Research Progress on Dental Age Estimation Based on MRI Technology.

Dental age estimation is a crucial aspect and one of the ways to accomplish forensic age estimation, and imaging technology is an important technique for dental age estimation. In recent years, some studies have preliminarily confirmed the feasibility of magnetic resonance imaging (MRI) in evaluating dental development, providing a new perspective and possibility for the evaluation of dental development, suggesting that MRI is expected to be a safer and more accurate tool for dental age estimation. However, further research is essential to verify its accuracy and feasibility. This article reviews the current state, challenges and limitations of MRI in dental development and age estimation, offering reference for the research of dental age assessment based on MRI technology.

How teeth can be used to estimate sexual dimorphism? A scoping review.

INTRODUCTION: Teeth are biological structures with a high degree of hardness, density, calcification, and capacity to adapt to extrinsic factors at physical, biological, and physiological levels. Subsequently, they resist for a longer period in deteriorating environmental conditions. With dental analysis, it is possible to acquire biographical data about a person. The aim of this scoping review was to identify publications using human teeth tissues to estimate sexual dimorphism. METHODS: The scoping review was carried out in the following databases: Jstor, Scielo, Science Direct, PubMed, and Scopus, using ten search strategies in English and guaranteeing completeness and reproducibility of the phases stipulated in the PRISMA guide. RESULTS: 143 studies on sexual dimorphism based on dental tissue traits were included, of which 40.6% (n = 58) were done in Asia and 27.2% (n = 39) in America. 80% of the studies (equivalent to 114 articles) focused their observations and measurements on the dental crown; 4.2% in enamel, dentin, and pulp together; 3.5% in dental pulp; 2.1% in the entire tooth; 2.8% in enamel, root, and the enamel-cementum junction, and only 0.7% in dentin and pulp. In addition, 92.3% of the studies used metric methods, while only 4.9% and 2.8% used biochemical and non-metric method respectively. CONCLUSION: For sexual dimorphism establishment, enamel has been the most analyzed dental tissue in permanent canines and molars mainly. Likewise, the most widely and accurately used methods for this purpose are the metrics, with the odontometry as the most implemented (intraoral or by using dental plaster models, digital scanning or software) with prediction percentages ranging from 51% to 95.9%. In contrast to biochemical methods, that can achieve the highest precision (up to 100%), the non-metric methods, to a less extent, reported prediction percentages of 58%.

Determining Whether an Individual is 18 Years or Older Based on the Third Molar Root Pulp Visibility in East China.

OBJECTIVES: To investigate the age-related changes of the mandibular third molar root pulp visibility in individuals in East China, and to explore the feasibility of applying this method to determine whether an individual is 18 years or older. METHODS: A total of 1 280 oral panoramic images were collected from the 15-30 years old East China population, and the mandibular third molar root pulp visibility in all oral panoramic images was evaluated using OLZE 0-3 four-stage method, and the age distribution of the samples at each stage was analyzed using descriptive statistics. RESULTS: Stages 0, 1, 2 and 3 first appeared in 16.88, 19.18, 21.91 and 25.44 years for males and in 17.47, 20.91, 22.01 and 26.01 years for females. In all samples, individuals at stages 1 to 3 were over 18 years old. CONCLUSIONS: It is feasible to determine whether an individual in East China is 18 years or older based on the mandibular third molar root pulp visibility on oral panoramic images.

Automatic removal of soft tissue from 3D dental photo scans; an important step in automating future forensic odontology identification.

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.

Legal conflicts in forensic dentistry: practice and methods of resolving them.

OBJECTIVE: Aim: To investigate and analyze legal conflicts in forensic dentistry of Ukraine. PATIENTS AND METHODS: Materials and Methods: A comparative research method for determining the common and distinctive features of the legal regulation of forensic dental expertise as a subcluster in the legislation of Ukraine. The descriptive (monographic) method reveals the problematic aspects of forensic dental examination through the lens of local normative and general normative connotations. The structural-functional research method made it possible to systematize the peculiarities of forensic medical and forensic dental expert activity. CONCLUSION: Conclusions: The analysis of legal conflicts made it possible to come to the following conclusions, that in Ukraine today there is no specific legal act that would regulate the aspects of performing dental activities. Forensic dental examination in Ukraine, in accordance with the legislation, is an examination of the actions and inactions of the dentist. The adoption of normative legal acts in the field of dental activity and forensic dental examination in Ukraine would make it possible to determine the specifics of establishing facts and circumstances that indicate a violation of the patient's rights.

Canine sexual dimorphism in crown and root dimensions: a cone-beam computed tomographic study.

The primary step in forensic odontological analysis is sex determination. The present study is one of the few studies that evaluated the accuracy of the combination of canine tooth root length and crown measurements for sex determination. The study sample comprised 196 cone-be am computed tomographic scans of individuals aged 20-80 years distributed in five age categories: 20-29, 30-39, 40-49, 50-59, and 60+ years old. Different parameters, such as width, length, and ratio measurements for the crown and root of each maxillary and mandibular canine tooth, were examined and recorded. The findings indicated that maxillary canines had greater sex dimorphism ability (87.3%) than mandibular canines (80.6%). Total tooth length and root length of maxillary canine were the most pronounced variables in the differentiation of sex groups. When the combination of the mandibular and maxillary measurements was considered, the accuracy for sex dimorphism was 85.7%. By using ratio variables, the accuracy was reduced to 68.9%. According to the findings of this study, total tooth length and root length are the most discriminant variables of canine teeth. These variables are more reliable sex indicators than crown measurements.

Artificial intelligence in age and sex determination using maxillofacial radiographs: A systematic review.

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.

The role of orthodontics in children identification: a case report of two victims of mass disaster.

INTRODUCTION: Human Identification based on dental evidence cannot be accomplished if antemortem dental records are unavailable or of poor quality. The involvement of the orthodontist in mass disaster victim identification processes may be crucial in relation to the amount and quality of the records which can be obtained before, during, and following the treatment. AIM: The aim of the study is the description of the contribution of the findings drawn from orthodontic records to the identification of victims of mass disasters who had received an orthodontic treatment, through the presentation of two cases. The first case involves the identification of a child victim of a plane crash and the second case involves the identification of two identical twin girls who died in a fire. In both cases, the identification was based on the findings obtained from the ante-mortem records provided by the orthodontist. CONCLUSIONS: The orthodontists apply customized orthodontic appliances and keep a comprehensive file of images, casts, radiographs, and other records in their practice. As a result, they can make a substantial contribution to the identification of young people or even adult victims of mass disasters in any case in which the authorities make a request.

Allied Dental Students' Perceived Knowledge, Confidence, and Attitudes Regarding Disaster Victim Identification Topics.

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.

Awareness of forensic dentistry among dental professionals in western Saudi Arabia: A knowledge, attitude, and practice-based cross-sectional study.

The aim of the study is to assess the knowledge, attitude, practice, and self-reported record for a list of items that are useful to forensic dentistry (FD) among dental professionals from the western region of Saudi Arabia. This cross-sectional survey was conducted among 406 dental health professionals. A pre-validated questionnaire written in Google Forms was used as a study tool. The questionnaire contained 4 parts: 1 - demographics; 2 - knowledge about FD; 3 - the attitudes; 4 - assessing dental record maintenance. Statistical data were analyzed using Pearson chi-square (χ2). The degree distribution amongst 406 respondents was: 64 bachelors; 162 masters; 180 Doctor of Philosophy (PhDs). 52% of respondents agreed that dentists should have enough knowledge about FD. Yet, 90.4% did not receive any training. All qualifications were aware of FD with no significant difference between groups (P = .06). According to degree, a significant difference between the 3 groups (P = .004), where a bachelor degree showed the least desire in testimony in court for FD evidence (50%) compared to master and PhD degrees (80%, 75%, respectively). Almost 56% of consultants reported that it is not primarily for the dentist to have a good knowledge of FD, while all other qualifications agreed to the opposite (66%). 55.4% of general dentists, 73% of residents, and 94% of consultants believed that FD is an accurate, sensitive, and reliable method in the identification of unknown victims or criminals. Our study revealed that there is a lack of knowledge, attitude, and practice among undergraduates and general dental practitioners. However, this scenario can be upgraded by the inclusion of FD in the dental curriculum in Saudi Arabia.

Evaluating legal age of 18 years through observation of third molars using Gambier et al. method in an orthopantomographic sample of subadults from South India.

In forensic practice, medicolegal physicians are often tasked with estimating age using dental evidence. This calls for an uncomplicated, reliable, and reproducible method for dental age estimation, enabling physicians to proceed without specific odontological expertise. Among various dental methods, third molar eruption analyses are less complicated and easier to perform. In our study, we explored the effectiveness of Gambier et al.'s scoring system, which examines the eruption of all third molars. We retrospectively analysed 1032 orthopantomograms (528 males and 504 females) of individuals aged between 15 and 24 years. The mean chronological age increased with the progression of stages (1 to 3) and phases (A to D) of the third molar eruption for both sexes. In terms of stages, none showed significant discrimination between minors (<18 years) and adults (>18 years), especially for males. However, Gambier's phase D displayed a relatively high likelihood of being 18 years or older, with an overall 85.9 % of males and 95.7 % of females having all third molars in stage 3 being 18 years or older. While the tested method could be helpful in indicating the completion of the 18th year of life, caution is advised (due to a high percentage of false positives), and it should be used alongside other age assessment methods by experts.

The effect of burning on dental tissue: A macroscopic and microscopic investigation.

Teeth are considered unique as fingerprints for identification purposes. Their structure and resilience mean they can remain for thousands and millions of years withstanding extreme conditions, including burning. During burning, bones undergo carbonization at approximately 400°C and calcination at approximately 700°C. This study aimed to investigate the effects of carbonization and calcination on dental tissue. It involved nondestructive analyses of 58 extracted human teeth before and after burning, using x-ray diffraction, micro-CT, and high-resolution confocal microscopy. The results revealed that during carbonization, dentin volume decreased in two thirds of the sample, accompanied by crack formation and significant reduction in hydroxyapatite crystal size (p<0.001). During calcination, dentin volume decreased in all teeth, along with a significant deepening of the cracks (p<0.001), while enamel crystal size increased slightly. Initial changes in teeth occurred at lower temperatures than had once been assumed, as indicated by the cracks during carbonization, and there was up to a 36% decrease in dentin volume during calcination, which should be considered when measuring burnt teeth. The results of this research provide new insight into understanding dental tissue response to burning. Thus, dental remains may contribute to the knowledge needed to reconstruct anthropological and forensic scenarios involving burning.

Effect of Geographic Variation in Bioarcheology: A Forensic Odontology Perspective.

How to cite this article: Yukta HN, Augustine D, SV Sowmya. Effect of Geographic Variation in Bioarcheology: A Forensic Odontology Perspective. J Contemp Dent Pract 2024;25(1):1-2.

Reconstrução facial forense: estudo antropométrico e antropomórfico da orelha / Forensic facial reconstruction: anthropometric and anthropomorphic study of the ear

O reconhecimento por meio da reconstrução facial forense é possível graças às pesquisas sobre as espessuras dos tecidos moles e características dos anexos faciais (olhos, boca, nariz e orelhas) e, a fidelidade dessas características são essenciais no processo do reconhecimento e posterior identificação. Na literatura científica, poucos trabalhos relacionam as orelhas à reconstrução facial forense. Este estudo tem como objetivo analisar as particularidades das orelhas, avaliando formato, tamanho, inclinação e posição, propor uma metodologia de classificação com vistas a uma maior reprodutibilidade que a forma atual existente e estabelecer relação com o biotipo facial. Diante da já referida dificuldade em se avaliar o formato da orelha foi elaborada uma abordagem mais objetiva que se mostrou eficaz quando da comparação entre o Índice Kappa (Cohen) realizado entre a forma atual e a forma proposta (de 0,63 para 0,83 intraexaminador e de 0,19 para 0,61 interexaminador). Foi também observada a predominância da orelha do tipo oval da população estudada. Foram avaliadas 99 fotografias de uma amostra de conveniência obtidas em um Pronto Socorro Odontológico particular da zona sul da cidade de São Paulo, composta por indivíduos de ambos os sexos com idade superior a 18 anos. Quanto às mensurações, o ICC intra e interexaminador obtiveram o mesmo resultado de 0,99. A análise comparativa entre os sexos revelou que o sexo masculino possui orelhas maiores quando comparado ao feminino. O estudo da inclinação da orelha em relação ao crânio mostrou um ângulo médio formado entre seu longo eixo e o Plano de Frankfurt de 73º para 76% dos homens e 69,76% das mulheres. Quanto à relação da orelha com outras estruturas, em 81,6% dos casos, o ponto mais superior da orelha coincide com a sobrancelha.

Latin American Forensic Odontology: A Scoping Review of its Current Research and the Objective/Subjective Nature of its Studies

SUMMARY: The new paradigm in Forensic Sciences initiated by the entry of genetics (the current standard of legal evidence) and accentuated by recognized wrongful convictions derived from experts today in the eye of criticism, has highlighted the potential for bias and error in forensic disciplines when they depend on human interpretation and subjectivity, which has not been avoided by Forensic Odontology (FO). However, a subjective judgment is not necessarily wrong, so the refinement of processes, the development of standards, and robust research can contribute to the validity of interpretation to increase objectivity. Latin America (LATAM) has its own realities and needs, which have conditioned the priorities and objectives of FO research. A scoping review is presented to systematically map the investigation of LATAM researchers and identify the objective or subjective nature of their assessments. LATAM shows interesting productivity and intentions to adhere to international standards, with Brazil leading this research significantly, followed by Chile and Colombia, among others. However, there is a disproportionate approach in certain lines of research (dental age estimation), and needs to address other quantitative studies, and to improve the visibility of the LATAM FO research.

El nuevo paradigma en ciencias forenses iniciado por la entrada de la genética (el actual estándar de la evidencia jurídica), y acentuado por reconocidas condenas injustas derivadas de pericias hoy en el ojo de la crítica, ha destacado el potencial de sesgo y error que poseen algunas disciplinas forenses cuando dependen de la interpretación humana y la subjetividad, lo cual no ha sido ajeno a la odontología forense (OF). Sin embargo, un juicio subjetivo no necesariamente es erróneo, con lo que el refinamiento de procesos, el desarrollo de estándares y la investigación robusta pueden contribuir a validar esa interpretación para aumentar su objetividad. Latinoamérica (LATAM) posee realidades y necesidades propias que han condicionado las prioridades y objetivos de la investigación en OF. Se presenta una revisión con búsqueda sistemática para mapear sistemáticamente la investigación en OF realizada por investigadores latinoamericanos, así como identificar la naturaleza objetiva o subjetiva de sus evaluaciones. LATAM demuestra una productividad interesante e intenciones de adherirse a estándares internacionales, con Brasil liderando significativamente esta investigación, seguido por Chile y Colombia entre otros. Sin embargo, se observa un enfoque desproporcionado en ciertas líneas de investigación (estimación de edad dental particularmente), y necesidad tanto de abordar otros estudios cuantitativos como de mejorar la visibilidad de la investigación latinoamericana en OF.

Exploring the feasibility of smartphone cameras for 3D modelling of bite patterns in forensic dental identification.

The field of bitemark analysis involves examining physical alterations in a medium resulting from contact with teeth and other oral structures. Various techniques, such as 2D and 3D imaging, have been developed in recent decades to ensure precise analysis of bitemarks. This study assessed the precision of using a smartphone camera to generate 3D models of bitemark patterns. A 3D model of the bite mark pattern was created using 3Shape TRIOSTM and a smartphone camera combined with monoscopic photogrammetry. The mesiodistal dimensions of the anterior teeth were measured using Rapidform Explorer and OrtogOnBlender, and the collected data were analyzed using IBM® SPSS® Statistics version 23.0. The mean mesiodistal dimension of the anterior teeth, as measured on the 3D model from 3Shape TRIOSTM and smartphone cameras, was found to be 6.95 ± 0.7667 mm and 6.94 ± 0.7639 mm, respectively. Statistical analysis revealed no significant difference between the two measurement methods, p > 0.05. The outcomes derived from this study unequivocally illustrate that a smartphone camera possessing the specific parameters detailed in this study can create a 3D representation of bite patterns with an accuracy level on par with the outputs of a 3D intraoral camera. These findings underscore the promising trajectory of merging smartphone cameras and monoscopic photogrammetry techniques, positioning them as a budget-friendly avenue for 3D bitemark analysis. Notably, the monoscopic photogrammetry methodology assumes substantial significance within forensic odontology due to its capacity for precise 3D reconstructions and the preservation of critical measurement data.

OPG-based dental age estimation using a data-technical exploration of deep learning techniques.

Dental age estimation, a cornerstone in forensic age assessment, has been extensively tried and tested, yet manual methods are impeded by tedium and interobserver variability. Automated approaches using deep transfer learning encounter challenges like data scarcity, suboptimal training, and fine-tuning complexities, necessitating robust training methods. This study explores the impact of convolutional neural network hyperparameters, model complexity, training batch size, and sample quantity on age estimation. EfficientNet-B4, DenseNet-201, and MobileNet V3 models underwent cross-validation on a dataset of 3896 orthopantomograms (OPGs) with batch sizes escalating from 10 to 160 in a doubling progression, as well as random subsets of this training dataset. Results demonstrate the EfficientNet-B4 model, trained on the complete dataset with a batch size of 160, as the top performer with a mean absolute error of 0.562 years on the test set, notably surpassing the MAE of 1.01 at a batch size of 10. Increasing batch size consistently improved performance for EfficientNet-B4 and DenseNet-201, whereas MobileNet V3 performance peaked at batch size 40. Similar trends emerged in training with reduced sample sizes, though they were outperformed by the complete models. This underscores the critical role of hyperparameter optimization in adopting deep learning for age estimation from complete OPGs. The findings not only highlight the nuanced interplay of hyperparameters and performance but also underscore the potential for accurate age estimation models through optimization. This study contributes to advancing the application of deep learning in forensic age estimation, emphasizing the significance of tailored training methodologies for optimal outcomes.

Bitemarks and 3D scanner: An objective comparison for bitemarks. A pilot study.

The marks left by the bite of a subject (bitemark) represent an unequivocal character, being useful in identifying the possible perpetrator of a crime. To date, the analysis of bitemarks is mainly based on the direct vision of photographic finds and on the visual comparison with the teeth of the hypothetically responsible person. However, the bitemark also retains three-dimensional characteristics detectable with a 3D scanner. In this pilot study, an innovative method of bitemark analysis, utilizing a three-dimensional scanner and some software, will be introduced, enabling a quantitative comparison of bitemarks and their corresponding human dentitions. For this purpose, 10 complete plaster models (human dentitions) of 10 adult subjects were used to make 20 experimental bitemarks on dentistry wax. All materials were individually scanned with the iTero® 3D scanner and reworked with MeshMixer software. A visual analysis of the characteristics and a computerized analysis with the CloudCompare software were also performed. Study showed a different trend of the distribution curves of the points which were obtained comparing the human dentition and coincident and non-coincident bitemarks. Current results support that the intraoral 3D scanner allows the fast record and the preservation of the three-dimensional characteristics of the bitemarks, and it allows computerized analyses to be carried out.

Validity of postmortem computed tomography for use in forensic odontology identification casework.

Forensic Odontology (FO) identification compares antemortem (AM) and postmortem (PM) dental datasets and is widely accepted as a primary identifier. Traditionally, a PM dental examination is undertaken in the same manner as a dental examination conducted for a living patient. Recently, the increased forensic application of computed tomography (CT) offers an alternative source of PM data. While charting from PMCT is widely accepted as less accurate, the impact on reconciliation is unknown. This study aims to determine if reconciliation outcome differs when PM dental data is collected from PMCT, compared with conventional PM examination. PMCT data was reviewed for 21 cases previously completed using conventional PM dental examination. Operators blinded to original identification outcomes charted from CT images before comparing to AM data to form an opinion regarding identity. Opinions formed were compared with original identification outcomes. Differences in PM dental charting between the two methods and the evidentiary value of AM and PM datasets were assessed to determine driving factors of differences in identification outcome. Compared to conventional PM dental examination, PMCT examination resulted in similar or less certain identification outcomes. Discrepancies in outcome were driven by the quality of AM and PM datasets rather than inaccuracies in charting from PMCT. Based on the results of this study, both conventional and PMCT methods of PM dental examination can reach similar identification outcomes. However, operators remained more certain in establishing identity when conducting conventional PM dental examinations especially when AM data was lacking.

Prevalence of abnormalities seen on orthopantomograms performed for forensic age estimation in unaccompanied minor asylum seekers.

OBJECTIVES: Evaluate the prevalence of radiological anomalies on orthopantomograms (OPT) performed as part of forensic age estimation in unaccompanied minors. METHODS: This is a retrospective study conducted on 208 OPT examinations requested by a magistrate. These OPTs were interpreted independently by two readers to establish the number of missing teeth (MT), presence of dental fillings (DF), and dental anomalies (DA). The presence of radiolucent (RL), radiopaque, and mixed lesions was also assessed. RESULTS: Most radiologic anomalies were RL, detected on 41% and 39% of the subjects evaluated for R1 and R2, respectively, with a mean of 1.3 ± 2.4 (1-16) and 1.1 ± 2 (1-13) RL lesions per subject. Among the RL identified, the majority were dental (70% for R1 and 65% for R2), all of which had a suspected infectious origin. Among readers, 43% and 41% of the subjects evaluated presented MT, 21% and 15% presented DF, and 22% and 20% presented DA for R1 and R2, respectively. The inter- and intra-observer reproducibility for OPT classification was considered excellent (Kappa = 0.84, 95% CI 0.78-0.90, and Kappa = 0, 95, 95% CI 0.86-0.99). DISCUSSION: There was a non-negligible prevalence of radiological anomalies in OPT studies performed for forensic age estimation. Most of these lesions were suspected to be infectious in origin, potentially requiring medical care. This constitutes an ethical dilemma inherent in the judicial expertise injunction requiring a limited specific response. CLINICAL RELEVANCE STATEMENT: This study highlights a non-negligible prevalence of supposedly infectious radiological abnormalities. The restricted possibility for the legal expert to declare these abnormalities raises ethical and medical questions. KEY POINTS: • Orthopantomograms can be performed as part of forensic age estimation. • Results indicate the majority of radiological anomalies detected on OPTs were of suspected infectious origin. • These findings give rise to ethical and medical questions about the way in which these forensic examinations are carried out.