RD 1.

1
RADIOLOGY FORENSIC
Trelia Boel
Forensic science is a unique discipline requiring its
practitioner to have, in addition to technical skill
communication skills, and an awareness of the role
of the scientist in our criminal justice system.
The American Academy of Forensic Sciences
(AAFS) lists nine primary disciplines in the field of
forensics:
criminalistics
engineering sciences
jurisprudence
odontology,
pathology/biology
physical anthropology
psychiatry/behavioral sciences
questioned documents, and toxicology.
 The multidisciplinary nature of forensic medicine
necessitates a team approach. The forensic
pathologist is most often the leader of that team
and is typically the only physician devoted full-time
to forensic activity.
The word forensic is derived from the Latin forens, which
translates to “public.”

The word forensics is defined as “characteristic of, or

suitable for a law court, public debate, or formal
argument.”

Therefore, forensic science applies highly specialized

scientific and/or technical knowledge to answer questions
with regard to civil and criminal law. When medical facts
and knowledge are required to deal with legal issues, the
special discipline is referred to as forensic medicine.
The definition of forensic medicine is broad, to
encompass of legal issues in which it is applied.
These include age determination, assault, civil rights
violations, inheritance, larceny, malpractice,
parentage, personal injury, product liability, sexual
offenses, smuggling, virginity, and wrongful birth or
death.
Legal medicine is defined as “the application of
medical knowledge to the administration of law
and to the furthering of justice and, in addition,
the legal relations of the medical man.” Therefore,
in addition forensic pathology, the terms legal
medicine, or medical jurisprudence, may be used
synonymously with forensic medicine.
 Radiologic Techniquesin Forensics
Forensic radiology : Konventional and digital the x-ray and
The newer modalities, such as computed tomography (CT)
and magnetic resonance imaging (MRI). Problems of
accessibility and cost have kept newer techniques, so
extensively used in clinical practice, from widespread use
in forensics

The forensic radiologist is an essential member of the

forensic team. Forensic radiology encompasses the
performance, interpretation, and reporting of radiological
examinations and procedures connected to the courts and
the law. By its nature, the science of radiology solves
mysteries as it reveals secrets that may be hidden within
the body.
 SCOPE of FORENSIC RADIOLOGY
Radiological identification depends in the early stages on
general biomedical knowledge and utilization of various
standards and tables in establishing the basic issues such
as animal vs. human remains, commingling, age, sex, and
stature.

Radiological determination of individual identity may be

presumptive upon demonstration of preexisting
injuries,illness, or congenital and/or developmental
peculiarities . Positive radiological identification requires
direct comparison of ante-mortem and post-mortem
images of thebody or its parts
Scope of Forensic Radiology

I. Service
A. Determination of Identity
B. Evaluation of Injury and Death
1. Accidental
2. Nonaccidental
a. Osseous injury
b. Missiles and foreign bodies
c. Other trauma
d. Other causes
 C. Criminal Litigation
1. Fatal
2. Nonfatal
D. Civil Litigation
1. Fatal
2. Nonfatal
E. Administrative Proceedings

II. Education
III. Research
IV. Administration
Scope of Forensic Dentistry

Forensic dentistry, simply defined, is the application

of dental knowledge to the legal system. The purview
of forensic dentistry can be divided into four main
areas:

1. Identification of unknown human remains.

2. Analysis of bitemarks.
3. Interpretation of oral and maxillofacial lesions in
clinical forensic cases such as child, spouse, and elder
abuse.
4. Dental jurisprudence (expert witness testimony,
malpractice, and self-policing of the profession).
In 1923, the first practical x-ray machine for dental use
was introduced. Film for intraoral radiographs was
developed 10 years earlier by Kodak. Each film had to
be hand wrapped.

The earliest case of an identification on an unknown

decedent made through comparison of sinuses in skull
radiographs was published in 1926.

The first reported use of dental radiography in a

forensic identification occurred in 1943
Dental radiology was used to help identify 72 of the
119 victims who perished in the 1949 fire on board
the steamship Noronic which burned in Toronto.

Today, radiographs are routinely used to identify

unknown decedents, individually and in mass
disasters, and have confirmed identifications in such
notable cases as Adolf Hitler, Josef Mengele, and Lee
Harvey Oswald.
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. This, combined
with the fact that some form of preexisting
record of the dentition exists on most people,
makes the dentognathic complex well suited for
identification.
Radiographs in Dental Identification

Dental identification is a comparative

technique; the dentition of the decedent is
compared to dental records of a suspect.
Sometimes the decedent’s teeth are compared
to antemortem written records although the
most accurate and reliable method is by
comparison of ante-mortem and post-mortem
radiographs.
Unlike subjective records which lack detail and can
include errors, radiographs supply objective data
through the precise recording of the unique
morphology of dental restorations and dento-osseous
anatomy. A written notation of a filling is of low
specificity because other people have similar fillings. A
radiographic rendition of that filling, however, shows
its specific..
The uniqueness of a filling’s shape is derived from
the fact that it is hand carved by the dentist so
that no two are alike. When fillings or teeth are
not present, radiographs are particularly
important because the written dental record is not
likely to have any useable information but the
radiographs are apt to show distinctive anatomy
Limitations of Dental Radiography
A radiograph represents two-dimensional shadows of
three-dimensional objects. Fillings on the cheek side of a
tooth cannot be distinguished from those on the tongue
side. Fillings can be obscured by superimposition of other
fillings in the same tooth. The various metals used in
dentistry cannot be distinguished; all are radiopaque.

A dentist, however, would recognize outline patterns

associated with the various metals. Radiolucent areas in
teeth can represent decay, nonmetallic esthetic fillings,
congenital defects, physical/chemical injuries, or artifacts.
Differentiation of these conditions is important yet
radiographically difficult. Artifacts and disparities
produced by improper angulation, orientation,
exposure, processing, labeling, and storage present
potential difficulties which must be controlled. These
will be discussed.

Radiolucent areas in teeth can represent decay,

nonmetallic esthetic fillings, congenital defects,
physical/chemical injuries, or artifacts. Differentiation of
these conditions is important yet radiographically
difficult.
Objectives in Radiographic Comparisons
The objective of using radiographs in identification is to
compare and evaluate similarities between ante-mortem
and post-mortem films. The tasks for the forensic
investigator include six steps:
1. Securing ante-mortem radiographs
2. Making post-mortem radiographs
3. Comparing meaningful features (those which are stable
and distinctive)
4. Accounting for discrepancies
5. Assessing uniqueness
6. Verbalizing the degree of confidence in the
identification
Dental Terminology

The following terms describe anatomic locations on teeth

Mesial — Distal — Buccal — Lingual — Occlusal — Incisal
Cervical — Proximal — Interproximal — in-between two
teeth

Fillings are named for the surfaces filled. For instance:

O = occlusal filling
MOD = multisurface filling extending onto the mesial,
occlusal, and distal surfaces
B = buccal
Resected jaw specimen with full dentition numbered
according to the Universal System. Labels coded as
follows:
Surfaces,
M — mesial, D — distal, B — buccal, L — lingual,
I — incisal, C — cervical;

Fillings,
O — occlusal amalgams in 14, 15, and 19, OL —
occlusolingual
amalgams in 3 and 14, MODL — amalgam covering
mesial, occlusal, distal and lingual surface in 30, B —
buccal amalgams in 19 and 30.
The Universal System is most commonly used in the
U.S. It numbers permanent teeth from 1 to 32,
beginning at the maxillary right third molar (#1),
extending across the maxilla to the left
third molar (#16), continuing at the left mandibular
third molar (#17), around the mandibl
arch to the right third molar #32 / In like manner, the
20 decidoous (baby) teeth are indicated by letters A–
T
• The Universal System for designating the
32 permanent and 20 deciduous teeth
Panographic radiograph showing landmarks,
restorations, and pathology. Labels are coded as
follows:

Landmarks (1) mandibular canal (2) mandibular

foramen (3) mental
foramen (4) external oblique ridge (5) coronoid
process (6) condylar neck (7) condylar head (8)
sigmoid notch (9) glenoid fossa (10) maxillary sinus
(11) zygomatic arch (12) hard palate (13) ,dorsal
rongue (soft tissue density) (14) soft palate (soft tissue
density);
Restorations (A) “kissing” mesial and distal non-
metallic moderately opaque fillings within
adjacent teeth (B) gutta percha root canal fillings
(C) silver point root canal fillings (more opaque)
(D) gutta percha root canal fillings in teeth with
metallic posts (E) four metal bridges, one in each
quadrant, each consisting of three abutments, and
one pontic to replace a missing first molar;

Pathology (F) large periapical radiolucency under

tooth #28 (G) several radiopaque areas of sclerotic
bone in the #19 healed extraction site.
Pic mandible :
Note the following: Tooth 1— extracted;Tooth 3—
two amalgam fillings;Tooth 4—lost post-
mortem;Tooth 30— buccal pit caries seen clinically
in A as a black spot (arrow) and in B as a darkening
in the crown (arrow);Tooth 32— occlusal carious
destruction of crown
Comparison
Ante-mortem and post-mortem radiographs are
compared, noting similarities and differences. Some
similarities are commonplace or nonspecific and are of
low discriminating value. Others might be so distinctive
as to ensure uniqueness. Likewise, apparent differences
between ante-mortem and post-mortem radiographs
might be explainable and sensible while others are
incompatible and rule out the putative victim as the
decedent.
A total file of recovered ante-mortem radiographs
might contain multiple series of full-mouth, bitewing,
and panographic radiographs spanning many years.
The most current films are examined first because they
will show the greatest similarity to the postmortem
status of the teeth and jaws.
 What to Compare
Number and arrangement of teeth (missing teeth, rotated
teeth, spacing, extra teeth,impacted teeth)
• Caries and periodontal bone loss
• Coronal restorations (visible in or on the crown)
• Hidden restorations (bases under fillings, pins, root canal
fillings, posts, and implants)
• seen only radiographically
• Bony pathology
• Dental anatomy
• Trabecular bone pattern and crestal bone topography
• Nutrient canals
• Anatomic bony landmarks
• Maxillary sinus and nasal aperture
• Frontal sinus
Ante Mortem Post mortem
A ntemortem Post
mortem
Postmortem (September 1990) Antemortem (August 1985)
Features examined during the comparative dental
identification. This extensive list represents the complexity
of these cases, particularly in those instances in which
restorative treatment is absent or minimal
Teeth • c. Lost postmortem
• Teeth present Tooth type
• a. Erupted • a. Permanent
• b. Unerupted • b. Deciduous
• c. Impacted • c. Mixed
Missing teeth • d. Retained primary
• a. Congenitally • e. Supernumerary
• b. Lost antemortem
 Tooth position
• a. Malposition
Crown morphology
• a. Size and shape
• b. Enamel thickness
• c. Contact points
• d. Racial variations
Crown pathology
• a. Caries
• b. Attrition, abrasion, erosion
• c. Atypical variations, enamel pearls, peg laterals etc.
• d. Dentigerous cyst
 Root morphology
• a. Size
• b. Shape
• c. Number
• d. Divergence of roots
Root phatology
• a. Dilaceration
• b. Root fracture
• c. Hypercementosis
• d. Root resorption
• e. Root hemisections
Pulp chamber/root canal morphology
a. size, shape and number
b. Secondary dentine
Pulp chamber/root canal pathology
a. Pulp stones, dystrophic calcification
c. Root canal therapy
d. Retrofills
e. Apicectomy

Periapical pathology
a. Abscess, granuloma or cysts
b. Cementomas
c. Condensing osteitis
 Dental restorations
1. Metallic
• a. Non-full coverage
• b. Full coverage
2. Non-metallic
• a. Non-full coverage
• b. Laminates
• c. Full coverage
3. Dental implants
• 4. Bridges
• 5. Partial and full removable prosthesis
 Periodontal tissues
Gingival morphology and pathology
• a. Contour, recession, focal/diffuse,
enlargements, interproximal craters
• b. Colour – inflammatory changes, physiological
(racial) or pathological pigmentations
• c. Plaque and calculus deposits
Periodontal ligament morphology and pathology
• a. Thickness
• b. Widening
• c. Lateral periodontal cysts and similar
 Alveolar process and lamina dura
• a. Height, contour, density of crestal bone
• b. Thickness of interradicular bone
• c. Exostoses, tori
• d. Pattern of lamina dura
• e. Bone loss (horizontal/vertical)
• f. Trabecular bone pattern and bone islands
• g. Residual root fragments
 Anatomical features
Maxillary sinus
• a. Size, shape, cysts
• b. Foreign bodies, fistula
• c. Relationship to teeth
Anterior nasal spine
• a. Incisive canal (size, shape, cyst)
• b. Median palatal suture
Mandibular canal
• a. Mental foramen
• b. Diameter, anomalous
• c. Relationship to adjacent structures
Coronoid and condylar processes
a. Size and shape
b. Pathology
Temperomandibular joint
a. Size, shape
b. Hypertrophy/atrophy
c. Ankylosis, fracture
d. Arthritic changes
Other pathologies
a. Developmental cysts
b. Salivary gland pathology
c. Reactive/neoplastic
d. Metabolic bone disease
e. Focal or diffuse radiopacities
f. Evidence of surgery
g. Trauma – wires, surgical pins etc.
Periapical radiograph of the four lower incisors showing the
pulp chamber (PC) and root canal (RC), lamina dura (L), and
periodontal membrane space (P).
 Comparison of Comparison A ante-mortem dental
radiograph, with B. : post-mortem radiograph of
disarticulated mandible. There is a perfect match of both the
restoration in the molar
and the broken-off drill bit tip. Figure 4-
• The forensic pathologist’s main duty is the
postmortem examination; therefore, he or she deals
primarily with the dead. Because of the managing
role of the forensic pathologist, the term forensic
medicine is often considered synonymous with
forensic pathology. Many other medical specialists,
such as forensic dentists and anthropologists, play an
important role on the forensic team, but these
professionals are often consultants, working only
part-time in the field of forensics.
 Conclusions
• Forensic dentistry plays a major role in the
• identification of those individuals who
• cannot be identified visually or by other
• means.