New aspects of dental implants and DNA technology in human identification.

Missing, ineligible or delayed reference data to establish conventional dental or DNA identification are common scenarios in forensic practice. Therefore, it is worthwhile to explore new avenues that facilitate human identification. Due to the recent remarkable evolution in the prosthetic dental restorations based on dental implants and the emergence of novel DNA technologies utilized to infer the biological profile, the identification process has become easier than ever before. We report on a characteristic case, which highlights the particular importance of dental implants and DNA approaches in the prospective investigations for human identification. The aim of this publication is to focus on the possibility of identifying the batch numbers, even if they were not engraved in dental implants, making antemortem dental records of dental implants more easily accessible to establish a comparative dental identification. In addition, the reported case presents the supplementary data yielded through estimating the epigenetic age using DNA methylation as well as the biogeographical origin using Y-Haplotype and mitochondrial DNA analyses. Our results demonstrate that expanded oral implant investigations that also include implants extraction and comprehensive microscopic measurements can lead to identifying their batch numbers despite the numerous number of implants systems manufactured and distributed worldwide. Data saved by dental implant manufacturers can be very supportive and represent additional reference data for dental identification, when antemortem dental records are still missing. Furthermore, DNA methylation and mitochondrial DNA analyses can support the progress of investigation.

The role of forensic medicine and forensic dentistry in estimating the chronological age of living individuals in Hamburg, Germany.

Age estimation represents one of the primary responsibilities of forensic medicine and forensic dentistry. It is an integral procedure aiming to estimate the chronological age of an individual, whose age is either unknown or doubtful, by means of assessing the stage of dental, skeletal, and physical development. The present publication reviews the methods and procedures used in estimating the age of young living individuals as well as the experiences of the Institute of Legal Medicine in Hamburg-Eppendorf, Germany, during the last 25 years. From 1990 to 2015, 4223 age estimations were carried out in Hamburg. During this time, forensic age estimation was requested by different concerned authorities including courts, the foreigners' registration office (Zentrale Ausländerbehörde), and the state office of education and consultation (Landesbetrieb Erziehung und Beratung). In the context of judicial proceedings, orthopantomograms, as well as X-ray examinations of both the left hand and the medial clavicular epiphyses were carried out in accordance with AGFAD recommendations. For investigations not associated with judicial proceedings, orthopantomogram examinations play a key role in the process of age estimation, due to their high diagnostic value and low radiation exposure. Since 2009, mainly unaccompanied young refugees were examined for age estimation. Orthopantomograms and clinical-physical examinations have been used as essential steps in this context to determine whether an individual is 18 years or less. Additional X-ray examinations of the left hand and the medial clavicular epiphyses have been used less frequently.

The assessment of adipocere to estimate the post-mortem interval - a skeleton from the tidelands.

SUMMARY: This paper discusses the discovery of a skeletonized water corpse with hollow bones filled with adipocere found in the tidelands of the river Elbe close to Otterndorf (Wesermarsch, Cuxhaven). Through macroscopic and microscopic methods, the existing adipocere was described. The post-mortem interval was assessed by a comparison of the radiocarbon data and the indications about the preservation of adipocere from the literature. The investigation has shown that the knowledge of post-mortem changes in adipocere within bone structures is still incomplete, especially for the assessment of water corpses with long post-mortem intervals.

Prevalence of Stafne's bone cavity--retrospective analysis of 14,005 panoramic views.

AIM: Stafne's bone cavity (SBC) is a very rare defect, affecting only selected parts of the mandibular bone. Its etiology is unknown. On two-dimensional images, it appears as a narrowed cavity and might be interpreted as a space-occupying process inside the bone. The aim of the present study was to investigate the prevalence of SBC on panoramic views, and compare these results to published reports. MATERIALS AND METHODS: A total of 14,005 panoramic views were examined retrospectively with regard to the presence of SBC. All images were analyzed regarding typical characteristics as originally described by Stafne. RESULTS: A total of 11 cases fulfilled diagnostic criteria of SBC (0.08%). All patients were men (100%), at a mean age of 58.1 years (range=38-75 years). Eight patients (72.7%) had SBC on the left side, three patients on the right side (27.3%). In eight cases, SBC was found in the mandibular corpus (72.7%), and in three cases in the mandibular angle (27.3%). Correlating with published results, SBC was found at a relative frequency of 0.13%. CONCLUSION: SBC on panoramic views or other imaging modalities should alert the clinician to exclude other potential pathologies. In doubtful cases, surgical procedures might be necessary to verify the diagnosis.

Osteochondroma of the mandibular condyle. Report of a case with 5-year follow-up.

In the current case, a 31-year-old patient who presented with a painful unilateral malocclusion and an unclear mass in the region of the right temporo-mandibular joint (TMJ) is reported. The malocclusion had been noticed by the patient a few months earlier. Chewing on the right side had become severely impaired and painful. The patient had no history of trauma to the TMJ. Plain radiographs and computed-tomographic scans depicted an enlarged and deformed mandibular condyle. A condylectomy was performed. The histological investigation of the specimen revealed an osteochondroma. The tumour did not express insulin-like growth factor-1 receptor. Five years following the surgical intervention, there has been no local recurrence and dental occlusion was re-established, without further treatment.

Radiographic findings of odontogenic myxomas on conventional radiographs.

UNLABELLED: Odontogenic myxoma (OM) is a rare tumour arising in the jaws. The tumour is believed to be of odontogenic origin due to the close relation to teeth. The radiographic appearance of OM is not specific and the diagnosis is frequently unexpected following surgical removal of the lesion. The aim of this study was to analyse the radiographic appearance of OM on conventional radiographs. This type of radiographic diagnosis is typically used by dental practitioners. MATERIALS AND METHODS: We studied panoramic radiographs and plain skull radiographs of 14 patients investigated over a period of 30 years (male: 3, female: 11; age at time of diagnosis: 8 to 45 years, ≤16 years: 3). The maxilla was affected in five and the mandible in nine patients. In each case, all tumour findings were restricted to one jaw. RESULTS: Tumour size varied considerably. The largest tumours were seen in the distal parts of the mandible and ramus. Displacement of teeth was a frequent finding (8 cases), but root resorption was rare (2 cases). Honeycomb appearance on plain radiographs was associated with the size of the lesion and restricted to mandibular involvement. CONCLUSION: The radiographic appearance of OM of the jaws varies considerably. Large lesions may exhibit characteristic radiological signs of a slowly growing lesion. However, discrete displacement of teeth associated with a small osteolytic zone of the alveolar process between two teeth can be an OM. Careful interpretation of conventional radiographs is a must in identifying early lesions.

Craniofacial fibrous dysplasia (CFD) of the maxilla in an 11-year old boy: a case report.

We present the case of a surgically treated 11-year old boy with a diagnosis of craniomaxillofacial fibrous dysplasia (CFD) in the maxillary sinus. When first seen in the outpatient clinic of our department he had minimal symptoms. After initial radiological diagnostics by computed tomography scans (CT-scans) the patient was treated operatively by radical excision of the tumor. The radiographs showed the typical intramedullary located and well-defined lesions, which eroded the cortical bone with the typical appearance of fibrous dysplasia. The histopathology showed the typical curved extending fibrous trabeculae in C, O and Y-shape which were embedded in a moderately cellular morphologically inconspicuous stroma, confirming the initial suspicion of fibrous dysplasia of the maxillary bone. Cone beam tomography was a valuable tool in determining the re-ossification of bone at the affected side. Local resection can be curative in limited disease.

Bilateral intraosseous lymphoepithelial cyst of the mandible.

A 29-year-old healthy patient was submitted for exploration of intraosseous, unicystic lesions of the mandibular angle distal to the wisdom tooth of both sides. Histological investigation of the enucleated cystic lesions revealed bilaterally developed lymphoepithelial cysts (LEC). Healing was uneventful and re-ossification of the bone complete. LEC are rarely diagnosed in oral tissues and usually located in the soft tissues. This report details the clinical, radiological and morphological findings of intraosseous LEC of the mandible.

Small peripheral developing odontoma of the maxilla in a 3-year-old patient depicted on cone-beam tomograms.

A 3-year-old male patient was referred to the Maxillofacial Surgery Clinic due to a painless swelling of the right palatal region. Conventional radiographs revealed no alteration of the dentition and did not delineate a lesion in the region of interest. Cone-beam tomography depicted small radiopaque, extraosseous deposits inside the palatal space. Histological examination revealed a minute mixed epithelial-mesenchymal lesion of odontogenic origin. We made the diagnosis of a peripheral developing odontoma, taking into consideration the components and arrangements of structures of the lesion. Early intervention is advisable to prevent these odontogenic lesions from eventually deforming the jaw and displacing adjacent teeth. Cone-beam tomography was a valuable pre-operative diagnostic tool to assess the lesion as being composed in part of hard tissue.

Correlation of age and ossification of the medial clavicular epiphysis using computed tomography.

OBJECT: The aim of this study was the examination of relationship between the age and the ossification of medial epiphysis of the clavicle referred to CT examination. MATERIALS AND METHODS: Concerning the epiphyseal ossification of the clavicle CT's of 100 patients (50 male and 50 female) between 16 and 25 years (10 patients for each year) were analyzed by three viewers. RESULTS: In the legal relevant age segment (16-25a) we saw a turnover from stage 3 to stage 4 at the age of 21 years. The calculated empiric distribution function showed 95% of stage 4 over 21 years while 75% of the patients with stage 3 were under 21 years. A reconstruction kernel suitable for osseous structures should be used, images should be viewed or presented in a bone window. CONCLUSION: According to these results it can be concluded that a person with stage 4 is probably 21 years or older, while a stage 3 leads to an estimated age under 21 years. On the other hand, a confidence level of 99.67% is not reached. Therefore, CT of the medial epiphysis of the clavicle will only be suitable for age estimation around the age of 21 years, if this relevant statistic obstacle is defeated. Bearing this in mind, further studies are needed to evaluate slice thickness as the most critical parameter.

Evaluation of transversal slice imaging in the diagnosis of tooth displacement with special consideration of the upper canines.

AIM: The exact localization and analysis of displaced, retained or impacted teeth can rarely be achieved by common radiologic methods providing eccentric or occlusal images. The aim of this study was to evaluate transversal slice imaging (TSI) as a diagnostic alternative, keeping radiation exposure under consideration. MATERIAL AND METHODS: In a pilot study, we simulated seven different canine positions in a phantom head. Each tooth position was visualized by transversal slice imaging and compared by several observers independently and blinded to computer tomography (CT) serving as the gold standard. The clinical study included the retrospective analysis of TSI samples from 27 patients (mean age 13.7 yrs.) according to these criteria: 1. location of the canine crown and root, 2. recognition of the crown, 3. stage of root development, 4. root dilaceration, 5. periodontal ligament space, 6. ankylosis, 7. relationship to neighboring teeth, and 8. resorptions of neighboring teeth. The evaluations of canine position were compared to the results gained intraoperatively. RESULTS: In the transversal slice images taken from a phantom head, the observers' estimations of the canine position were identical in five cases (71.4%). At least four observers using TSI described identical tooth positions in 89% of patients. In 2.5%, no statement concerning tooth position was feasible. Crown recognition was possible in 75% of cases. Ankylosis, periodontal ligament space, root development, dilacerations and resorptions were not assessable in the majority of the cases. CONCLUSION: Transversal slice imaging can be recommended as a second plane projection in diagnosing tooth displacement, especially concerning oro-vestibular localization (effective radiation dose 0.003-0.012 mSv). However, as far as periodontal ligament space, resorptions and root morphology are concerned, this method has its limits.