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Review Article

Forensic radiology: An emerging tool

in identification
Raghav Kumar, Appaji Athota, Trisha Rastogi, Sunil Kumar Karumuri
Department of Oral Medicine and Radiology, DJ College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India

ABSTRACT

In any mass disaster condition, identification of the person is most important. For this purpose, the forensic investigators
use different methods for identifying the dead. They consider skeletal remains of the dead as the initial step in identification.
Radiographs carry great evidence to act as antemortem records and also assist in identifying the person, age, gender,
race, etc. Forensic dentistry is also emerging as a new branch in forensics. So, the forensic dentist must be aware of
different techniques, developments, and resources to incorporate the technology in order to achieve success in human
identification. So, our aim of the present review is to focus on different radiological techniques and new developments
available for successful identification of the dead.
Key words: Antemortem, forensic radiology, identification, postmortem, radiographs

Introduction be used if the remains are burnt, decomposed, mutilated,

and destroyed. In the human body, teeth and facial

I
n spite of the fast growing technology and modern
advancements, human race is still facing problems
due to natural disasters (earthquakes, tsunamis),
medical breakthroughs, crime, and violence, taking
many lives. Very little can be done to repair such
damage. The main motto of identifying the dead
is for personal, social, and legal purposes. Forensic
science deals with the identification of the dead using
numerous techniques. Forensic odontology has a lot of
scope in human identification. Methods like rugoscopy,
bite marks, palatal rugae, photographs, lip prints, etc.
are used for identifying the individuals.[1]
bones are resilient and withstand the decompositional/
destructional forces well even under extreme forces and/
or temperature variations. As radiographs are able to
capture their distinct anatomical features, they become
an invaluable tool in forensic sciences. Radiographic
identification has long been in use and the technique is
efficient, comparatively easy, records can be obtained
in both living and dead, and is economical than DNA
technology. [2] So, expertise knowledge and proper
application of maxillofacial radiological techniques has
a valuable role in forensic identification and solving
medico-legal cases.[3,4] Now-a-days, forensic radiology

Most of these methods rely largely on the preservation of This is an open access article distributed under the terms of the
Creative Commons Attribution-NonCommercial-ShareAlike 3.0
soft-tissue components of the body in question and cannot
License, which allows others to remix, tweak, and build upon the
Access this article online work non-commercially, as long as the author is credited and the
new creations are licensed under the identical terms.
Quick Response Code:
Website: For reprints contact: reprints@medknow.com
www.jiaomr.in

DOI: How to cite this article: Kumar R, Athota A, Rastogi T, Karumuri

10.4103/0972-1363.170478
SK. Forensic radiology: An emerging tool in identification. J Indian
Acad Oral Med Radiol 2015;27:416-22.

Address for correspondence: Dr. Sunil Kumar K., Department of Oral Medicine and Radiology, DJ College of Dental Sciences
and Research, Modinagar - 201 204, Uttar Pradesh, India. E-mail: drsunilkarumuri@gmail.com
Received: 29-07-2015  Accepted: 17-11-2015  Published: 25-11-2015

416 © 2015 Journal of Indian Academy of Oral Medicine and Radiology | Published by Wolters Kluwer - Medknow
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Kumar R et al.: Forensic radiology
is evolving as a branch of forensic dentistry, in which
radiographs play a vital role in identification of the
dead. In this review, the authors attempt to sensitize
the readers regarding the scope of oral radiology in
forensic science.
Historical Milestones in Forensic Radiology
• 1895 – Discovery of X-rays by Wilhelm Conrad
Roentgen.
• 1896 – Prof. Arthur Schuster used X-rays to visualize
the lead bullets in the head of a dead person.[5]
• In October 1898 issue of the American X-ray Journal,
Dr. Fovau d’Courmelles wrote, “Knowing the
existence of a fracture in a person who has been
burned or mutilated beyond recognition, we can
hope to identify him by the X-ray.”[6]
• In 1921, Schuller compared the radiographs of the
frontal sinuses.[7]
• In 1927, Culbert and Law described the complete
radiological identification of the skull by using
pneumatic cells of the sinuses.[7]
• In 1991, Happonen et al. recommended the use
of orthopantomography in identification, which
enables visualization of the jaws and related
structures as a single radiograph. In the same
year, Haerting et al. stated that panoramic dental
radiography is the only regularly updated and
“truly reliable identification card” for comparison
radiography.
• Radiology was also applied in the identification
of celebrities like Theodore Roosevelt and Adolph
Hitler.
• Forensic radiologists had been using the
traditional methods for capturing the images.
With the advancement of technology, newer
armamentarium like NOMAD (portable hand
held X-ray generating device manufactured
by Aribex, Charlotte, North Carolina, USA),
computed tomography (CT), cone beam computed
tomography (CBCT), multidetector CT (MDCT),
and magnetic resonance imaging (MRI) are
gradually replacing the traditional ones.
Forensic Identification
Identification is a process which involves different
procedures and techniques to confirm an object or person
in both living and deceased conditions.[5] The conditions
that demand identification are:
• Medico-legal cases.
• Natural disasters like tsunamis, earthquakes,
explosions, etc.
• For confirming death in monetary issues.
• Religious and social purposes.
Journal of Indian Academy of Oral Medicine & Radiology | Jul-Sep 2015 | Vol 27 | Issue 3
Following are the various methods of identifying the
person using dental/oral radiographs as a main tool.
Dental Identification
When a body of a person is available in a burned,
decomposed state, any dental remains of the person,
such as restorations, teeth present, any missing teeth,
and prosthesis, play a major role in identifying the dead.
Teeth (max. 1000°C) and dental restorations (acryclic
540°C, gold and amalgam 870°C, porcelain 1100°C)
are resistant to destruction by fire and, therefore,
useful in identification. Dental identification is based
on comparison and exclusion of the radiographs
exposed prior to death (antemortem) to those exposed
after death (postmortem). This data is assessed based
on factors like teeth present, teeth missing, crown
structure, root morphology, pulp anatomy, occlusion,
wear and tear of tooth structure, pathology, different
treatment procedures, etc. Proper comparison and
interpretation of these factors leads to successful
identification.[3,8]
The American Board of Forensic Odontology (1986)[9]
has given the following four situations regardless of
the factors and methods used in comparing ante- and
postmortem radiographs:
1. Positive identification: Comparable items are
sufficiently distinct in the ante- and postmortem
databases; no major differences are observed.
2. Possible identification: Commonalities exist among
the comparable items in the ante- and postmortem
databases, but enough information is missing from
either source to prevent the establishment of a
positive identification.
3. Insufficient identification evidence: Insufficient
supportive evidence is available for comparison and
definitive identification, but the suspected identity of
the decedent cannot be ruled out. The identification
is then deemed inconclusive.
4. Exclusion: Unexplainable discrepancies exist among
comparable items in the ante- and postmortem
databases.
Anatomical Identification
Schuller[10] had given a classification using frontal sinus
radiography taken in the forehead-nose position for
assessing sex and race. He proposed seven characteristics
of radiographs:
• Septum and its deviation.
• Upper border.
• Partial septum.
• Ethmoidal and supraorbital extensions.
• Height from planum.
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Kumar R et al.: Forensic radiology
• Total breadth.
• Position of sinus midline.
Some typical features of frontal sinus morphology are its
highly variable nature even in genetically identical twins,
which was proven by Christensen,[11] stable structure
in the adult period, and its resilient structure with
strong bony walls, which protects them from damage
and decomposition.[12] It has high fracture resistance;
a minimum of 800-1600 foot pounds is required to
fracture the frontal sinus. It is helpful in identifying
the persons who are victims of high-impact accidents
or gunshot wounds.[13] Cox et al. reported in 2009 that
superimposition of an antemortem radiograph of the
suspected victim’s frontal sinuses over a postmortem
radiograph helped to make correct identification in
100% of cases.[11]
Dental Profiling
It is a way to recreate the deceased person’s profile prior
to death based on clinical and radiological data available.
Dental radiology helps in assessing the angulation of
anterior teeth that are lost after postmortem, and also
examination of sockets aids in number and alignment of
teeth.[14] Ante- and postmortem radiographic comparison
also helps in dental profiling. Unusual dental anatomy
like mandibular premolars which show high variations
in the pattern and number of grooves and cusps helps
in comparison. [15] Radiovisiography allows spatial
resolution of the images and helps in the precise analysis
of the structures on ante- and postmortem images. It also
reduces the number of new exposures, record keeping,
and comparison of these images is made easy.[15] The
information provided by the antemortem CT image can
be utilized in fabrication of the postmortem profile, so
that the craniometric points can be accurately located
and measured.[16]
Medico-legal Cases
Forensic radiology helps in determining the cause of death
(accident or intention). The radiographs can interpret the
Table 1: Skeletal anthropologic variations associated with racial characteristics of the skull
Parameter White
Width Narrow
Height High
Profile Straight
Orbit Triangular/tear drop
Shape Rounded
Face Small
Nasal opening Tapered
Palate Narrow
Inter-orbital distance Narrow
418 Journal of Indian Academy of Oral Medicine & Radiology | Jul-Sep 2015 | Vol 27 | Issue 3
point and direction of impact. Strangulation is indicated
by broken thyroid cornua or hyoid bone. Metabolic
abnormalities, infections and dietary deficiencies, and
bleeding disorders may leave signs on the bones that can
be seen radiographically. Radiographs provide evidence
of foreign bodies or bullets present in soft tissues due to
mass disasters. CT and CBCT can be used in assessing
the degree of wound in cases of skull injury.[17,18]
Racial and Gender Determination
Forensic dentists along with forensic anthropologists
analyze the calcified structures of the body like bones
and teeth. This aids in determining the race and gender
of the deceased persons. [19,20] Important features in
identifying the race and gender are tabulated in Tables 1
and 2, respectively.
Cranio-facial Reconstruction
Cranio-facial reconstruction (CFR) is considered when no
ante- and postmortem data is available of the unknown
person. It is widely used in anthropology, medicine,
and forensic dentistry. The progress made in computer
science and computer software programs on medical
imaging techniques allows the superimposition of known
and unknown skull radiographs. As the clinical use of
cross-sectional imaging methods such as CT and MR
has increased, many forensic dentists also have begun
to evaluate these technologies as potential tools in CFR.
The use of CT has evolved into the “virtual autopsy” (or
“virtopsy”) concept. This involves a complete forensic
investigation using CT and MR imaging combined with
3D reconstruction and postprocessing. The images are
taken before the conventional autopsy begins. New
MDCT scanners increase the volume acquisition of data
sets along the same axis, which may be measured in
two and three dimensions. The resulting reconstruction
closely resembles standard autopsy.[21,22]
MDCT is effective in evaluating projectile entry
and exit locations, path, and associated tissue
injury to characterize penetrating and perforating
Black Asian/native American
Narrow Broad
Low Intermediate
Prognathic Intermediate
Square Circular
Narrow and elongated Square
Maxilla and mandible prognathic Large and flattened
Wide Rounded
Wide Intermediate
Wide Intermediate
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Kumar R et al.: Forensic radiology

Table 2: Sexual dimorphism

Characteristics Male Female
Skull size Larger Smaller
Supraorbital ridge More pronounced Less pronounced
Orbits Square, lower, smaller with rounded margins Round, higher, larger, sharp margins
Forehead Steeper, less rounded Vertical, round
Fronto-nasal junction Distinct angulation Smoothly curved
Condyles Larger Smaller
Cheek bone Heavily, laterally arched Lighter, more pronounced
Zygomatic arch More pronounced Less pronounced
Gonial angle Less obtuse, prominent More obtuse
Palate Larger, broader, prominent Smaller, parabola shaped
Frontal sinus More developed Less developed
Nasal aperture High and narrow margins Lower and broader
Mandible size Larger Smaller
Ascending ramus Greater breadth Smaller breadth
Body height Greater at symphysis Smaller at symphysis
Chin Square Rounded

injuries. The method has limitations compared presented to the English parliament.[24] Age estimation
with clinical application, such as the inability can be done by various factors like:
to use contrast to better distinguish among soft • Jaw bones.
tissues and vascular structures. MDCT is usually • Tooth germs.
performed in the supine position, which can affect • Process of mineralization.
projectile tracks and organ shifts. However, the • Stages of crown development, completion and their
technique is noninvasive and potentially can enhance eruption into oral cavity.
investigations. [23] • Volume of pulp chamber.
• Third molar development and eruption pattern.
Digital Radiography in Forensic Odontology • Root morphology.

Digital radiography when used along with dental
matching software fastens the forensic victim’s
identification. Also, digital radiography reduces the
exposure times by requiring 90% less radiation than that
required to expose a standard type D film radiograph
and 50% less radiation than that required in exposure
of type E film radiographs.
Digital Photography
The various digital photography equipment include
through-the-lens (TTL), light-metering, and single-lens
reflex (SLR). The Scientific Working Group on Imaging
Technology (SWGIT) provides the imaging guidelines
for forensic radiologist with information regarding the
limitations and parameters imposed by the judicial
system for manipulation of digital photographic
evidence.
Age Estimation
Estimating age is the most important prerequisite for
identification of the dead. Historically, the first age
assessment using teeth was done by Edwin Saunders
in 1837 in a paper titled “Teeth A Test of Age” that was
Age estimation methods may be classified as:[25]
1. Age estimation methods for the forming dentition.
2. Age estimation methods for the adult dentition.
Methods of age estimation may also be classified based
on the techniques used:
1. Clinical or visual examination.
2. Radiographic examination.
3. Histological and biochemical methods.
There are different techniques and methods of age
estimation given by different authors. Here, we discuss
some of the important methods utilizing radiography.
1. Schour and Masseler (1941):[26] Their work is based
on the studies done by Logan and Kronfield (1933).
Schour and Masseler proposed 21 chronological steps
from 4 months to 21 years of age [Figure 1]. They did
not propose any method for males and females.
2. Demirjian et al. (1973):[27] They have developed a
system for estimating the chronologic age based on
eight stages of tooth development as follows:
A: Cusp tips mineralized, but not yet closed.
B: M ineralized cusps are united, so the mature
coronal morphology is well defined.
C: C rown is about half formed, pulp chamber is
evident, and dentin deposition is occurring.

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Kumar R et al.: Forensic radiology

Figure 1: Dental chart given by Schour and Masseler (American Dental Association, 1982)

D: Crown formation is complete up to dentino-
enamel junction; pulp chamber has a trapezoid
form.
E: Formation of inter-radicular bifurcation has
begun; root length is less than crown length.
F 1: Root length is at least as great as crown length;
root has funnel-shaped ending.
F 2: Root length is at least twice the crown length;
still the root has funnel-shaped ending.
G: Root walls are parallel, but apices remain open.
G 1: Root walls are parallel, but apices are not entirely
closed. Periodontal ligament (PDL) space at
apical ending is ≥1.0 mm.
H: Apical ends of roots are completely closed and
PDL has uniform width around the root.
Willems,[15] in the year 2001, modified this method.
He directly calculated the scores for expressing age
in years and also eliminated the conversion step
from maturity index to dental age, making it easier
and simple.
3. Nolla’s technique: Mineralization patterns of
permanent teeth were used in 10 stages for assessing
the age. Maxillary and mandibular teeth were used
with or without the presence of third molar.
4. Kvaal method: This method is based on the ratio of
pulp to tooth. Six maxillary and mandibular teeth
were used. The formula given by Kvaal et al. is:
Age = 129.8 – (316.4 × M) (6.8 × (W − L))
where in the following parameters are measured and
calculated: Maximum tooth length, pulp length, root
length on mesial side of teeth, pulp width at level
a [cementoenamel junction (CEJ)], level c (midroot
level), and level b (midpoint of c and a), root width
at level a, level c, and level b, root length/tooth
length ratio (T), pulp length/tooth length ratio (R),
pulp length/root length ratio (P), pulp width/root
width ratio at level a (A), pulp width/root width
ratio at level b (B), pulp width/root width ratio at
level c (C), mean values of all ratios (M), mean value
of width ratios from levels b and c (W), mean value
of length ratios P and R (L), and difference between
W and L (W – L).
5. Van Heerden method: [28] This method uses third
molar for age assessment in adults. He studied
mesial root of third molar in five stages [Table 3]
using panoramic radiographs. Males and females
were studied independently with no significant
differences between them.
Other Uses of Forensic Radiography
As early as the 19th century, the French customs service
was using fluoroscopy to image contraband in smugglers.
Imaging may detect packages in body cavities; advanced
techniques, such as CT, have proven more useful in
detecting modern packaging.[29] Smuggled drugs may

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Kumar R et al.: Forensic radiology
Table 3: Stages of mesial root of third molar in Van Heerden method
Stages Description
Stage 1 Crown complete, radiographic evidence of root formation
Stage 2 Root length >1/3 <1/2
Stage 3 Root length >2/3, but not complete
Stage 4 Root fully formed with open apex
Stage 5 Apex closed
be incidental findings when patients who have been
assaulted or victims of motor vehicle accidents are
imaged. Imaging has also been used to detect other
ingested materials and to identify nonballistic material in
the body, such as knife blades and needles. Radiographic
methods also have been used to detect art forgeries.
Advanced imaging techniques not only have improved
forensic investigation, but also have provided more
powerful and informative exhibits for jurors.[30]
Neuroimaging may be used as evidence to support
mental health expert testimony. A defense expert used
a CT scan of John W. Hinckley’s brain to support the
notion that he suffered from schizophrenia when he
attempted to assassinate former president Ronald
Regan. Functional neuroimaging techniques such as
positron emission tomography can demonstrate blood
flow changes that are associated with changes in neural
activity. Functional neuroimaging evidence has been
used in criminal cases to support insanity defenses,
claims that a defendant was incompetent to stand trial,
or for pleas of leniency in sentencing; the imaging
information is an adjunct to behavioral and clinical
data.[31]
A new revolution is using diagnostic imaging modalities
like dual X-ray absorptiometry (DEXA) for measuring bone
mineral density (BMD) and bone mineral content (BMC)
in forensic identification. Measuring the bone density has
many uses like calculating the body mass index, bone
length, composition, bone structure, and neutral density in
various body parts. The use of DEXA in measuring bone
density is well established in the field of diagnostic imaging
for pathologies like osteoporosis, osteomalacia, etc. A lot
of field research and studies are conducted to apply this
newer modality in the field of forensic anthropology and
for identification of skeletal remains.[32,33]
Conclusion
Forensic radiology has humble and ancient origins.
Ancient writings have provided evidence that medical
principles have been applied to legal issues for thousands
of years. It was not long after Roentgen discovered “a
new kind of ray” that innovative forensic scientists
established its value in forensic science. Professor
Roentgen furnished the tool; the imagination and
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Length (mm) Age (y)
3.5-5.3 16.8-16.9
7-8.6 17.5
10-12.9 17.8-17.9
12-15.4 18.4-18.5
diligence of many scientists to follow resulted in X-ray’s
myriad uses. Radiologic imaging is better defined as
the practice that lies at the many interfaces of medicine
and law. Radiologic imaging plays a vital role at many
of those intersections, from the identification of dead to
the authentication of priceless art.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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