Artificial intelligence in forensic medicine and forensic dentistry.

This review article aims to highlight the current possibilities for applying Artificial Intelligence in modern forensic medicine and forensic dentistry and present the advantages and disadvantages of its use. For this purpose, the relevant academic literature was searched using PubMed, Web of Science and Scopus. The application of Artificial Intelligence in forensic medicine and forensic dentistry is still in its early stages. However, the possibilities are great, and the future will show what is applicable in daily practice. Artificial Intelligence will improve the accuracy and efficiency of work in forensic medicine and forensic dentistry; it can automate some tasks; and enhance the quality of evidence. Disadvantages of the application of Artificial Intelligence may be related to discrimination, transparency, accountability, privacy, security, ethics and others. Artificial Intelligence systems should be used as a support tool, not as a replacement for forensic experts.

Forensic dental identification in complicated fractured skull conditions: case report with adapted algorithm for image comparison.

OBJECTIVE: To analyze the perspective of using an adapted algorithm for digital images comparison while providing forensic dental identification in complicated fractured skull conditions by ante-mortem and post-mortem radiographical data sets. MATERIALS AND METHODS: Ante-mortem orthopantomogram and post-mortem peri-apical X-ray images were converted in *.jpeg format with their further import into GIMP 2.10 software (The GIMP Development Team). Segmentation of OPG-image was provided in topographical projections of jaw segments obtained directly from the victim. Comparison of analyzed image segments was provided manually within GIMP 2.10 software using functions of "Layers" and "Opacity" through the proposed algorithm. RESULTS: Considering the fact that 20 positive concordant dental identifiers overall were verified during comparison of AM and PM X-ray datasets, we can conclude that odontological identity was established. All above-mentioned discrepancies could be classified as explainable. Inter-agreement rate between two investigators considering correspondence between AM and PM datasets reached Cohen's kappa level which is equal to 0,97, while positive 100% agreement was reached considering 21 out of 24 analyzed characteristics. CONCLUSION: Available AM and PM radiographical datasets represent a sufficient information for effective forensic dental identification, even if such were obtained by different roentgenological techniques (orthopantomography and periapical radiography). Using of an adapted algorithm for digital images comparison with forensic dental purposes could potentially overcome cognitive bias and observer's effect, speed up the process of analysis and increase the accuracy and inter-agreement rate while referencing AM and PM datasets.

Quality assurance for the use of computational methods in dosimetry: activities of EURADOS Working Group 6 'Computational Dosimetry'.

Working Group (WG) 6 'Computational Dosimetry' of the European Radiation Dosimetry Group promotes good practice in the application of computational methods for radiation dosimetry in radiation protection and the medical use of ionising radiation. Its cross-sectional activities within the association cover a large range of current topics in radiation dosimetry, including more fundamental studies of radiation effects in complex systems. In addition, WG 6 also performs scientific research and development as well as knowledge transfer activities, such as training courses. Monte Carlo techniques, including the use of anthropomorphic and other numerical phantoms based on voxelised geometrical models, play a strong part in the activities pursued in WG 6. However, other aspects and techniques, such as neutron spectra unfolding, have an important role as well. A number of intercomparison exercises have been carried out in the past to provide information on the accuracy with which computational methods are applied and whether best practice is being followed. Within the exercises that are still ongoing, the focus has changed towards assessing the uncertainty that can be achieved with these computational methods. Furthermore, the future strategy of WG 6 also includes an extension of the scope toward experimental benchmark activities and evaluation of cross-sections and algorithms, with the vision of establishing a gold standard for Monte Carlo methods used in medical and radiobiological applications.

Forensic determination of dental age by cementum thickness of human teeth.

The purpose of this study was to assess the correlation between the known chronological age and the dental cementum thickness (DCT) in male and female subjects in different age groups. MATERIAL AND METHODS: The study sample consisted of 57 donor teeth of both sexes. Teeth were classified by donors' sex and divided into three age groups: 10-19, 30-39 and 60-69 years. Tooth roots were cut with transverse ground sections in the apical, middle, and cervical thirds. DCT measurements were made on photomicrographs of light microscope. The correlation between DCT and the chronological age was calculated using the Spearman correlation coefficient. RESULTS: A positive correlation was found (r=0.47, p <0.001) between DCT and age of the donor. DCT decreased from apical to cervical ground section (median [IQR] apical section 216.72 [128.25-375.00] µm, middle section 158.44 [87.66-284.90] µm; cervical section 96.60 [70.05-165.59] µm). DCT variability was influenced by sex, number of tooth roots and the condition of the tooth crown. The influence differed depending on the location of the section, being most prominent cervically. CONCLUSION: The present study showed correlation of DCT with age, with significant influence of sex, number of tooth roots, condition of the tooth crown and location of the root section.

Human 3-hydroxyanthranilate 3,4-dioxygenase () dynamics and reaction, a multilevel computational study.

3-Hydroxyanthranilate 3,4-dioxygenase () is a non-heme iron dependent enzyme. It catalyses the cleavage of the benzene ring of 3-hydroxyanthranilic acid (3-Ohaa), an intermediate in the kynurenine pathway, and therefore represents a potential target in treating numerous disorders related to the concentration of quinolinic acid (QUIN), the kynurenine pathway product, in tissues. The stability and behaviour of the enzyme in nearly physiological conditions, studied by the empirical molecular modelling methods enabled us to determine the influence of several, for the enzyme activity relevant, point mutations (Arg43Ala, Arg95Ala and Glu105Ala) on the protein structure, particularly on the active site architecture and the metal ion environment, as well as on the substrate, 3-Ohaa, binding. Besides, the water population of the active site, and the protein flexibility as well as the amino acid residues interaction networks relevant for the enzyme activity were determined for the 3-Ohaa complexes with the native and mutated enzyme variants. Finally, using the hybrid quantum-mechanics/molecular-mechanics (QM/MM) calculations the catalysed 3-Ohaa oxidation into 2-amino-3-carboxymuconic acid semialdehyde was elucidated.

Carabelli's trait in Croatian populations over 1800 years.

Examination and comparison of the morphological features of tooth crown in archaeological and recent samples can be difficult due to the different levels of tooth wear seen both within and between populations. These differences make the comparison of frequency data for Carabelli trait problematic. The aim of the present study is to detect the frequency and degree of expression of Carabelli's trait in Croatian populations from late antiquity to recent times and to use these data as supplementary evidence of complex population migration. A total of 1287 individuals from the late antiquity, medieval, early modern and modern periods were examined. Correlation between the presence of Carabelli's trait and tooth crown size was tested. The results of our analyses show that the frequency of Carabelli's trait is significantly greater in the early modern period (51.3%) and in the 21st century (43.1%) than in the late antiquity (20.4%) and medieval periods (23.4%). These results are consistent with historical evidence of migration and population change in the territory of present-day Croatia throughout the almost 1800 years covered by this study. The results also provide additional evidence for the complex nature of population change in the transition from the late antiquity to the early medieval period.

Age estimation in archaeological skeletal remains: evaluation of four non-destructive age calculation methods.

Estimation of age at death is an essential part of reconstructing information from skeletal material. The aim of the investigation was to reconstruct the chronological age of an archaeological sample from Croatia using cranial skeletal remains as well as to make an evaluation of the methods used for age estimation. For this purpose, four age calculation methods were used: palatal suture closure, occlusal tooth wear, tooth root translucency and pulp/tooth area ratio. Cramer's V test was used to test the association between the age calculation methods. Cramer's V test showed high association (0.677) between age determination results using palatal suture closure and occlusal tooth wear, and low association (0.177) between age determination results using palatal suture closure and pulp/tooth area ratio. Simple methods like palatal suture closure can provide data about age at death for large number of individuals, but with less accuracy. More complex methods which require qualified and trained personnel can provide data about age for a smaller number of individuals, but with more accuracy. Using different (both simple and complex) age calculation methods in archaeological samples can raise the level of confidence and percentage of success in determining age.

Characteristics of the craniofacial complex in Turner syndrome.

OBJECTIVE: To identify characteristics of the craniofacial complex in Turner syndrome (TS) patients from Croatian population, to investigate the interrelationship among craniofacial variables and to assess their correlation with age. DESIGN: Cephalometric analysis was carried out on lateral cephalograms of 36 TS patients, aged 10-33 years. Cephalograms of 72 age-matched healthy females with class I occlusion served as control. RESULTS: Logistic regression analysis sorted out two variables as predictors of TS: shorter posterior cranial base length (sella-basion) and reduced mandibular prognathism angle (sella-nasion-supramentale). Sixty-four percent of TS patients and 92% of the controls were classified correctly. After exclusion of the variable sella-nasion-supramentale, three variables were significant predictors of TS: shorter sella-basion, larger cranial base angle (nasion-sella-basion) and shorter subspinale-basion distance. Retrognathic position of the jaws in TS subjects was not correlated with the shape of the cranial base. Correlations with age revealed lack of maxillary longitudinal growth with persistent retrognathism and posterior rotation along with reduced mandibular growth. CONCLUSION: Shorter posterior length and increased cranial base angle along with bimaxillary retrognathism were characteristics of TS patients. Results indicated that deficiency of the X chromosome genes had a direct influence on all three anatomic parts - cranial base, maxilla and mandible - causing irregular growth.

Accuracy of age estimation in children using radiograph of developing teeth.

The aims of this study were: first, to determine the accuracy of the Cameriere method for assessing chronological age in children based on the relationship between age and measurement of open apices in teeth and, second, to compare the accuracy of this method with the widely used Demirjian et al. method and with the method proposed by Willems et al. Orthopantomographs taken from white Italian, Spain and Croatian children (401 girls, 355 boys) aged between 5 and 15 years were analysed following the Cameriere, Demirjian and Willems methods. The difference between chronological and dental age was calculated for each individual and each method (residual). The accuracy of each method was assessed using the mean of the absolute values of the residuals (mean prediction error). Results showed that the Cameriere method slightly underestimated the real age of children. The median of the residuals was 0.081 years (interquartile range, IQR=0.668 years) for girls and 0.036 years for boys (interquartile range, IQR=0.732 years). The Willems method showed an overestimation of the real age of boys, with a median residual error of -0.247 years and an underestimation of the real age of girls (median residual error=0.073 years). Lastly, the Demirjian method overestimated the real age of both boys and girls, with a median residual error of -0.750 years for girls and -0.611 years for boys. The Cameriere method yielded a mean prediction error of 0.407 years for girls and 0.380 years for boys. Although the accuracy of this method was better for boys than for girls, the difference between the two mean prediction errors was not statistically significant (p=0.19). The Demirjian method was found to overestimate age for both boys and girls but the mean prediction error for girls was significantly greater than that for boys (p=0.024), and was significantly less accurate than the Cameriere method (p<0.001). The Willems method was better than that of Demirjian (p=0.0032), but was significantly less accurate than that of Cameriere (p<0.001).

Age estimation methods using anthropological parameters on human teeth-(A0736).

The research was conducted on the 160 intact extracted human teeth with one and two roots of the known age and sex. The teeth were disinfected, dried and X-rayed. After that the section of the longitudinal cut through the teeth was performed in order to facilitate monitoring of all tissues and morphological characteristics of the teeth. The age was determined in three ways: Method 1 [G.Bang, E. Ramm, Determination of age in humans from root dentin transparency, Acta Odontol. Scand. 28 (1970) 3-35]--analysis of the translucency of the root dentine, Method 2 [S. Kvaal, T. Solheim, A non-destructive dental method for age estimation, J. Forensic Odonto-stomatol. 12 (1994) 6-11]--analysis of the root and the root canal from the X-ray, Method 3 [G. Johanson, Age determination from human teeth, Odontol. Revy. 22 (1971) 1-126]--analysis of six parameters on each teeth. All data were subject to the correlation and regression analysis which showed the following: all of the three applied methods were in the significant correlation with the real age, and the best of them proved to be Method 3 where the coefficient of correlation was 0.85, p<0.001. The teeth of the maxilla are more convenient for the age determination than the teeth of mandible. They are in the significant strong correlation with the known real age, and in Method 3, the coefficient of correlation is 0.78, p<0.001. Age determination of the teeth with two roots is in significant correlation with the known real age p<0.001 in relation to the determined age on the teeth with one root. The results show that sex too, is in significant correlation with the real age, p<0.001. In practice, the methods used and the results achieved in this research have been enabling the dental age estimation of human remains from mass graves after the 1991 war in Croatia.

Life stress on the Roman limes in continental Croatia.

The purpose of the paper is to analyze and compare the demographic profiles and disease frequencies between a skeletal series from Zmajevac, a settlement on the Danubian limes, and a composite "non-limes" skeletal series consisting of human osteological remains from three large urban settlements to the west of the limes; roman Mursa (modern Osijek), Cibalae (Vinkovci) and Certissia (Strbinci). To determine if life stresses were different in settlements on the limes the age and sex distribution in Zmajevac was compared to the composite "non-limes" series. All skeletons were also analyzed for the presence of dental pathology, dental enamel hypoplasia, cribra orbitalia, trauma, and physical stress. Data collected from the skeletal series show that, with the exception of some indicators of physical stress, no significant differences in quality of life is evident. Both series are characterized by an under-representation of subadults from the youngest age category and by similar average adult male and female ages at death. In Zmajevac the average ages at death for adult males and females were 40.0 and 39.0 years respectively, in the composite "non-limes" series 37.4 years for both males and females. The frequencies of dental disease, subadult stress indicators, and trauma are similar in both series. The only consistent difference between the two series is noted in the frequencies of skeletal markers of physical stress, in particular the frequencies of vertebral osteoarthritis and Schmorl's defects. Total male and total female vertebral osteoarthritis frequencies in the two series are significantly different, as is the difference in total male frequencies of Schmorl's defects. Young adult males in the Zmajevac series seem to have been experiencing particularly heavy physical strain on the vertebral column. They exhibit significantly higher frequencies of both vertebral osteoarthritis and Schmorl's defects than young adult males from the composite non-limes series.

Dental identification after two mass disasters in Croatia.

AIM: To determine the usefulness of dental methods in the identification of victims in the railway accident in Zagreb (August 30, 1974) and midair collision of a British and a Slovenian airplane near Vrbovec (September 10, 1976). METHODS: There were 152 people killed in the railway accident, and 176 fatalities in the plane crash (63 in the British and 113 in the Slovenian plane). Individual victim identification and autopsy forms, and group identification reports were analyzed. RESULTS: Of the railway accident victims, 111 were identified. Dental characteristics, along with clothes, personal descriptions, personal documents, fingerprints, and jewelry, proved to be decisive in 5% of the cases. All 63 passengers and crew members from the British plane were identified; in 33% of the victims dental features, along with other characteristics, were decisive. From the Slovenian plane 103 victims were identified, 14% exclusively by teeth and 16% by teeth in combination with other characteristics. Ten bodies remained unidentified. CONCLUSION: The reasons for the small number of dental identifications in the victims of the railway accident were incomplete or unavailable antemortem data provided by relatives and friends of the deceased, and the predominant orientation toward other forensic identification methods. The significant number of dental identifications in the plane crash is explained by the provision of complete and accurate antemortem odontological data. Dental characteristics proved to be particularly valuable in the identification of carbonized victims.

Hereditary and environmental dental findings in identification of human remains.

The paper presents the results on hereditary and environmental dental findings in identification of human remains exhumed from mass graves in the Republic of Croatia. The total of 17,880 teeth from all the categories (incisors, canines, premolars and molars) was examined. Hereditary findings of the teeth such as shape, size, position, as well as age were used in all of the cases confirming and completing the identification. In only 15% of the cases they were the starting points for the identification that would be later confirmed with another 3-5 traditional identification procedures. Disturbances in tooth eruption were recorded in 22% of the cases, impaction of teeth in 10%, and retarded eruption of teeth in 12%. Disturbances of tooth position were recorded in 65% of the cases. Tooth rotation in 26% and diastema mediana in maxilla or mandible in 39%. Disorders of tooth number in the form of unilateral and bilateral missing of lateral maxillary incisors were recorded only in 2% of the monitored cases. Abnormalities of the tooth shape were found in 11% of the cases. The majority of them were found on the tooth crowns 6%, and less on the tooth roots 5%. Environmental dental findings that were the most significant for the identifications were prosthetic appliances in 30% of cases. Prostheses were helpful in the identification of 3% of the cases, while crowns and bridges were helpful in 27% of the cases. Ante mortem teeth extractions were helpful in 25% of the cases. Teeth restorations were recorded in 20% of the identified cases, amalgams in 19% and aesthetic filings in 1%. Dental caries was helpful in only 10% of the cases, superficial caries in 3% and caries of dentin in 7% of cases.

Odontological identification of human remains from mass graves in Croatia.

This paper reports the results and methods of dental identification of 1000 human remains exhumed from mass graves in Croatia up to July 1998. Personal identification of the victims was performed at the Department of Forensic Medicine and Criminology at the School of Medicine in Zagreb. A forensic odontologist participated in the identification process by carrying out the dental identification. A total of 824 victims were positively identified, while 176 victims remained unidentified. Dental identification based on available dental antemortem data was achieved in 25% of the cases. Dental identification based on dental charts was achieved in 35%, on x-rays in 15%, on photographs of teeth in 22%, on interviews in 18%, and on confirmation by odontologists in 10% of the cases. Teeth, in combination with anthropological parameters, age, sex and height, as well as other specific characteristics such as tattoos, personal identification cards, clothes, jewellery and DNA, were helpful for identification of 64% of the victims, but the significance for the identification was not dominant. Only in 11% of the cases was identification achieved by other relevant means and teeth not used at all. Identification procedures in Croatia will continue until another 1700 people who are still missing or kept as prisoners of war since the aggression on Croatia in 1991 are found and/or identified.

Craniocerebral injuries in combat soldiers treated at the Sapna war hospital, Bosnia and Herzegovina.

AIM: To assess the importance of the first aid and medical care administered on the battlefield and at a field surgical unit for the outcome of craniocerebral war injuries. METHODS: State of consciousness of 38 persons with craniocerebral injuries was assessed by the Glasgow Coma Scale (GCS), and follow-up of the vital signs and neurological deficit were determined by GCS outcome scale. RESULTS: Total mortality was 36.8%. The mortality highly correlated with the extent of injury. In general, all patients with Glasgow Coma Scale score of 7 and less died, and those with a higher score survived. CONCLUSION: A strict application of the basic principles of the first aid and medical care is a prerequisite for the improvement of the outcome of craniocerebral injuries.

Dental identification of war victims from Petrinja in Croatia.

In this paper the authors report their experiences and problems encountered in the identification of war victims from Petrinja in Croatia. Soon after Croatian forces regained Petrinja in 1995, four mass graves were discovered from which the bodies of 46 civilians, 38 males and 8 females, were recovered. Identification of the victims was performed at the Department of Forensic Medicine and Criminology at the School of Medicine in Zagreb. A forensic odonto-stomatologist from the Department of Dental Anthropology of the School of Dental Medicine at the University of Zagreb participated in the identification process by carrying out dental identifications. A total of 27 victims (59%) were identified, while 19 (41%) are at present still unidentified. Identification by supportive and anthropological evidence (e.g. sex, age, height, personal documents, dress, jewellery) was achieved in 43% of cases, while identification based only on dental records was achieved in 16%. The most useful dental characteristics for the purpose of identification were fixed and removable prosthetic appliances for oral rehabilitation. The reason for the low number of dental identifications was the lack of antemortem dental data which could be compared with postmortem dental records.

Occlusal plane orientation in Klinefelter syndrome (47,XXY males).

Occlusal plane position was analysed cephalometrically in 35 Klinefelter adults (47,XXY) and compared with 60 eugnath control males (46,XY). The significantly smaller angles between the occlusal plane and the cranial base (NSL-OLs) and between the occlusal plane and the Frankfort horizontal plane (Fr-OLs) were obtained in 47,XXY males (P < 0.01), while the angles between the maxillary base and the occlusal plane (NL-OLs) and between the Camper's line and the occlusal plane (Camp.-OLs) were not significantly different (P > 0.05) from the control group. Significantly smaller angles between the occlusal plane and the cranial base (NSL-OLs) and between the occlusal plane and the Frankfort horizontal plane (Fr-OLs) in Klinefelter males are attributed to the hereditary influence of an extra X chromosome on the smaller growth of the cranial base and the greater growth of the lower border of the mandible. Although the maxilla was also shifted forward in XXY males in relation to the cranial base it was not enough to compensate for the hereditary influence, due to the greater growth of the lower border of the mandible and the smaller cranial base in 47, XXY males, on the inclination of the occlusal plane to the Frankfort horizontal plane and the cranial base. The forward shift of the maxilla was sufficient to compensate for the inclination of the occlusal plane in 47, XXY males to the maxillary base and the Camper's line (P > 0.05).

The bond strength of polymers and metal surfaces using the 'silicoater' technique.

The silicoater technique, or silicoating, is a chemical bond system (makes mechanical retentions unnecessary) which prevents the rising of a gap in the margin area between resin and metal. This procedure solves the problems of fracture and detachment of the veneer or its discolourization. The purpose of this investigation was to find out the values of the bond strength achieved by using the silicoater technique on Ag-Pd alloy with smooth surface and with mechanical retentions on the surface. Ninety specimens were divided into groups, subjected to water storage and thermocycling. The values of the bond strength were investigated in combination with this technique with Ag-Pd alloy and three veneer materials. The silicoater technique gave the best results in combination with Dentacolor XS veneer material and mechanical retentions on the surface of the dental alloy.

A study of the occlusal plane orientation by intra-oral method (retromolar pad).

Reliability of the intra-oral method which orientates the occlusal plane to terminate at the upper level of the retromolar pad was studied. Thirty individuals all with natural teeth and 34 complete denture wearers participated in the study. Stone casts were mounted in the S.A.M. 2 articulator by a quick mount face bow transfer. The angle between the occlusal plane and the articulator horizontal plane was measured in both groups. The angle was 9.42 degrees +/- 4.1 degrees in dentate individuals and 8.53 degrees +/- 2.8 degrees in complete denture wearers. No statistically significant difference was found between the groups (t = 0.72, P > 0.05). Therefore, the method can be advocated for a wide clinical use, as it is a simple method and places the artificial occlusal plane very close to the position of the natural plane of occlusion.

Shape of the craniofacial complex in patients with Klinefelter syndrome.

The shape and size of the craniofacial complex in 35 adults with Klinefelter syndrome (47,XXY) were analyzed cephalometrically and compared with 60 control males. Twenty-four angular and 18 linear measurements were obtained for each subject. The results showed that the 47,XXY males were different from the controls in several areas of the craniofacial skeleton. Most of the differences were located in the cranial base and the cranial base angle (p < 0.02). The length of the maxillary base was greater (p < 0.05) and more prognathic (p < 0.01) in the study group. The mandible was also longer and more prognathic (p < 0.01).