European Journal of Forensic Sciences

Case Report
www.ejfs.co.uk
DOI: 10.5455/ejfs.205492

Dental human identification using

bitewing radiographs: A case report
Rhonan Ferreira Silva1,2, Ademir Franco3, Fernando Fortes Picoli1,2,
Livia Graziele Rodrigues4, Roberta Gomes Resende5

1
Department of Forensic ABSTRACT
Odontology, Federal
The present study aims to illustrate the usefulness of bitewing radiographs in Forensic Odontology reporting
University of Goias,
Brazil, 2Department of
a case of positive human identification achieved through the comparison between ante-mortem and post-
Legal Odontology and mortem dental data. In 2014, a charred human body was referred for identification at the local medicolegal
Forensic Anthropology, institute. Maxilla and mandible were dissected, enucleated and cleaned for a proper exam. The ante-mortem
Scientific Police of Goias, data consisted of 4 bitewing radiographs and a clinical dental file. The bitewing angulation was reproduced
Brazil, 3Department of post-mortem manipulating both dental arches, enabling a radiographic comparison of dental evidence. Positive
Forensic Odontology, identification was obtained comparing specific morphological and treatment identifiers. The present study
Katholieke Universiteit highlights the importance of adequate management and storage of dental radiographs, which are potentially
Leuven, Belgium, useful for legal purposes.
4
Department of Forensic
Odontology, Federal
University of Goias,
Brazil, 5Department of
Oral Radiology, Brazilian
Association of Dentistry,
State of Goias, Brazil

Address for correspondence:

Rhonan Ferreira Silva,
Av. Universitaria, Esquina
com 1ª Avenida,
Setor Universitario,
Goiania, Goias, Brazil,
postal code: 74605-220.
E-mail:rhonanfs@terra.
com.br

Received: October 18, 2015

Accepted: November 18, 2015
Published: December 20, 2015 KEY WORDS: Forensic sciences, forensic odontology, bitewing radiology, human identification

INTRODUCTION records of potential victims. Positive human identifications are

Dentists play an essential part in complex forensic scenarios,
such as the identification of putrefied and charred bodies as
well as skeletal remains, in which fingerprint analysis becomes
unfeasible [1]. Specifically in charred bodies, the anterior
teeth are often found fragile or destroyed after exposed to a
high temperature. However, the posterior teeth are mostly
preserved by the adjacent soft tissue, such as facial muscles,
buccal mucosa, and tongue [2,3].
Once the human teeth are preserved, they allow for the
registration of post-mortem (PM) data, which will be further
compared with ante-mortem (AM) data collected from dental
achieved when the dental identifiers registered PM match the
identifiers registered AM [4,5].
Considering that radiographic exams are constantly performed
for dental treatment purposes, forensics finds within dentistry
a large database for AM information [6-8]. Bitewing radiograph
arises as a technique used for detailed investigation of dental
crowns and alveolar bone of the posterior teeth. Consequently,
bitewings represent great AM/PM materials for dental human
identifications in the forensic casework. Based on that
the present study aims to report a case of positive human
identification achieved after the comparison of AM and PM
bitewing radiographs of an unknown charred victim.

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Silva, et al.: Bitewings in forensic odontology

CASE REPORT Considering that the local medico-legal institute follows the
parameters of Interpol, dental identification was attempted
In 2014, a charred body found inside a burned-out car was before DNA analysis, which was further considered not
referred for cadaveric examination in the local medico- necessary. Specifically, dental identification consists of a
legal institute. The preliminary medical exam revealed comparative procedure, making necessary AM dental records
that the victim was an adult male deceased due to thermal containing unique dental identifiers [2,3,5,8,10,11]. Currently,
carbonization. panoramic and periapical radiographs figure as the most
common AM radiographic records due to their constant use for
The victim presented charred hands hampering fingerprint treatment interventions in the dental routine [2,3,5,8,10,11].
analysis, making a necessary dental identification. The dental Yet bitewings have more specific clinical importance [13] such
autopsy was performed with resection of maxilla and mandible as: The exam of interproximal surfaces of the posterior teeth, in
through the incision proposed by Luntz and Luntz [9], 1973. operative dentistry; the exam of calculus deposits and alveolar
The orofacial soft tissue was removed, and bones were cleaned bone height, in periodontology; the exam of pulp nodules, in
enabling to observe third molars; anterior teeth with charred endodontics; the exam of cervical adaptation of prosthetic
and fractured crowns; posterior teeth with non-metallic
restorations; and rotation of the mandibular right canine Table 1: Comparison between ante-mortem and post-mortem
[Figure 1]. identifiers and respective outcomes
Tooth* AM (2011) PM (2014) Outcomes
In parallel, police investigations were conducted to retrieve #
13 Sound** Sound SI
any AM data from potential relatives of the victim. The #
14 Caries (D) NM (DO) ED
investigations resulted in a clinical dental file and 4 bitewing #
15 Caries (M) NM (MO) ED
radiographs dated from 2011 [Figure 2]. PM bitewing #
16 NM Class I NM Class I SI
radiographs were performed reproducing the AM data, enabling
#
17 NM Class I NM Class I SI
#
18 NM Class I NM Class I SI
a comparative approach [Figure 3]. #
23 Sound** Fractured crown ED
#
24 Sound** Sound SI
Outcomes of the AM/PM comparison consisted of morphological #
25 Sound** NM Class II ED
and therapeutic similarities in 19 teeth. Five explainable #
26 NM Class I NM Class I SI
differences in 5 teeth were also detected [Table 1]. From
#
27 NM Class I NM Class I SI
#
28 NM Class I NM Class I SI
a qualitative scope, the comparison between radiographs #
33 Sound** Fractured crown ED
highlighted the anatomic pattern of non-metallic restorations #
34 Sound** Sound SI
in the lower left first molar and in the lower right third molar. #
35 Sound** Sound SI
Positive identification was achieved linking the deceased body #
36 NM Class I NM Class I SI
with the missing persons by dental evidence found in bitewing
#
37 NM Class I NM Class I SI
#
38 NM Class I NM Class I SI
radiographs. #
43 Sound** Sound SI
#
44 Sound** Sound SI
DISCUSSION #
45 Sound** Sound SI
#
46 NM Class I NM Class I SI
#
47 NM Class I NM Class I SI
The application and effectiveness of forensic odontology #
48 NM Class I NM Class I SI
for the identification of charred bodies are consolidated
and well supported in the scientific literature and forensic AM: Ante-mortem, PM: Post-mortem, NM: Non-metallic restoration,
O: Occlusal surface, DO: Distal-occlusal surfaces, MO: Mesial-occlusal
practice [2-8,10,11], becoming considered by Interpol as a surfaces, M: Mesial surface, D: Distal surface; SI: Similarities,
primary method for human identification in mass disaster ED: Explainable differences, *FDI’s dental notation, **Considering
environments [12]. radiographically visible dental parts, #tooth number

a b
Figure 1: Occlusal view of maxilla (a) and mandible (b) after resection

32 Eur J Forensic Sci ● Jul-Sep 2016 ● Vol 3 ● Issue 3


Figure 2: Ante-mortem bitewing radiographs dating from 2011
Figure 3: Post-mortem bitewing radiographs dating from 2014
crowns, in prosthodontics; and the exam of anatomic relation
between deciduous and permanent teeth, in pediatric dentistry.
The usefulness of bitewing radiographs for the identification of
charred bodies remains on the fact that bitewings allow for the
optimal visualization of the dental crowns of posterior teeth.
It directly converges with the fact that in charred bodies the
anterior dentition is commonly destroyed by thermal reaction,
and the posterior dentition is protected by the adjacent soft
tissue [11].
Eur J Forensic Sci ● Jul-Sep 2016 ● Vol 3 ● Issue 3
Silva, et al.: Bitewings in forensic odontology
From a legal scope, this information highlights the need
for major clinical attention with the technical process for
radiographic image acquisition, as well as the need for proper
storing and updating dental data.
Similarly to the other modalities of dentomaxillofacial
radiographs, bitewings have essential value as a source of
AM information for human identifications. However, this
technique seems to have major importance for the comparative
identification of charred bodies, once it registers the forensic
evidence found in dental crowns of the posterior teeth, which
are often found preserved in charred victims.
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Source of Support: Nil, Conflict of Interest: None declared.
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