Dental Science - Review Article

Forensic radiology in dentistry

T. Manigandan, C. Sumathy1, M. Elumalai2, S. Sathasivasubramanian3, A. Kannan4

Department of Oral ABSTRACT

Medicine and Radiology,
Radiography can play an important part in forensic odontology, mainly to establish identification. This may take
Sree Balaji Dental College
and Hospital, Bharath the precise form of comparison between antemortem and postmortem radiographs. Radiographs may also be
University, 1Department taken to determine the age of a minor victim and even help in the assessment of the sex and ethnic group.
of Oral Medicine and Comparable radiographs are an essential factor to confirm identification in a mass disaster.
Radiology, Meenakshi
Ammal College and
Hospital, 2Department
of Pharmacology, Sree
Balaji Dental College and
Hospital, Pallikaranai,
3
Department of Oral
Medicine and Radiology,
Sri Ramachandra Dental
College and Hospital,
4
Department of Oral
Medicine and Radiology,
SRM Dental College and
Hospital, Ramapuram,
Chennai, Tamil Nadu,
India

Address for correspondence:

Dr. T. Manigandan,
E‑mail: manident@yahoo.com

Received : 31-10-14
Review completed : 31-10-14
Accepted : 09-11-14 KEY WORDS: Ante mortem, postmortem radiographs, radiography

F orensic radiology has a long tradition in the forensic

sciences. Its history started in 1895 when the first
radiograph was made by Conrad Roentgen. Three years
Uses and utilization of radiology in forensic dentistry

Radiographs have helped to solve difficult cases in the forensic

later, in 1898, postmortem radiographic examination was science.[1-3]
introduced. Forensic radiology, so far as depended almost
exclusively on the X‑ray and the static image captured on Identification of victims
the roetgenogram.
Radiographs are helpful to determine the age of an individual
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by assessing the stage of eruption of teeth. Skull radiographs can
Website: be used in the identification by superimposing on antemortem
www.jpbsonline.org radiograph or photograph. Since frontal sinuses are known for
greatest normal variations among individuals, they are used
DOI: for this purpose. Yoshino et al. have classified frontal sinuses
10.4103/0975-7406.155944 based on size, bilateral asymmetry, superiority of side, outline
of upper borders, presence of partial septa and supraorbital cells

How to cite this article: Manigandan T, Sumathy C, Elumalai M, Sathasivasubramanian S, Kannan A. Forensic radiology in dentistry. J Pharm Bioall Sci
2015;7:S260-4.

 S260 Journal of Pharmacy and Bioallied Sciences April 2015 Vol 7 Supplement 1

and reported a criminal case in which frontal sinus was used to
identify a person.
Sassouni has suggested use of measurements in postero‑anterior
and lateral radiographs of the skull to match the ante and
postmortem radiographs, which includes
• Bigonial width
• Cranial height (from mastoid to vertex)
• Bimaxillary breadth
• Height from bigonial width to temporal crest
• Maximum cranial breadth
• Frontal sinus breadth
• Incisor height
• Facial height.
Evidence in the identification of the suspect
Cases have been reported where suspects were identified
because of fractured tooth parts of victims in the body of the
suspects or fractured tooth of suspect in the victim as in the bite
mark cases. Deliberate alteration in the shape of the teeth in
suspects can be identified with radiographs in bite mark cases.
To determine the cause of death
Radiographs may provide evidence of bullets or foreign bodies in
the soft tissues following firearm incidence and explosion. After
air crash accidents, the cause of the crash may be elucidated by
the presence of radio opaque objects in the soft tissues. This
is due to contamination with molten aircraft metal producing
irregular shaped radio opacity.
To find faulty charting of teeth
Sometimes, while charting postmortem data teeth may be
wrongly numbered especially in cases where adjacent tooth
migrate into the extraction space. This can be connected using
radiographs.
Legal matters
Following injury or assault radiological imaging is commonly
obtained by medical expert interpretation of these images may
provide useful evidence in criminal and civil jurisdiction.
Body identification
Along with dental and DNA analysis, radiographic images are
used in the unknown victims. This requires the securing of
premortem examination e.g.,  Computed tomography  (CT)
scan or radiograph of the suspect individual and the matching
of specific anatomical details with similar postmortem studies.
Postmortem examination
Nortje  (1986) stated “radiographic appearance of teeth and
bone of the face is a permanent record of these tissues even
when teeth and sections of bone are removed for histopathologic
examination.”
Journal of Pharmacy and Bioallied Sciences April 2015 Vol 7 Supplement 1 S261 
Manigandan, et al.: Forensic radiology in dentistry
Nonaccidental injuries of children
Radiology places an important role in diagnosing child abuse.
Accidental cranial fractures in infants are usually simple, linear
and unilateral, affect the parietal bone and do not branch or
cross sutures. Forensic radiologists suggest different techniques
for specific head injury. CT is recommended for detection
of subarachnoid hemorrhages while magnetic resonance
imaging (MRI) is superior in revealing subdural hematomas,
concussive injuries, and shear injuries. CT and MRI are equally
efficient for demonstrative epidural hematoma, and CT
advocated detection of fractures.
Forensic anthropology
Establishing biological age and identification of human
remains are issues addressed by forensic anthropologists.
The most common radiograph used for establishing age up
to 16 years old are dental radiographs and hand radiographs.
Postcranial radiographs of specific ossification centers
depending on the reputed age of the individual are useful
estimating older individual. Panoramic radiographs which
visualize most structures of the jaws and related areas
on a single radiograph, have been advocated for mass screening.
Record keeping
Careful record keeping, in medical facilities and private
practices for as long as feasible, is extremely important. In most
countries, radiographs pertaining to inactive patient’s files are
stored for at least 5 years. Radiographs are generally regarded
as the property of the hospital or office in which they were
produced although the law guarantees patient access to them.
Expert testimony
It is important to remember to present the biological data both
in scientific and layman terms. Before submitting the data
circumstances, the radiographs were produced. The expert
should know if the radiograph is original or a copy and the
whereabouts of the radiographs at all times.
Basic principle used for postmortem radiograph
When a radiograph of postmortem remains is performed to
compare with ante mortem radiograph “Identical projection”
must be achieved with similar magnification, exposure factors,
and angulations so as to reproduce the ante mortem radiograph
like image. This is carried out using various angles of projection
and by varying technical factors.[1-4]
General considerations
Radiograph should be taken before and after head and neck
autopsy. Whenever possible, radiograph should be made at the
scene of accident or crime. They should be properly labeled
with identification number, site, and date of examination for
future reference.
 Manigandan, et al.: Forensic radiology in dentistry
All intra and extra oral projections including panoramic
radiographs have to be taken as and when it is needed depending
on the case and type of remains.
Intra oral radiographs
Intraoral radiographs are difficult to perform particularly
when there is restricted mouth opening. It may be necessary
to remove soft tissues from the floor of the mouth or cheeks to
insert the film. A miniature intraoral X‑ray source may be used.
Resected maxilla may be split through the midpalatal suture.
The posterior mandible and maxilla are placed on occlusal film
to produce an “enlarged bite‑wing film.”
Whenever fragmented remains consisting teeth, restorations,
bone pieces, appliances are recovered they have to be separated
by the method proposed by Johanson.
Johanson’s method
• Place the debris on the plastic grid.
• Place the film on a wire grid identical to the plastic grid.
• From the resultant radiograph type of remaining can be
identified.
Radiographic Techniques Used in Forensic Dentistry
Extra oral radiography
With the oblique – lateral technique, it is necessary to increase
the anode – object distance in order to enlarge the field of
irradiation. The minimum distance is 40 cm which will project
onto the film a 10 cm diameter beam of X‑rays. The exposure
factors using high definition intensifying screens will be 55–60
kVp and 20 mAs [Table 1]. When using faster screens, the
milliampere seconds is reduced.[4]
Panoramic radiographs
The X‑ray tube and film rotate around a stationary patient;
specimens must be elevated in position, articulated, and
oriented with the occlusal line or Frankfort plane parallel to
the ground. A setting of 8 mA at 80 kVp is a good starting
exposure; a previously exposed black film can be placed in the
cassette against the unexposed film to reduce the effect of
intensifying screen.
Investigatory Methods in Forensic Dentistry by
Means of Various Radiographic Interventions
Bite marks
Radiographs may be used to assist in the identification by bite
marks. The impressions are made with dental modeling wax
and cut to size of an occlusal film. The resultant impression
is then filled with radiopaque dental alloy and placed with
occlusal surface downwards on film. The X‑ray beam is
 S262 Journal of Pharmacy and Bioallied Sciences April 2015 Vol 7 Supplement 1
Table 1: Intensity of extra oral radiographs
View kVp mAs Time (s)
PA townes 65 30 0.3
Lateral 55 30 0.3
OM 65-75 60 0.3
PA: Posterio Anterior view, OM: Occipital Mental view
directed centrally at right angles to the object and film. An
anode – film distance of at least 40 cm is recommended to
give more parallel beam.
Comparisons of antemortem and postmortem
radiographs
Antemortem and postmortem radiographs are compared
noting similarities and differences. The most current films are
examined first because they will show the greatest similarity
to the postmortem status of the teeth and jaws. Comparison
is done on
• Number and arrangement of teeth (missing teeth, rotated
teeth, spacing, extra teeth, impacted teeth)
• Caries and periodontal bone loss
• Coronal restorations
• Hidden restorations (posts, implants, root canal fillings)
• Bony pathology
• Dental anatomy
• Trabecular bone pattern
• Anatomic bony landmarks
• Maxillary sinus and nasal aperture
• Frontal sinus.
Age estimation of adults from dental radiograph
With the advancing age, the size of the dental pulp cavity is reduced
as a result of secondary dentine deposit so that the measurements
of this reduction can be used as an indicator of age.[5-9]
Secondary dentine as also been measured indirectly on
radiograph of extracted teeth. Such measurements were
suggested use in nondestructive method to predict the age.
The ratio between pulp and the root has also been used in
age estimation as the size of the pulp is reduced with age.
Radiographs of the middle phalanx of the third finger are taken
to know the skeletal maturation status of the child.
Diversity of dental patterns in the orthopantomography
for human identification
The comparison and antemortem and postmortem dental
characteristics are a commonly applied method to perform
personal identification. Orthopantomography is broadly applied
standard method in dentistry. It provides the complete view of
the teeth and both jaws and one image. Gustafson was the first
to use orthopantomography in forensic practice for the purpose of
identification, according to the theory proposed by Paatero, Rocca
et al. considered orthopantomograms to be the most important
antemortem source of information outside the written treatment

records. The use of orthopantomography is practically applicable
for the identification of victims of mass disasters as well as wars.[4]
Personal identification on the basis of antemortem and
postmortem radiographs
There are many parts of the human skeleton, which because
of their anatomical variability are very applicable to the
identification process. The first authority to point this out was
Schuller, who found that X‑rays of the frontal sinuses are very
good tool for identification.[10,11]
Currently, there are three main comparison methods of personal
identification used in Hungarian forensic practice:
• Examination of dental records
• Superimposition of photographs
• Comparison of radiographs.
New horizons in forensic radiology – multislice
computed tomography
Alternatives to classic autopsy to collect forensically relevant
data the potential of multislice computed tomography can be
used. With this modern method, the scan time for a full body
examination with a gunshot wound to the head is approximately
60 s. This method is rapider, based on nondestructive
documentation process and in some respects is more precise
than the standard forensic autopsy.[12-14]
Dental Computed Tomography Screening Tool for
Dental Profiling
The newer CT imaging based software called  Dentascan (GE
Health care, UK)  used for identification purpose. Using the
Dentascan software, reformatted panoramic images could
be reconstructed for each case that was compared to the
antemortem dental periapical radiographs, bite‑wing films, and
panoramic radiograph.[15]
A reformated panoramic overview created by Dentascan delivers
in a noninvasive way to overview jaws showing basic components
of teeth,  (enamel, dentin, pulp) anatomic structures of
alveolar bone  (mandibular nerve canal or floor of nasal
cavity and maxillary sinus), pathology (caries, radiolucencies,
radio‑opacities, or position of third molars), and restorations.
The most important advantage of Dentascan in contrast
to classical methods is that documentation can be made
noninvasive and digital way without jaw resection, which is often
performed to facilitate classical radiological documentation on
decomposed, charred, and mutilated corpses.
Identification of skull by its suture patterns
The examination of 320 skulls collected at random revealed
ectocranial suture patterns in them are highly individualistic
and that no two skulls can ever have an identical pattern. The
possibility of the suture patterns being recorded incidentally in
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Manigandan, et al.: Forensic radiology in dentistry
routine diagnostic skull radiograph was verified by examining
the skull skiagrams preserved in the radiology department and
can be more effectively used in personal identification problems.
A positive method of identification of the skull is suggested by
the comparison of radiographic with visible skull suture pattern.
The added advantage in the process of identification through
suture pattern is that they cannot be altered or destroyed in
case of finger ridges.[16]
Individual identification by means of conventional
bite‑wing film and subtraction radiography
The digital subtraction technique used in clinical trials for the
evaluation of small tissue changes. It may, however, also be able
to determine hard tissue similarities for use in forensic dentistry.
Principle of digital subtraction included features for correction
of variations in exposure geometry and density. Subtractions
were performed between identical images (images of the same
individual) and between nonidentical images (images of two
different individuals).[17,18]
Bite‑wing radiography is considered as a good candidate for
potential victim identification [Figure 1]. A quantitative analysis
of subtraction images based on bite‑wing radiographs as recently
been reported. The subtraction images derived from identical
photographs significantly more homogenous than those derived
from nonidentical radiographs originating in individuals with
and without simple dental restorations.
Sex determination by lateral radiographic cephalometry
In general, male skulls are identifiable by being more robust.
Female skull is characterized by weaker development of its
super‑structures. All bony ridges, crests, and processes are
smaller and smoother in the female skull than in the male
skull, especially true for the temporal line, mastoid processes,
nuchal lines, external occipital protuberance, and superciliary
arches. Sella to nasion, Frankfort horizontal place and basion to
nasion as reference lines or planes are commonly used in lateral
radiographic cephalometric analysis. Thus, morphometric traits
a
b
Figure 1: (a) Antemortem bite-wing radiographs (b) Postmortem lower
bite-wing radiographs
 Manigandan, et al.: Forensic radiology in dentistry
of the skull super‑structures and intracranial structures are
easily assessed. This enables us to use them as morphometric
variables.[19]
X‑ray screening system at a mass disaster
A security scanning system known as line scan unit was used
which allows screening where space may be limited. They
operate on 105–125 VAC, and the X‑ray voltage is 160 kVp.[20]
Summary and Conclusion
The radiological identification of individual human remains
depends entirely on matching specific and unique visual findings
or features on both ante mortem and postmortem radiological
images of that person. Postmortem findings confirming the sex,
age, stature, or race may be either confirmatory or exclusionary.
Dental identification is also scientific, relying on the patterns of
missing, filled, and decayed teeth as well as anatomic variation
of the teeth, jawbones, and sinuses. Teeth and bones are also
durable, surviving decompositional and destructive forces.
The decedent’s teeth are compared to ante mortem written records
although the most accurate and reliable method is by comparison
of ante mortem and postmortem records. Unlike subjective
records, which lack detail and can include errors, radiographs
supply objective data through precise recording of unique
morphology of dental restorations and dento – osseous anatomy.
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Source of Support: Nill, Conflict of Interest: None declared.
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