Odontogeneza trajnih zuba pretežito pripada postnatalnom razvoju i traje više godina. Nakon rođenja djetetov je organizam i sva njegova tkiva u mnogo dinamičnijem suodnošaju s izvanjskom sredinom nego u razdoblju intrauterinog života. Time se stvaraju uvjeti da mnogi izvanjski čimbenici utječu na formativnu djelatnost zubnog organa. Poremećaji u razvoju zuba koji nastaju u razdoblju morfologijske diferencijacije mogu se očitovati i kao fuzija zuba. Fuzionirani su zubi osebujnog izgleda te mogu stvarati estetski nesklad ili, zbog povećanog mezio-distalnog promjera, utjecati na svekoliku morfologiju zubnoga luka. U radu je prikazan slučaj uspješne identifikacije žrtve Domovinskoga rata iz godine 1991. ekshumirane 1995. iz masovne grobnice u Petrinji temeljem nalaza fuzioniranih zuba, odgovarajućih podataka dobivenih od rodbine, te nekolicine dodatnih materijalnih dokaza koji su našu tvrdnju još podkrijepili.Odontogenesis of permanent teeth in its major part belongs to the process of postnatal growth and continues for many years following the birth or an individual. After the child is born her or his organism and all the tissues establish a much more dynamic relationship with the external environment than they do during intrauterine life. In this way conditions are made for numerous external factors to affect the formation activity of tooth organs. Disorders in the development of teeth and other structures within the oral cavity may occur at any stage of organogenetic growth. Fused teeth, apart from their causing aesthetic impairment, may on account of their enlarged mesiodistal diameter affect the entire dental arch morphology and cause compression of the frond dental region, rotation and malposition of the approximate teeth. In this case report the presence of such an anomaly facilitated accurate and reliable identification of a victim killed during 1991. when war raged in Croatia, and exhumed from the mass grave in Petrinja in 1995. The specific morphological shape of the victim\u27s dentition undoubtedly contributed to accurate identification of this young male, which was additionally substantiated by other available material evidence

Hrvoje Brkić

Jadranka Keros-Naglić

Hrčak - Portal of scientific journals of Croatia

M o r f o l o g i j a  k a o  t e m e l j  d e n t a l n e  i d e n t i f i k a c i j e :  p r i k a z  s l u č a j aHrvoje BrkićJadranka Keros-NaglićZavod za dentalnu antropologiju Stomatološki fakultetSveučilišta u ZagrebuSažetakOdontogeneza trajnih zuba pretežito pripada postnatalnom razvoju i traje više godina. Nakon rođenja djetetov je  organizam i sva njegova tkiva u mnogo dinamičnijem suodnošaju s izvanjskom sredinom nego u razdoblju intrauterinog života. Time se stvaraju uvjeti da mnogi izvanjski čimbenici utječu na formativnu djelatnost zubnog organa. Po­remećaji u razvoju zuba koji nastaju u razdoblju morfologijske dife­rencijacije mogu se očitovati i kao fuzija zuba.Fuzionirani su zubi osebujnog izgleda te mogu stvarati estetski ne­sklad ili, zbog povećanog mezio-distalnog promjera, utjecati na sveko­liku morfologiju zubnoga luka.U radu je  prikazan slučaj uspješne identifikacije žrtve Domovinskoga rata iz godine 1991. ekshumirane 1995. iz masovne grobnice u Petri­nji temeljem nalaza fuzioniranih zuba, odgovarajućih podataka dobi­venih od rodbine, te nekolicine dodatnih materijalnih dokaza koji su našu tvrdnju još podkrijepili.Ključne riječi: fuzija, morfologija zubigo vi pojedini dijelovi. Nepravilnosti oblika jesu: mi- krodoncija, makrodoncija, fuzija, geminacija, kon- krescencija, taurodontizam, Hutchinsonovi sjekuti- či, malinasti kutnjak, šiljasti lateralni sjekutić, pa- latinalni žlijeb, paramolarne kvržice, dens in dente (dens invaginatus), Carabellijeva kvržica, izrazito povećan opseg zubnoga vrata, pandžasti zubi, hipo- plastični defekti, te ostala izobličenja.Među nepravilnosti oblika zuba ubrajamo i fu­ziju dvaju susjednih zametaka tijekom njihova ra­zvoja, a prije mineralizacije (1,2,3). Mogući su eti- ološki čimbenici fuzije: tlak uvjetovan manjkom prostora što dva susjedna zuba dovodi u doticaj i uv­jetuje njihovo spajanje, zaostajanje dentalne lami-Acta Stomatol Croat 1999; 359—362PRIKAZ SLUČAJA Primljeno: 12. srpnja 1999.Adresa za dopisivanje:Doc.dr.sc. Hrvoje Brkić Zavod za dentalnu antropologiju Stomatološki fakultet Sveučilišta u Zagrebu Gundulićeva 5, 10000 ZagrebRazvoj zuba dugotrajan je i zamršen proces koji ne mora uvijek imati uvriježen tijek i čije osobito­sti mogu uzrokovati nastanak raznih nepravilnosti. U mliječnih zuba odontogeneza djelom pripada in­trauterinem razvoju, a dijelom razdoblju nakon ro­đenja. Trajno se pak zubalo razvija pretežito nakon rođenja.Nepravilnosti mogu nastati u svakom stupnju zubnoga razvoja (inicijacija, profileracija, histologij- ska i morfologijska diferencijacija, apozicija, mine- ralizacija).Promjene oblika zuba nastaju, primjerice, u raz­doblju morfologijske diferencijacije, a nepravilna oblika može biti cijeli zub ili su izobličeni samo nje-Acta Stomatol Croat, Vol. 33, br. 3, 1999. EMI 359H. Brkić i Jadranka Keros-Naglić Dentalna identifikacija: prikaz slučajane, poremećaji metabolizma, manjak hormona i vi­tamina. Pojedini pak istraživači drže kako je fuzija dominantno nasljedna anomalija s reduciranom pe­netracijom gena (4,5,6,).Ovisno o vremenu i o razvojnoj fazi u kojoj je nastalo stapanje, zubi mogu biti stopljeni cijelom du­žinom i svim dijelovima, pa je riječ o pravoj fuziji. Nepotpuna se stapanja očituju samo u području zub­ne krune (što je razmjerno rijetkost) ili samo u po­dručju zubnoga korijena pa govorimo o konkrescen- ciji korijena (7,4,8,9).Prigodom fuzije najčešće su sljedeće kombina­cije:1. Fuzija dvaju susjednih zuba u nizu, pa u tom seg­mentu manjka jedan zub. Diferencijalno dijagno­stički valja pomisliti na geminaciju jednog uz ne­dostatak (hipodonciju) susjednoga zuba.2. Fuzija normalnoga zuba s prekobrojnim zubom, pa je broj zuba normalan. Diferencijalno dijag­nostički mogućnost je geminacije jednoga zuba.3. Fuzija dvaju prekobrojnih zuba, pa je u tome seg­mentu jedan zub više. Diferencijalno dijagnostič­ki valja pomišljati na geminaciju jednoga preko­brojnog zuba.Oblik fuzioniranih zuba sličan je onom u gemi­nacije, tj. povećanje mezio-distalni promjer zubne krune s urezom na griznome bridu i brazdom na ve- stibularnoj i oralnoj površini, što dijeli krunu na dva nejednaka dijela. Pri geminaciji se za razliku od fu­zije na rendgenskoj snimci vide jedna pulpna šup­ljina i jedan korijenski kanal. Ako se fuzionirani zubi računaju kao jedan, tada u tom segmentu nedostaje jedan zub pa postoji slika prirođenog manjka zuba, odnosno hipodoncije (10,11,12,13).Fuzija je češća pojava u mliječnome nego u traj­nome zubalu. U trajnoj denticiji pojavljuje se u 0,5 do 2,5 osoba, a najčešće se, kao u našem primjeru, fuzija javlja u području sjekutića, jednostrano ili obostrano, a u našem je primjerku bilo jednostrano. Pri tome su najčešće po dva zuba stopljena pod ku­tom od 140° do 150°, rjeđe se nalazi i fuzija triju zuba (14,15).Prikaz slučajaTijela ljudi ubijenih tijekom godine 1991. na po­dručju Hrvatske dijelom su ekshumirana iz masov­nih grobnica 1995. Među najvećim grobnicama s vi­še od dvadeset ekshumiranih trupla jest pronađena u Petrinji. U identifikaciji žrtava sudjelovao je i sto­matolog, član tima za identifikaciju iz Zavoda za dentalnu antropologiju Stomatološkog fakulteta Sve­učilišta u Zagrebu. Zubi su se pri identificiranju ubi­jenih ljudi pokazali vrlo važnim. Identifikaciju jed­nog ubijenog mladića u toj skupini omogućilo je vrlo rijetko dentalno obilježje.Premortalni podatci dobiveni od rodbine upući­vali su na zdravo i bijelo zubalo s postojanjem "dvo­strukoga zuba", veliki zub. U Zavodu za sudsku me­dicinu i kriminalistiku Medicinskog fakulteta Sve­učilišta u Zagrebu dopremljeno je muško truplo u kojega su dentalna obilježja upućivala na dobivene podatke, a nalaz su potkrijepili još neki dodatni ma­terijalni dokazi.Dvostruki zub 21+22 gornjega desnog kvadran­ta u nizu između prvoga lijevog središnjeg sjekuti­ća i gornjega desnog očnjaka izvađen je iz usne šup­ljine uz pristanak rodbine, te rendgenski i odonto­metry ski istražen.Izvađeni je zub 22 tijekom 48 sati uronjen u 3% vodikov peroksid, a potom u 10% otopinu formali- na. Nakon nekoliko dana zub je rendgenski snim-Slika 1. Fuzija 21 i 22 promatrana s vestibularne strane Figure 1. Fusion of 21 and 22 seen from the vestibular side360 m Acta Stomatol Croat, Vol. 33, br. 3, 1999. m 360H. Brkić i Jadranka Keros-Naglić Dentalna identifikacija: prikaz slučajaljen postupkom male intraoralne snimke s dugim ko­nusom, a zatim je dijagnosticirana ta rijetka dental­na anomalija.Morfološki se zub 22 doima podijeljenim na dva međusobno nejednolika zuba, pri čemu je medijal- ni veći od distalnoga. Zub, koji inače spada u ge­netski labilne zubne jedinice, anatomski gledano ima dvije nejednake krune i dva nejednaka korijena (Sli­ka 1).Zubne su krune odijeljene uzdužnom brazdom koja je uočljiva i s labijalne i s oralne strane. Jasno su izražena dva korijena, što potvrđuje njihovu odvojenost pri razvoju te na njihovo kasnije stapa­nje (konkrescenciju) nastalo povećanim nakuplja­njem cementa tijekom žrtvina života (Slika 2).Slika 2. Fuzija 21 i 22 promatrana s oralne strane Figure 2. Fusion of 21 and 22 seen from the oral sideStapanje je krune dakle nastalo u fazama razvo­ja zuba (histodiferencijacija), dok je sraštavanje kor- jenova nastalo kasnije tijekom života.Raščlamba endodoncijskih prostora potvrđuje dva posve odvojena endodoncijska sustava obliko­vana iz dviju pulpnih komora i dvaju korijenskih ka­nala.Sva nabrojena obilježja otklanjaju geminaciju kao moguću dentalnu anomaliju (Slika 3).Slika 3. Rendgenska snimka stopljenih zuba 21 i 22Figure 3. X-ray scan of the tooth by using the technique of small intraoral scanning with long conePostojanje spomenute anomalije imalo je presud­no značenje da se točno i pouzdano identificira ta žrtva rata tijekom godine 1991. ekshumirane iz ma­sovne grobnice u Petrinji 1995. godine.Specifičnosti morfološkog izgleda zubala opisa­ne žrtve nedvojbeno je potvrdila njezin pravi iden­titet, što je dodatnim nalazima nekih materijalnih do­kaza samo potkrijepljeno.L iteratu ra1. PRINDBORG JJ. Pathology of dental hard tissues. Cho- penhagen: Munksgaard 1970:47-58.2. LEVITAS TC. Gemination, fusion, twinning and concre­scence. ASDC 1965;32:93-100.3. CAMM JH, WOOD AJ. Gemination, fusion and supernu­merary tooth in the primery dentition; report of a case. ASDC 1989;56:60-61.4. DIXON GH, STEWART RE. Genetic aspect of tooth ano­malies development. St Louis: Mosby 1976.5. STEWART RE, BARBER TK, TROUTAN KC et al. Pe­diatric dentistry. St Louis: Mosby 1982:91-105.6. BROOK AH, WINTER GB. Double teeth: a retrospective study of "geminated" and "fused" teeth in children. Br Dent J 1970;129:123-130.Acta Stomatol Croat, Vol. 33, br. 3, 1999. m m 361H. Brkić i Jadranka Keros-Naglić Dentalna identifikacija: prikaz slučaja7. YUEN SWS, CHAN JCY, WEI SHS. Double primary te­eth and their relationship with their permanent successors. Pediatr Dent 1987;9:42-52.8. CROLL TP, RAINS NJ, CHEN E. Fusion and gemination in one dental arch: Report of a case. Asdc 1981;48:279- -2299.9. NIK-HUSSEIN NN. Bilateral symetrical fusion of primary and permanent mandibular lateral incisors and canines. J Pedod 1989;13:378.383.10. DUNCAN WK, HELPIN ML. Bilateral fusion and gemi­nation: a literature analysis and case report. Oral Surg Oral Med Oral Pathol 1987;64:82-87.11. KELLY JR. Gemination, fusion or both. Oral Surg Oral Med Oral Pathol 1978;45:655-666.12. EIDELMAN E. Fusion of maxillary primary central and lateral incisors bilaterally. Pediatr Dent 1981;3:346-347.13. KILLIAN CM, CROLL TP. Dental twinning anomalies: the nomenclature enigma. Quintesence Int 1990;21:571-576.14. REISEINBERGER RE, KILLIAN CM. Triplication and twinning in one dental arch: report of a case. Quintesence Int 1990;21:621-623.15. ŠUTALO J, HULJEV S, LEDIĆ B, ANIĆ I. Fusion and gemination of the permanent teeth. Acta Stomatol Croat 1993;27:195-198.362 Acta Stomatol Croat, Vol. 33, br. 3, 1999. m 362T o o t h  M o r p h o l o g y  a s  t h e  B a s i s  o f  D e n t a l  I d e n t i f i c a t i o n :  C a s e  R e p o r t Department of DentalAnthropologySchool of Dental MedicineUniversity of ZagrebHrvoje BrkićJadranka Keros-NaglićSummaryOdontogenesis of permanent teeth in its major part belongs to the process of postnatal growth and continues fo r many years following the birth or an individual. After the child is born her or his organism and all the tissues establish a much more dynamic relationship with the external environment than they do during intrauterine life. In this way conditions are made fo r numerous external factors to affect the formation activity of tooth organs. Disorders in the development of te­eth and other structures within the oral cavity may occur at any stage of organogenetic growth. Fused teeth, apart from their causing aest­hetic impairment, may on account of their enlarged mesiodistal dia­meter affect the entire dental arch morphology and cause compression of the frond dental region, rotation and malposition of the approxima­te teeth. In this case report the presence of such an anomaly facilita­ted accurate and reliable identification of a victim killed during 1991. when war raged in Croatia, and exhumed from the mass grave in Pe­trinja in 1995. The specific morphological shape of the victim's denti­tion undoubtedly contributed to accurate identification of this young male, which was additionally substantiated by other available materi­al evidence.Key words: fusion, tooth morphologyActa Stomatol Croat 1999; 363—365CASE REPORT Received: Jully 12, 1999Address for correspondence:Doc.dr.sc. Hrvoje BrkićDepartment of DentalAnthropologySchool of Dental MedicineUniversity of ZagrebGundulićeva 5, 10000 ZagrebCroatia■■■■■■■■■■ ■ ■ I^M H Iil^H B H nn iIntroductionDevelopment of dentition is a long and complex process that need not always take a regular course and its characteristics may cause various anomali­es. With regard to decidual teeth their odontogene­sis partially belongs to intrauterine development and partially to postnatal growth. Permanent teeth de­velop as a rule after the birth of an individual.Abnormalites may occur at any stage of dental development (initiation, proliferation, histologicaland morphological differentiation, apposition, mine­ralisation). Changes in the form of the teeth may oc­cur during morphological differentiation when eit­her the whole tooth or only parts of it may acquire irregular shapes. The following irregularities are among the most common: microdontia, macrodon- tia, fusion, gemination, concrescence, taurodontism, Hutchinson's incisors, raspberry or mulberry molars, conical lateral incisors (peg teeth), palatal groove, paramolar prominence, dens invaginatus (dens in dente), carabelli tubercle (or cusp), markedly enlar-Acta Stomatol Croat, Vol. 33, br. 3, 1999. EMI 363H. Brkić and Jadranka Keros-Naglićged dental neck volume, claw teeth, hypoplastic de­fects, and other anomalies.Fusion or union of two approximating tooth ger­ms in the cours of their development, prior to the process of mineralisation, is also considered a den­tal abnormality (1-3). The following are among eti­ological factors of teeth fusion: pressure caused by insufficient space because of which two neighbou­ring teeth become too close during their growth - which eventually leads to their fusion, delay of den­tal lamina, metabolic disorders, deficient hormone production and lack or vitamins. However, a great number of authors are of the opinion that fusion is a dominant heritable abnormality with reduced ge­nie penetration (4-6).Depending on the stage of development during which fusion has occurred the teeth may be fused along their entire length and in all their segments, which is referred to as true fusion. Incomplete fusi­on indicates union in the crown region (which is a rare case), or only in the root region and is referred to as concrescence of the roots (4,7-9).In fusion defects the following combinations ha­ve usually been noticed:1. Fusion of two approximating teeth in sequence: in this segment one tooth is missing. In differen­tial diagnosis gemination of one tooth and absen­ce (hypodontia) of the neighbouring one should be taken into consideration.2. Fusion of a normal tooth with a supernumerary one, so that the total number of teeth is normal. In differential diagnosis the gemination of only one tooth should be taken into account.3. Fusion of two supernumerary teeth producing one supernumerrary tooth should be considered.The shape öf a fused tooth is similar to the shape of a geminated one, i.e. it has an enlarged mesiodi- stal diameter of the dental crown with an incision in the biting edge and a groove in the vestibular and oral surface dividing the crown into unequal parts. In gemination, as opposed to the fusion process, the x-ray scan shows one pulp cavity and one root ca­nal. If the fused teeth count as one then there is one missing tooth in this segment and is similar to the natural absence of a tooth, or hypodontia (10-13).Fusion occurs more commonly in decidual than in permanent dentition. In permanent teeth, as in our case, fusion usually takes place in the region of theDental Identification: Case Reportincisors, either on one side or bilaterally: ours was a unilateral case of fusion. During the process two teeth are usually fused together at an angle of 140 to 150 degrees. The fusion of three teeth is an ex­tremely rare case (14,15).Case reportThe bodies of people killed during the 1991 war in Croatia were exhumed to some extent from mass graves in 1995. One such mass grave, containing more than twenty bodies, was recently found in the town of Petrinja. In the identification of victims a forensic odonto-stomatologist was also included as a member of the identification team, acting on be­half of the Zagreb University School of Dental Me­dicine, Department of dental Anthropology. During the identification process of war victims teeth have proved of great importance as essential identificati­on factors. A rare dental feature made it possible to identify a young man, one of the victims found in the Petrinja mass grave.Premortal history obtained from his relatives in­dicated that the man had healthy white dentition with the presence of "double tooth" (incisors). At the De­partment of Forensic medicine and Criminology Sc­hool of Medicine University of Zagreb the body the young male was identified in whom dental features corresponded to the obtained information and the finding was further substantiated by additional ma­terial evidence.After obtaining the informed consent of the re­latives, the double tooth (22) in the upper right ca­nine was removed from the oral cavity. W-ray acan- ning and odontometric examination were then per­formed. The extracted tooth (22) was suspended for 48 hours in 3% hydrogen peroxide and after words in 10% formaline solution. After a few days, an x- -ray scan was made of the booth by using the tec­hnique of small intraoral scanning with long cone. The image showed a rare dental abnormality (Figu­res 1,2,3).Morphologically (22), the tooth appeared to be divided into two unequal teeth, with the medial to­oth being larger than the distal one. The tooth, ot­herwise considered a genetically unstable dental unit, from the anatomical point of view has two une­qual crowns and two unequal roots.364 Acta Stomatol Croat, Vol. 33, br. 3, 1999.H. Brkić and Jadranka Keros-Naglić Dental Identification: Case ReportThe dental crowns are divided by a longitudinal furrow that may be seen from both the labial and the oral sides. Two roots are seen quite clearly, in­dicating their separate development and later con­crescence, resulting from excessive deposits of ce- mentum during the victim's lifetime. The fusion of crowns took place in the course of different deve­lopmental stages of the teeth (histodifferentiation), while the fusion of the roots occurred later in life. The analysis of endodontial spaces shows two enti­rely separated endodontial systems formed out of two pulp chambers and two root canals. All of the above described features rule out the possibility of gemination as dental irregularity.365 Acta Stomatol Croat, Vol. 33, br. 3, 1999.

Tooth Morphology as the Basis of Dental Identification: Case Report

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