#15); the pneumatization of the right maxillary sinus in the molar region; and the missing maxillary right first molar (#16).Slika	2. Usporedba antemortem (A: 2001 i B: 2004) i postmortem (C: 2006) periapikalnih radiograma – vidi se endodontsko liječenje lijevog bočnog maksilarnog sjekutića (22).Figure	2 Comparison of ante-mortem (A: 2001 and B: 2004) and post-mortem (C: 2006) periapical radiographs, highlighting the endodontic treatment of the maxillary left lateral incisor (#22).www.ascro.hrDental ID – a Case Report 149Ferreira Silva et al.Potencijalna rodbina žrtve pojavila se 2006. godine pa je obavljena ekshumacija ostataka. Identifikacija otiskom prsti-ju nije bila moguća jer ih nije bilo u policijskoj bazi poda-taka. Zbog toga je odlučeno da se kod žrtve potraže osobni podatci o prijašnjim medicinskim i dentalnomedicinskim za-hvatima. Rodbina je nabavila prijesmrtne (AM) dokumente u privatnoj klinici dentalne medicine, a sastojali su se od pe-riapikalnih radiograma snimljenih od 2001. do 2004. godine u sklopu endodontskih terapija na drugom desnom maksi-larnom pretkutnjaku (15) (slika 1) i lijevom bočnom maksi-larnom sjekutiću (22) (slika 2.). Periapikalni radiogrami po-kazali su i obostranu pneumatizaciju maksilarnih sinusa u području kutnjaka te ekstrakciju prvoga desnog maksilarnog kutnjaka (16). Na temelju tih dokaza učinjeni su poslijesmrt-ni (PM) radiogrami i uspoređeni s prijesmrtnim (AM) po-datcima. Isti forenzični dokazi nađeni su i na AM i na PM radiogramima, što je rezultiralo pozitivnom identifikacijom žrtve.RaspravaRadiogrami zuba smatraju se najpouzdanijim prijesmrt-nim (AM) podatcima u humanoj identifikaciji (6). Naime, ti radiogrami omogućuju blisko preklapanje i uspoređivanje poslijesmrtnih (PM) i prijesmrtnih (AM) podataka, što re-zultira optimalnom usporedbom. Još se mora istaknuti da se endodontska punjenja rjeđe i teže modificiraju nego što je to slučaj s postupcima na zubnim krunama, pa se endodont-ski dokazi dulje mogu koristiti kao forenzično sredstvo (6). Osim toga endodontski materijal stabilan je i do 1100 Celzi-jevih stupnjeva, što omogućuje postupak humane identifika-cije (10). Bonavilla i suradnici potvrdili su 2008. godine da se mikroskopska struktura korijenskih cemenata i gutaper-ke ne mijenja nakon što su izloženi visokim temperaturama (11). Praktičnu korist endodontskih podataka u identifikaci-ji ljudi opisali su već 1990. godine Spyropoulos i Liakakoy (12). Ti su autori obavili pozitivnu identifikaciju zuba na te-melju endodontskih zahvata i morfoloških obilježja pojedi-načnih drugih desnih maksilarnih pretkutnjaka. Wiesman i njegovi kolege istaknuli su 1996. godine pouzdanost prije-smrtnih (AM) endodontskih podataka kao forenzičnog sred-stva pri uspješnoj humanoj identifikaciji zuba (13). U ovdje opisanom slučaju ističe se koliko je pravno važno dokumen-tirati i čuvati podatke o kliničkim postupcima radi eventu-alne identifikacije stradalih osoba na temelju endodontskih terapijskih zahvata. Endodonti moraju biti svjesni primije-njenih tehnika, kad je riječ o optimalnoj radiografskoj pro-cjeni zuba, jer omogućuju izradu poslijesmrtnih (PM) radi-ograma te usporedbom omogućuju komparativni postupak pri identifikaciji. ZaključakUnatoč stalnom napretku dentalnih tehnika, materijala i opreme, standardni radiogrami kojima se liječnici koriste u kliničkoj praksi i dalje su najčešći izvor forenzičnih prije-smrtnih (AM) podataka u slučaju identifikacije ljudi. Zbog toga endodoncija postaje vrlo vrijedna specijalnost, posebice In 2006, six months after the burial, potential relatives of the victim claimed the body, and the exhumation and hu-man identification were performed. The fingerprint identifi-cation was not feasible due to the absence of AM fingerprint data, making necessary the search for personal data from pre-vious medical and dental treatments of the victim. The rela-tives provided dental AM data collected from a private den-tal clinic. The data consisted of periapical radiographs, dated from 2001 and 2004, related to the endodontic treatment of the maxillary right second pre-molar (#15) (Figure 1); and the maxillary left lateral incisor (#22) (Figure 2). Moreover, the periapical radiographs revealed bilateral pneumatization of the maxillary sinuses in the molar region, and the absence of the maxillary right first molar (#16). Based on that, the PM data was obtained performing periapical radiographs of teeth highlighted AM. The same forensic evidence was de-tected both AM and PM, resulting in a positive dental iden-tification.DiscussionDental radiographs are considered the most reliable source of AM data in the human identification field (6). Spe-cifically, dental radiographs allow for a close PM duplication of AM evidence, consequently enabling an optimal compar-ative procedure. Additionally, root canal treatments are less modified in the clinical routine if compared to dental inter-ventions performed on the dental crown. Thus, endodon-tic identifiers are maintained for a longer period as foren-sic tools (6). In special situations, such as major fire disasters, the den-tal structures become fragile (9). However, endodontic filling materials remain preserved up to 1100° Celsius, allowing for human identification processes (10). Accordingly, Bonavilla et al (11), 2008, confirmed the preservation of microscopic structural patterns of root sealers and gutta percha exposed to high temperatures. The practical usefulness of endodontic evidence for hu-man identification was already described by Spyropoulos and Liakakoy (12) in 1990. The authors achieved a positive den-tal identification based on the endodontic treatment and morphologic outline of a single maxillary right second pre-molar. In 1996, Weisman (13) corroborated the reliability of AM endodontic records as a forensic tool performing a suc-cessful dental human identification. Nowadays, the present study highlights the legal importance of storing and updat-ing clinical records which allow for a positive dental identi-fication based on endodontic treatment. Endodontists must be aware of the proper techniques for optimal radiographic dental assessment, making feasible a PM radiographic du-plication for the comparative human identification process. ConclusionDespite the constant enhancement of dental techniques, materials and facilities, the conventional radiographs, rou-tinely performed in the clinical practice, are still the most common source of forensic AM data for the human iden-tification process. In this context, endodontics becomes a Dentalna identifikacija - prikaz slučaja150www.ascro.hrFerreira Silva i sur.References1. Franco A, Alqerban A, Lima AAS, Tanaka OM, França BHS. The or-thodontist’s responsibility and the bioethical aspects in the cur-rent jurisprudence. Eur J Gen Dent. 2012;1(1):20-3. 2. Silva RF, Chaves P, Paranhos LR, Lenza MA, Daruge Jr E. Use of orthodontic records in human identification. Dental Press J Or-thod. 2011;16(2):52-7.3. Lorkiewicz-Muszynska D, Przystanska A, Glapinski M, Kociemba W, Zaba C. Difficulties in personal identification caused by unreli-able dental records. J J Forensic Leg Med. 2013 Nov;20(8):1135-8.4. Astekar M, Saawarn S, Ramesh G, Saawarn N. Maintaining den-tal records: are we ready for forensic needs? J Forensic Dent Sci. 2011 Jul;3(2):52-7.5. Forrest AS, Wu HY. Endodontic imaging as an aid to forensic per-sonal identification. Aust Endod J. 2010 Aug;36(2):87-94.6. Franco A, Thevissen P, Coudyzer W, Develter W, Van de Voorde W, Oyen R et al. Feasibility and validation of virtual autopsy for dental identification using the Interpol dental codes. J Forensic Leg Med. 2013 May;20(4):248-54.7. Silva RF, Botelho TL, Prado FB, Kawagushi JT, Daruge Jr E, Ber-zin F. Human identification based on cranial computed to-mography scan: a case report. Dentomaxillofac Radiol. 2011 May;40(4):257-61.8. Silva RF, Franco A, Dias PEM, Gonçalves AS, Paranhos LR. Inter-relationship between forensic radiology and forensic odontology – a case report of identified skeletal remains. J Forensic Radiol Imag. 2013;1(4):201-6. 9. Hill AJ, Lain R, Hewson I. Preservation of dental evidence follow-ing exposure to high temperatures. Forensic Sci Int. 2011 Feb 25;205(1-3):40-3.10. Savio C, Merlati G, Danesino P, Fassina G, Menghini P. Radio-graphic evaluation of teeth subjected to high temperatures: ex-perimental study to aid identification processes. Forensic Sci Int. 2006 May 10;158(2-3):108-16.11. Bonavilla JD, Bush MA, Bush PJ, Pantera EA. Identification of in-cinerated root canal filling materials after exposure to high heat incineration J Forensic Sci. 2008 Mar;53(2):412-8.12. Spyropoulos ND, Liakakoy P. The use of periapical x-rays in the identification of a corpse. Hell Stomatol Chron. 1990 Apr-Jun;34(2):151-6.13. Weisman MI. Endodontics – a key to identification in forensic dentistry: report of a case. Aust Endod J. 1996;22(3):9-12. Received: March 21, 2014Accepted: May 22, 2014Address	for	correspondenceRhonan Ferreira SilvaFederal University of GoiasAv. Universitaria, Esquina com 1ª Avenida s/n, Setor Universitario Postal code: 74605-220 Goiania, Goias, Brazil Phone: 00 55 62 3209 6051rhonanfs@terra.com.brAbstractObjective	of	work: The present study aims to report a case of successful human identification based on the comparison of ante-mortem and post-mortem records of endodontic treatment. Based on these, the legal value of storing and updating clinical records is highlighted through-out the text. Case	report: An unknown body was recovered from a traffic accident site. Forensic examination was conducted in order to establish the identity of the victim. Based on the absence of ante-mortem fingerprint registration in the national database, the search for AM data was per-formed using periapical radiographic records from private dental clinics. A positive dental identifi-cation was achieved analyzing evidence of endodontic treatment. Conclusion: Dental radiographs play a valuable role as legal tools supporting the criminal demands on the daily forensic practice. Specifically in endodontics, periapical radiographs are essential for a proper treatment. In foren-sics, these radiographs represent a solid source of ante-mortem data for human identifications.Key	wordsForensic Dentistry; Forensic Anthropolo-gy; Dental Radiography; Autopsy; Dental Records.zbog forenzičnih razloga jer se radiografije obavljaju u sklopu liječenja. Opisani slučaj pokazuje koliko je važan klinički ar-hiv s dokumentima o obavljenim zahvatima, a posebice radi-ogrami jer omogućuju uspješnu identifikaciju ljudskih osta-taka na osnovi endodontskih podataka. valuable specialty in the forensic scope, once periapical ra-diographs are often performed. The present case report il-lustrates the relevance of properly recording clinical inter-ventions, through dental radiographs, providing a successful case of positive dental human identification based on end-odontic findings. 

Dental Identification Through Endodontic Radiographic Records: a Case Report

Objective of work: The present study aims to report a case of successful human identification based on the comparison of ante-mortem and post-mortem records of endodontic treatment. Based on these, the legal value of storing and updating clinical records is highlighted throughout the text. Case report: An unknown body was recovered from a traffic accident site. Forensic examination was conducted in order to establish the identity of the victim. Based on the absence of ante-mortem fingerprint registration in the national database, the search for AM data was performed using periapical radiographic records from private dental clinics. A positive dental identification was achieved analyzing evidence of endodontic treatment. Conclusion: Dental radiographs play a valuable role as legal tools supporting the criminal demands on the daily forensic practice. Specifically in endodontics, periapical radiographs are essential for a proper treatment. In forensics, these radiographs represent a solid source of ante-mortem data for human identifications

Dental Identification Through Endodontic Radiographic Records: a Case Report

Abstract

Similar works

Full text

Available Versions

Hrčak - Portal of scientific journals of Croatia

Directory of Open Access Journals