forensic odontology

法医牙本质学
  • 文章类型: Journal Article
    技术改进为牙科带来了重大创新,并扩大了牙科护理工具和技术的范围。在过去20年中广泛研究的一项技术发展是使用近红外透射照明(NIRT)成像来诊断龋齿。本文旨在介绍一个全面的NIRT图像集合,旨在作为常规牙科检查的参考工具,牙科研究,教学活动,和法医牙科学。该集合呈现了成对的临床和NIRT图像,分类如下:(a)健康的牙齿,(b)龋齿,(c)修复的牙齿,(d)釉质缺陷,和(e)不同的发现。该地图集可能是牙科界的宝贵工具,因为它被设计为NIRT说明牙齿特征的识别指南。
    Technological improvements have introduced significant innovations in dentistry and broadened the array of tools and techniques in dental care. One technological development that has been widely researched over the past 20 years is the use of Near-Infrared Transillumination (NIRT) imaging for the diagnosis of dental caries. This paper aims to introduce a comprehensive collection of NIRT images, intended as a reference tool for routine dental examinations, dental research, pedagogical activities, and forensic odontology. The collection presents pairwise clinical and NIRT images categorized as follows: (a) healthy teeth, (b) carious teeth, (c) restored teeth, (d) enamel defects, and (e) diverse findings. This atlas could be a valuable tool for the dental community as it is designed as an identification guide of NIRT illustrated dental features.
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  • 文章类型: Journal Article
    背景牙釉质,牙齿的最外层,它是一种独特而卓越的组织,在保护牙齿免受各种外部因素的侵害方面起着至关重要的作用。牙齿表面搪瓷棒末端图案的检查和分析,被称为象形文字,为法医中的牙齿鉴定和法医调查提供了一个有希望的途径,从而提高法医分析的准确性和可靠性。本文旨在在立体显微镜下评估和比较不同物种的象形文字。本研究中检查的物种包括海狸(蓖麻属),狐狸(Vulpes属),和人类(智人)。方法从牙齿库中收集每个物种(n=3)的牙齿样本,并在立体显微镜下以各种放大倍数进行检查。有和没有石墨染色。拍摄了照片,并仔细评估了搪瓷图案。通过利用地块剖面,比较了不同物种的釉质图案,并仔细注意到它们之间的任何明显差异。结果分析了三种植物的样地概况,揭示了鲜明的特点。具体来说,据观察,蓖麻属牙齿和智人牙齿的地块表现出分散的排列,而Vulpes属的地块轮廓显示出紧密排列的图案。结论在当前调查的范围内,可以推断,每个哺乳动物都表现出独特而独特的釉质棒排列。因此,如果不能彻底理解结构特征,通过牙齿印记识别死者的任务可能会带来困难。
    Background Dental enamel, the outermost layer of the tooth, stands as a unique and remarkable tissue that plays a crucial role in safeguarding teeth against various external factors. The examination and analysis of enamel rod end patterns on tooth surfaces, referred to as ameloglyphics, offer a promising avenue for dental identification and forensic investigations in forensic medicine, thereby enhancing the precision and reliability of forensic analyses. This paper aims to evaluate and compare the ameloglyphics of different species under a stereomicroscope. The species examined in this study include the beaver (genus Castor), fox (genus Vulpes), and human (Homo sapiens). Methods Teeth samples from each species (n = 3) were gathered from the tooth repository and examined under a stereomicroscope at various magnifications, both with and without graphite staining. Photographs were captured, and the enamel patterns were meticulously evaluated. Through the utilization of plot profiles, the enamel patterns of the different species were compared, and any discernible differences between them were carefully noted. Results The plot profiles of the three species were analyzed, revealing distinct characteristics. Specifically, it was observed that the plots of the genus Castor teeth and Homo sapiens teeth exhibited dispersed arrangements, whereas the plot profile of the genus Vulpes displayed a closely arranged pattern. Conclusions Within the confines of the current investigation, it can be inferred that every mammal exhibits a distinct and exclusive arrangement of enamel rods. Hence, the task of identifying a deceased individual through dental imprints may pose difficulties if the structural characteristics are not thoroughly comprehended.
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  • 文章类型: Journal Article
    子痫是最危险的妊娠并发症之一,在发展中国家发病率很高。它的特征是在患有高血压的孕妇中昏迷和广泛性强直阵挛性癫痫发作的发生。舌头上的深度咬伤和其他口面部损伤已被描述为这些癫痫发作的后果。我们介绍了一例与子痫相关的死亡病例,其中癫痫发作期间的咬伤导致舌头几乎完全截肢(巨舌)。讨论了这一发现的医学法律价值以及由于先前的病理状况和缺乏常规筛查而导致的情况,这些孕妇可能合法或非法迁移以获得更好的医疗服务。
    Eclampsia is one of the most dangerous complications of pregnancy and has a high incidence in developing countries. It is characterized by coma and the occurrence of generalized tonic-clonic seizures in pregnant women with hypertension. Deep bites on the tongue and other orofacial injuries have been described as consequences of these seizures. We present a case of death associated with eclampsia in which the bite during the seizure episode caused almost total amputation of an enlarged tongue (macroglossia). The medico-legal value of this finding and the situation due to antecedent pathological conditions and lack of routine screening in pregnant women who may migrate legally or illegally to give birth with better medical care are discussed.
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  • 文章类型: Journal Article
    口腔内3D照片扫描在法医牙科学鉴定中的潜力仍未被开发,即使高度的细节可以自动比较验尸前和验尸后的牙列。术前和术后口腔内3D照片扫描之间的软组织状况差异可能会导致模糊的变化,增加了匹配过程的潜在自动化,并强调了在牙科比较中限制软组织包含的必要性。软组织去除必须能够处理牙齿缺失的牙弓,和口腔内3D照片扫描不是来自石膏模型。为了应对这些挑战,我们开发了网格切割方法。该方法是可自定义的,允许使用小网格尺寸进行细粒度分析,并适应从裁剪的牙科扫描中排除了多少软组织。在66次牙科扫描上进行测试时,在63/66牙科扫描中,网格切割方法能够限制软组织的数量而不去除任何牙齿.其余的3次牙科扫描已部分萌出第三磨牙(智齿),并通过网格切割方法将其去除。总的来说,网格切割方法代表了使用口内3D照片扫描自动化法医牙科学鉴定匹配过程的重要一步。
    The potential of intraoral 3D photo scans in forensic odontology identification remains largely unexplored, even though the high degree of detail could allow automated comparison of ante mortem and post mortem dentitions. Differences in soft tissue conditions between ante- and post mortem intraoral 3D photo scans may cause ambiguous variation, burdening the potential automation of the matching process and underlining the need for limiting inclusion of soft tissue in dental comparison. The soft tissue removal must be able to handle dental arches with missing teeth, and intraoral 3D photo scans not originating from plaster models. To address these challenges, we have developed the grid-cutting method. The method is customisable, allowing fine-grained analysis using a small grid size and adaptation of how much of the soft tissues are excluded from the cropped dental scan. When tested on 66 dental scans, the grid-cutting method was able to limit the amount of soft tissue without removing any teeth in 63/66 dental scans. The remaining 3 dental scans had partly erupted third molars (wisdom teeth) which were removed by the grid-cutting method. Overall, the grid-cutting method represents an important step towards automating the matching process in forensic odontology identification using intraoral 3D photo scans.
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  • 文章类型: Systematic Review
    在过去的几年里,人工智能的应用及其在多个领域的应用有了巨大的增长,包括医疗保健。法医学和法医牙齿学使用AI具有巨大的发展空间。在严重烧伤的情况下,组织完全丧失,骨结构的完全或部分损失,腐烂的尸体,大规模灾难受害者识别,等。,需要及时识别骨性遗骸。下颌骨,是面部区域最强壮的骨头,高度抵抗过度的机械,化学或物理影响,并已广泛用于许多研究,以确定年龄和性二态。对颌骨进行年龄和性别的射线照相估计更可行,因为它很简单,并且可以同样地应用于死亡和活着的病例,以帮助识别过程。因此,本系统综述的重点是颌面部X线照片中用于年龄和性别确定的各种AI工具。数据是通过在各种搜索引擎中搜索文章获得的,2013年1月至2023年3月出版。QUADAS2用于定性合成,随后对纳入研究的偏倚风险进行Cochrane诊断测试准确性评价分析.研究结果非常乐观。获得的准确性和精密度与人类检查者相当。这些模型,当设计了正确的数据时,可以在医学法律场景和灾难受害者识别中发挥巨大作用。
    In the past few years, there has been an enormous increase in the application of artificial intelligence and its adoption in multiple fields, including healthcare. Forensic medicine and forensic odontology have tremendous scope for development using AI. In cases of severe burns, complete loss of tissue, complete or partial loss of bony structure, decayed bodies, mass disaster victim identification, etc., there is a need for prompt identification of the bony remains. The mandible, is the strongest bone of the facial region, is highly resistant to undue mechanical, chemical or physical impacts and has been widely used in many studies to determine age and sexual dimorphism. Radiographic estimation of the jaw bone for age and sex is more workable since it is simple and can be applied equally to both dead and living cases to aid in the identification process. Hence, this systematic review is focused on various AI tools for age and sex determination in maxillofacial radiographs. The data was obtained through searching for the articles across various search engines, published from January 2013 to March 2023. QUADAS 2 was used for qualitative synthesis, followed by a Cochrane diagnostic test accuracy review for the risk of bias analysis of the included studies. The results of the studies are highly optimistic. The accuracy and precision obtained are comparable to those of a human examiner. These models, when designed with the right kind of data, can be of tremendous use in medico legal scenarios and disaster victim identification.
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  • 文章类型: Journal Article
    短串联重复序列(STR)分型不仅广泛用于血缘关系鉴定,而且还用于身份不明的个人鉴定。然而,DNA易受环境因素的影响,从而导致DNA产量降低。因此,为了最大限度地提高鉴定所需的DNA产量,牙齿通常在DNA提取过程中完全粉碎。然而,这使得DNA分析后的后续测试不可能。在这项研究中,我们调查了DNA分析的实用性,这些DNA分析仅使用在户外放置了很长一段时间的牙齿的牙骨质.我们分析了在牙科诊所六个月内提取的90颗磨牙(新鲜牙齿)和暴露在户外超过70年的90颗磨牙(陈旧牙齿),牙骨质提取后,STR分析的准确性,牙骨质收集的最佳地点,并确定了STR剖面所需的最低牙骨质量。结果表明,从牙骨质中提取的DNA的谱分析准确性与牙髓和牙本质中的DNA相当。此外,从子宫颈线附近或从根尖区域收集的牙骨质没有显示DNA分析准确性的显着差异,表明确保至少5mg牙骨质足以确保精确的DNA谱分析。这些发现表明,即使在经过长的死后间隔的牙齿中,仅使用牙骨质进行DNA分析也是可行的。
    Short tandem repeat (STR) typing is widely used not only for blood relationship identification but also for the personal identification of unidentified bodies. However, DNA is susceptible to the effects of environmental factors, consequently leading to reduced DNA yields. Therefore, to maximize the DNA yield required for identification, teeth are generally completely pulverized during DNA extraction. However, this renders subsequent testing after DNA profiling impossible. In this study, we investigated the utility of DNA profiling using only the cementum from teeth that had been left outdoors for long postmortem intervals. We analyzed 90 molars (fresh teeth) that were extracted within six months at a dental clinic and 90 molars (stale teeth) exposed outdoors for over 70 years, and following cementum extraction, the accuracy of STR profiling, optimal site for cementum collection, and minimum amount of cementum required for STR profiling were determined. The results demonstrated that the profiling accuracy of DNA extracted from cementum was comparable to that of DNA from dental pulp and dentin. Furthermore, the collection of cementum from either near the cervical line or from the root apex areas did not show significant differences in DNA profiling accuracy, indicating that securing at least 5 mg of cementum was sufficient to ensure precise DNA profiling. These findings suggest that DNA profiling using only cementum is viable even in teeth that have been subjected to a long postmortem interval.
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  • 文章类型: Journal Article
    年龄估计是识别人类尸体的重要步骤。由于衰老会引起形态学变化,因此已经突出显示了一些下颌标志作为年龄估计的骨骼部位。报告表明,下颌圆环的大小可能与衰老有关;然而,由于测量困难,尚未进行彻底的调查。因此,本研究旨在利用日本尸体的死后计算机断层扫描数据确定年龄与下颌环面厚度之间的关系.这项研究包括2,792具尸体,平均(标准差)年龄为58.0(22.4)岁(范围,0-101岁)和67.6%的男性。Further,2,662(95.3%),14(0.5%),59(2.1%),和57(2.0%)的尸体是永久性的,混合,小学,和牙列前期,分别。进行了多变量分析,以量化年龄对下颌圆环厚度的影响,适应性,高度,体重,和咬合接触状态。该模型还包括年龄和咬合状态之间的相互作用项,因为咬合可能会产生影响。多元回归分析结果显示,下颌环面厚度随年龄增长而增加(回归系数(95%置信区间)为0.6(0.2-1.0),0.7(0.3-1.0),1.0(0.6-1.4),1.3(0.9-1.7),1.3(0.8-1.8),30-39、40-49、50-59、60-69、70-79和80-89岁年龄组的1.1(0.4-1.7),分别),尤其是有咬合接触的男性。下颌圆环厚度与年龄之间存在显着关联,通过咬合状态和性别改变,已确定。因此,有关下颌圆环厚度和咬合状态的数据可能对人体尸体的年龄估计有用。
    Age estimation is an essential step in identifying human corpses. Several mandibular landmarks have been highlighted as skeletal sites for age estimation since aging causes morphological changes. Reports suggest that mandibular torus size may be associated with aging; however, thorough investigation has not been performed owing to the difficulty in measuring it. Therefore, this study aimed to determine the association between age and mandibular torus thickness using postmortem computed tomography data from Japanese corpses. This study included 2,792 corpses with mean (standard deviation) age of 58.0 (22.4) years (range, 0-101 years) and 67.6 % males. Further, 2,662 (95.3 %), 14 (0.5 %), 59 (2.1 %), and 57 (2.0 %) corpses were in the permanent, mixed, primary, and predental dentition periods, respectively. Multivariable analysis was performed to quantify the impact of age on mandibular torus thickness, adjusting for sex, height, weight, and occlusal contact status. The model also included an interaction term between age and occlusal status because of the potential effect modification by occlusion. Results of the multivariable regression analysis showed that mandibular torus thickness increased with age (the regression coefficients (95 % confidence interval) were 0.6 (0.2-1.0), 0.7 (0.3-1.0), 1.0 (0.6-1.4), 1.3 (0.9-1.7), 1.3 (0.8-1.8), and 1.1 (0.4-1.7) for age groups 30-39, 40-49, 50-59, 60-69, 70-79, and 80-89 years, respectively), especially in males with occlusal contact. A significant association between mandibular torus thickness and age, modified by occlusal status and sex, was identified. Therefore, data regarding the thickness of the mandibular torus and occlusal status may be useful for age estimation in human corpses.
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    文章类型: Journal Article
    目的灾难受害者识别(DVI)服务需要知识,信心,和准备的态度(KCA)。这项研究的目的是评估牙科学生对DVI技能和主题的感知KCA。方法通过电子邮件招募高级口腔卫生学生(n=27)和高级牙科助理学生(n=14)的便利样本,然后提供不匹配的模拟生前(AM)和死后(PM)咬伤X射线照片,并要求指示正确的匹配。总的来说,参与者进行了205个射线照相匹配,并将205度的确定性二进制标记为“阳性”或“可能”(每个匹配一个)。参与者还完成了研究人员设计的前测/后测电子调查,其中包含七个三点李克特量表项目,答案选项为“略”,\"适度\",或“极度”关于自我感知的知识。用R软件使用α=0.05显著性水平进行统计分析。结果共有41名学生参加,产生85.4%的应答率。单侧线性趋势检验显示,关于法医牙科医生在DVI中的作用,从前测到后测,对知识的感知信心在统计学上显着增加(p<0.0001),DVI应用于大规模死亡事件(MFI)(p<0.0001),牙科放射学在DVI中的作用(p<0.0001),和DVI的牙齿形态应用(p<0.0001)。参与者对个人临床技能表示中等或极端的信心,以协助法医牙科医生进行DVI。单侧Fisher精确检验显示,表达的确定性(置信度)与正确的射线照相匹配之间存在统计学上的显着(p<0.05)正相关。单侧线性趋势检验显示,对于参与者的态度有统计学意义(p<0.0001)的改善,他们认为自己的职业对DVI志愿服务的重要性。结论本研究的参与者报告了关于DVI技能和主题的自我感知KCA的显着改善。这些特征可能会鼓励相关牙科专业人员在需要MFI支持时寻求进一步的DVI教育机会和未来服务。
    Purpose Disaster victim identification (DVI) service requires knowledge, confidence, and an attitude (KCA) of readiness. The purpose of this study was to assess allied dental students\' perceived KCA regarding DVI skills and topics.Methods A convenience sample of senior dental hygiene students (n=27) and senior dental assistant students (n=14) were recruited by email then presented mismatched simulated antemortem (AM) and postmortem (PM) bitewing radiographs and asked to indicate correct matches. Collectively, participants made 205 radiographic matches and indicated 205 degrees of certainty binarily as \"positive\" or \"possible\" (one per match). Participants also completed a researcher designed pretest/posttest electronic survey with seven 3-point Likert-scale items with answer options of \"slightly\", \"moderately\", or \"extremely\" regarding self-perceived knowledge. Statistical analyses were conducted with R software using an α=0.05 significance level.Results A total of n=41 students participated, yielding a response rate of 85.4%. A one-sided linear trend test revealed statistically significant increases of perceived confidence in knowledge from pretest to posttest regarding forensic odontologists\' role in DVI (p<0.0001), DVI applications for mass fatality incidents (MFI) (p<0.0001), role of dental radiology in DVI (p<0.0001), and dental morphology applications for DVI (p<0.0001). Participants indicated moderate or extreme confidence in personal clinical skillsets to assist forensic odontologists with DVI. A one-sided Fisher\'s exact test revealed a statistically significant (p<0.05) positive association between expressed degree of certainty (confidence) and correct radiographic matches. A one-sided linear trend test revealed statistically significant (p<0.0001) improvements in attitude regarding participants\' perceived importance for their respective professions to volunteer in DVI.Conclusion Participants of this study reported significant improvements of self-perceived KCA regarding DVI skills and topics. These characteristics may encourage allied dental professionals to pursue further DVI educational opportunities and future service when support is needed for MFI.
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  • 文章类型: Journal Article
    Cameriere基于年龄与第三磨牙成熟指数I3M之间的关系,开发了一种用于正像图(OPG)的方法来评估18岁的成年年龄。这项研究的目的是评估Cameriere的方法是否可以应用于法国青少年和年轻人的计算机断层扫描(CT扫描),并比较从同一个体的OPG获得的结果。我们的样本包括2007年至2020年在法国大学医院放射科进行的200次检查。每个患者都接受了OPG和头颅CT扫描以用于医疗目的,并且我们使用基于OPG的I3M的类似自适应来确定基于CT扫描的I3M。由于排除标准,我们的最终样本包括71个OPG和63个CT扫描。基于71个OPG,实际年龄和估计年龄之间存在一致性,灵敏度为78.57%,特异性为89.47%,根据38号牙齿的错误分类率为18.03%,敏感度为78.79%,特异性为91.67%,根据牙齿48,错误分类率为17.78%。我们基于CT扫描的结果显示了38颗牙齿的实际年龄和估计年龄之间的一致性,灵敏度为77.78%。特异性为94.12%,错误分类率为16.98%。实际年龄与基于48岁的估计年龄之间的一致性具有75.00%的敏感性,特异性为93.75%,错误分类率为19.23%。>90%ICC表明基于OPG和CT扫描的牙齿38和48的测量之间的极好相似性。这项研究揭示了Cameriere方法基于法国人群的CT扫描计算I3M的适用性。基于CT扫描的结果类似于基于来自相同个体的OPG的结果。
    Cameriere developed a method on orthopantomograms (OPG) to assess adult age of 18 years based on the relationship between age and the third molar maturity index I3M. The aim of this study was to evaluate whether Cameriere\'s method could be applied to computed-tomography scans (CT-scans) from a population of French juveniles and young adults and compare the results obtained from OPG of the same individuals. Our sample comprised 200 examinations that had been performed at the radiological department of a French University hospital between 2007 and 2020. Each patient had received an OPG and a cranial CT scan for medical purposes, and we used a similar adaptation of I3M based on OPG to determine the I3M based on CT scans. Due to exclusion criteria, our final sample comprised 71 OPGs and 63 CT scans. Based on the 71 OPGs, there was concordance between chronological age and estimated age, with a sensitivity of 78.57%, a specificity of 89.47%, and a misclassified rate of 18.03% based on tooth 38, and a sensitivity of 78.79%, a specificity of 91.67%, and a misclassified rate of 17.78% based on tooth 48. Our results based on CT scans presented concordance between chronological age and estimated age for tooth 38 described by a sensitivity of 77.78%, a specificity of 94.12%, and a misclassified rate of 16.98%. The concordance between chronological age and estimated age based on 48 had a sensitivity of 75.00%, a specificity of 93.75%, and a misclassified rate of 19.23%. The > 90% ICC indicate an excellent similarity between measurements of teeth 38 and 48 based on OPGs and CT scans. This study has revealed the applicability of the Cameriere\'s method to calculate the I3M based on CT scans from a French population. The results based on CT scans are similar to results based on OPGs from the same individuals.
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  • 文章类型: Journal Article
    这项研究提出了一种新颖的保守技术,可在法医学尸检(MLA)期间增加口腔开放并克服僵直。该方法提出了颞肌和咬肌的肌切开术,利用开颅手术的切口,在具有严格性的新鲜尸体中实现明显的口腔开放(≥30mm),而不改变面部美学。这项研究是对48名年龄在18至66岁之间的个体进行的(20名男性和28名女性),他们在国立国立法证研究所进行尸检。SergioSaritaValdez博士(圣多明各,多米尼加共和国)。拟议的技术不仅可以通过口腔进入所有尸体解剖的尸体,而且还符合当前保留面部美学的道德标准。考虑到家庭成员的关切,允许尊重地观看尸体。这种进步不仅有助于提高口腔尸检的效率,而且还影响了公众对法医程序的看法,并突出了在MLA背景下道德和美学考虑的重要性。拟议的技术代表了朝着更加尊重和道德的法医实践迈出的重要一步,并为MLA期间更完整和准确的评估提供了实际优势。
    This study presents a novel conservative technique to increase oral opening and overcome rigor mortis during medicolegal autopsy (MLA). The method proposes a myotomy of the temporalis and masseter muscles, taking advantage of the incisions of the cranial opening procedures, to achieve a significant oral opening (≥ 30 mm) in fresh cadavers with established rigor mortis without altering facial aesthetics. The study was performed on 48 individuals aged between 18 and 66 years (20 males and 28 females) who were autopsied at the Instituto Nacional de Patología Forense Dr. Sergio Sarita Valdez (Santo Domingo, Dominican Republic). The proposed technique not only allowed the oral access to all autopsied cadavers but also complied with current ethical standards for preserving facial aesthetics, taking into account the concerns of family members by allowing respectful viewing of the cadaver. This advancement not only contributes to the efficiency of oral autopsies but also influences public perception of forensic procedures and highlights the importance of ethical and aesthetic considerations in the context of MLAs. The proposed technique represents a significant step towards more respectful and ethical forensic practices, and offers practical advantages for a more complete and accurate assessment during MLA.
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