Identificação odontológica de corpo íntegro utilizando tomografia computadorizada pós-morte - relato de caso pericial / Dental identification of intact body through postmortem computed tomography - forensic case report

Há muito, os conhecimentos odontológicos têm se apresentado como uma ferramenta primordial na determinação da identidade de vítimas de morte violenta, especialmente quando estas se apresentam carbonizadas, putrefeitas, mutiladas ou esqueletizadas, mas também em casos atípicos, como em cadáveres "frescos". Nesse contexto, o presente trabalho tem o objetivo de relatar o primeiro caso de identificação odontológica utilizando-se o equipamento de tomografia computadorizada do Instituto Médico Legal (IML) de Goiânia-GO para obtenção das informações post-mortem (PM) de um cadáver íntegro, que foram confrontadas com os dados da radiografia panorâmica antemortem (AM). Relato de Caso: Um indivíduo vítima de projéteis de arma de fogo foi removido para o IML de Goiânia para os exames de praxe depois de vir a óbito em unidade hospitalar. Apesar de o corpo se apresentar "fresco", a coleta (tomada) de impressões digitais revelou um registro cuja qualidade não permitia a demarcação dos pontos necessários para um confronto papiloscópico. Os supostos familiares, então, apresentaram radiografia panorâmica AM, fato que motivou a equipe pericial a utilizar o recém instalado equipamento de tomografia computadorizada para a obtenção de imagem PM, possibilitando o devido processo de reconciliação (AM x PM), onde foram identificadas diversas similaridades de natureza anatômica e terapêutica que remeteram a uma identificação positiva da vítima. Conclusão: A adoção de abordagens tecnológicas e a alocação de recursos humanos especializados para a identificação humana devem ser prioridades nos serviços de Medicina e Odontologia Legal, visando aumentar a eficiência e precisão no processamento das demandas usuais, bem como para solucionar eventuais desafios técnicos

For a long time, dental knowledge has proven to be a fundamental tool in determining the identity of victims of violent death, especially when they are charred, putrefied, mutilated or skeletonized, but also in atypical cases, such as fresh corpses. In this context, the present work aims to report the first case of odontological identification using the computerized tomography equipment of the Forensic Medical Institute (IML) of Goiânia-GO to obtain post-mortem (PM) information from an intact corpse, which was compared with antemortem (AM) panoramic radiograph data. Case Report: An individual victim of gunshot wounds was taken to the IML of Goiânia for routine examinations after dying in a hospital unit. Although the body was "fresh," fingerprint collection revealed a record whose quality did not allow the necessary points for a papilloscopic confrontation to be marked. The supposed relatives then presented antemortem panoramic radiography, which motivated the forensic team to use the newly installed computerized tomography equipment to obtain PM images, enabling the proper reconciliation process (AM x PM), where several anatomical and therapeutic similarities were identified leading to a positive identification of the victim. Conclusion: The adoption of technological approaches and the allocation of specialized human resources for human identification should be priorities in Forensic Medicine and Odontology services, aiming to increase efficiency and accuracy in processing usual demands, as well as to solve any technical challenges that may arise

Why are brazilian orthodontists prosecuted and convicted? an overview of the contemporary jurisprudence / Por que ortodontistas brasileiros são processados ​​e condenados? uma revisão da jurisprudência contemporânea

Orthodontics figures as one of the largest community of specialists in Brazil. Unfortunately, numbers are high not only for the professionals but also for the lawsuits against them. The aim of this study was to screen the Brazilian jurisprudence in order to identify the reasons that motivated patients against orthodontists and motivated Judges towards convictions in lawsuits. The sample consisted of 395 lawsuits retrieved from the State Civil Courts of Brazil (n=27). The lawsuits were founded on conflicts between orthodontists and patients. Case-specific legal information were registered, such as patients' main reason behind the lawsuit and the decision in second instance. Chi-square and relative risk tests were calculated to investigate the influence of research variables towards conviction. Most of the lawsuits were judged in the State of São Paulo (n=151; 38.2%) and were published between 2011 and 2017 (rho: 0.797). The main reasons behind the lawsuits against orthodontists were the dissatisfaction with treatment outcomes (n=143, 36.2%), the occurrence of periodontal disease (n=45, 11.4%) and the need for tooth extractions (n=43, 10.9%). Statistically significant outcomes were detected between convictions in first and second instances and between convictions and the contractual obligation of result (p<0.001). The combination of I) patients' dissatisfaction and II) judgments under the obligation of results in second instance figure as the main risk factors for the prosecution and conviction of orthodontists.

A Ortodontia figura como uma das maiores especialidades no Brasil. Infelizmente, os números não são elevados apenas no que concerne aos profissionais, mas também quanto aos processos judiciais contra eles. O objetivo deste trabalho foi pesquisar a jurisprudência Brasileira para identificar as razões que levam os Ortodontistas a serem processados pelos pacientes e os motivos que levam os Magistrados a condená-los. A amostra consistiu de 395 processos judiciais obtidos dos Tribunais Judiciais Brasileiros (n=27). Todos os processos descreveram lides entre Ortodontistas e pacientes. Informações demográficas e legais foram registradas, como a queixa principal do paciente ao instaurar o processo e a decisão do Magistrado em segunda instância. Os testes de Qui-quadrado e de risco relativo foram utilizados para verificar a influência das variáveis sobre o desfecho. A maioria dos processos foi julgada no Estado de São Paulo (n=151; 38.2%) e publicada entre 2011 e 2017 (rho: 0.797). O principal motivo de processo contra Ortodontistas foi a insatisfação do paciente com os resultados do tratamento (n=143, 36.2%), seguido da ocorrência de doença periodontal (n=45, 11.4%) e da necessidade de extrações (n=43, 10.9%). Resultados estatisticamente significantes foram observados entre julgamentos em primeira e segunda instância e entre condenação e julgamento sob a obrigação de resultado (p<0.001). A combinação da I) insatisfação do paciente com II) o julgamentos sob a obrigação de resultados emergiram como principais fatores de risco para condenações.

Suicidal tandem bullets to the heart with subsequent embolization - a case report.

A tandem bullet phenomenon is a rare situation in which two bullets travel nose-to-base towards the target. In terminal ballistics, a classic feature of the tandem bullet phenomenon is the presence of a single entrance wound with two or more bullets inside the body. During the autopsy, the phenomenon may result in confusion, especially related to the dynamics of the shooting. The present study reports a case of suicide by tandem bullets to the heart with subsequent bullet embolization into the aorta. A 40-year-old Caucasian woman, with a previous history of suicide, shot herself in the chest with a 0.32 revolver. During the autopsy, a single entrance wound (one centimeter in diameter) was observed in the sternal region. The injury was a close-range shot. Internally, a single wound was detected in the right atrium of the heart. Two 0.32 S&WL lead bullets were found inside the descending abdominal aorta. The bullets fitted each other perfectly in a nose-to-base position. Both bullets were tracked back to a single firearm that belonged to the victim's father using forensic ballistics. The forensic report suggested a suicide. A multidisciplinary approach involving crime scene investigation, forensic pathology and forensic ballistics is necessary to investigate tandem bullet cases. Forensic experts must be aware of this phenomenon and, more importantly, they must be aware of its unusual manifestations, such as embolization, in order to come to optimal conclusions.

Dental Cingulum and Position of Fixed Orthodontic Appliance as Source of Morphological and Therapeutic Identifiers: An Unusual Case Report.

Orthodontic records, such as photographs, radiographs, and dental casts, provide information useful for identification purposes because it may reveal important morphological, therapeutic, and pathological dental identifiers. Among these identifiers, the type and position of orthodontic appliances figure as distinctive tools for human identification. In this context, the present study aims to report an uncommon case of identification of a putrefied body, found near to a forest region in Brazil. The postmortem (PM) examination showed that the victim had part of a fixed orthodontic appliance installed in the maxillary and mandibular dental arches. To identify the body, relatives of the potential victim presented orthodontic examinations containing panoramic radiography and photographs of the orthodontic treatment. The body was identified based on the analysis of the radiographs and photographs that confirmed the presence of the orthodontic appliances observed PM. More specifically, the identification was supported by the analysis of bracket bonding position of the maxillary and mandibular incisors and the presence of distinctive morphological traits of the canines and incisors, as well dental roots observed radiographically. The present case highlights the importance of orthodontic records as a source of morphological dental identifiers for cases in which only unrestored teeth are available.

Forensic Identification of Decomposed Human Body through Comparison between Ante-Mortem and Post-Mortem CT Images of Frontal Sinuses: Case Report.

OBJECTIVE: The aim of this paper is to report on a case of positive human identification of a decomposed body after the comparison of ante-mortem (AM) and port-mortem (PM) computed tomography images of frontal sinus. CASE REPORT: An unknown, highly decomposed human body, aged between 30 and 40 years, was found in a forest region in Brazil. The dental autopsy revealed several teeth missing AM and the presence of removable partial prostheses. The search for AM data resulted in a sequence of 20 axial images of the paranasal sinuses obtained by Multislice Computed Tomography (MSCT). PM reproduction of the MSCT images was performed in order to enable a comparative identification. After a direct confrontation between AM/PM MSCT, the data were collected for morphological findings, specifically for the lateral expansion of the left lobe, the anteroposterior dimension, and the position of median and accessory septa of the sinuses. CONCLUSION: The importance of storing and interpreting radiographic medical data properly is highlighted in this text, thus pointing out the importance of application of forensic radiology in the field of law.

Identifying murder victims with endodontic radiographs.

Endodontics is a special branch of dentistry constantly guided by imaging examinations. From a forensic scope, endodontics plays a valuable role providing solid antemortem (AM) radiographic evidence for comparison with postmortem findings in human identifications. This study illustrates the interface between endodontics and forensic odontology describing three cases of human identification based on radiographic endodontic records. From 2009 to 2012, three unknown male victims of murder were examined in a local Brazilian medico-legal institute to retrieve identity and potential cause of death. Specifically, when asked for AM data, a relative of the three victims provided periapical radiographs of endodontic treatments. Based on that, forensic dentists reproduced the same imaging acquisition techniques obtaining similar periapical radiographs, enabling a comparative dental identification. All the victims were positively identified based on patterns of dental morphology and treatment intervention. This study draws the attention of general and forensic dentists highlight the importance of properly recording dental treatments and searching for evidence in AM endodontic data, respectively.

Importância ético-legal e significado das assinaturas do paciente no prontuário odontológico / Legal and ethical importance and patient’s signature significance in dental records

Introdução: O prontuário odontológico é um importante documento na prática clínica, pois é possível arquivar nele informações como diagnóstico; planejamento; evolução do tratamento e exames complementares, e, também porque possui finalidade administrativa e legal. Objetivo: discorrer sobrequem, porque, quando e onde assinar os documentos odontológicos do prontuário, bem como analisar osignificado dessas assinaturas com o intuito de orientar o cirurgião-dentista para atuar ética e legalmente.Material e método: Foram selecionados, por amostra de conveniência, dois Acórdãos que versavam sobrequestionamentos de paciente contra cirurgião-dentista, sendo um do Tribunal de Justiça do estado deMato Grosso do Sul e outro de São Paulo. O conteúdo desses documentos foi analisado qualitativamente,sendo transcritos os trechos de interesse odontolegal. Discussão: Quando acionados judicialmente, oscirurgiões-dentistas não foram capazes de provar, por meio de documentos, as faltas recorrentes dospacientes, a entrega de documentos odontológicos aos pacientes, a realização de instruções erecomendações referente ao tratamento realizado. O valor da assinatura do paciente em qualquerdocumento odontológico pode ser questionado tanto pelo momento e forma de obtenção, quanto deacordo com a sua capacidade civil. Conclusão: o registro detalhado dos procedimentos executadosjuntamente com a assinatura do paciente/responsável é a conduta que melhor respalda o profissional deforma administrativa e legal.

Introduction: The dental record is an important document in clinical practice, because it can be used torecord: diagnostic information; planning; developments in the treatment and complementary tests, andalso because it has administrative and legal purpose. Objective: To discuss who, why, when and where tosign dental records documents and analyze the meaning of these signatures in order to guide the dentistto act ethically and legally. Methods: two judgments that focused on patient inquiries from dentists, one ofthe Court of the State of Mato Grosso do Sul and another in Sao Paulo, were selected by conveniencesample. The content of these documents was qualitatively analyzed, being transcribed excerpts of most interest to Legal Dentistry. Discussion: When the dentists were sued, they were not able to prove, throughdocuments, recurring patients’ absences; handing over documents of dental records to patients; carryingout instructions and recommendations regarding the treatment performed. The value of the patient’ssignature in any dental document can be questioned both concerning the timing and form of obtaining andalso considering their legal capacity. Conclusion: the detailed record of the procedures performed alongwith the signature of the patient or their guard is the conduct that best supports the professionaladministrative and legal manner.

Delineamento dental computadorizado das bordas incisais, em fotografias de sorriso, com finalidade pericial / Computerized dental delimitation of incisal edges in smile photographs with forensic purposes

Introdução: O aumento da criminalidade no Brasil tem gerado um incremento dos casos de identificação humana envolvendo corpos carbonizados, putrefeitos e esqueletizados nos Institutos Médicos Legais dopaís. Neste contexto, a Odontologia Legal tem demonstrado sua importância na identificação humana porvárias técnicas, dentre elas a identificação por meio de fotografias do sorriso. Objetivo: Demonstrar, pormeio de um relato de caso, a execução da técnica de demarcação da linha incisal em fotografiascasuais/sociais de sorriso utilizando o software Power Point®(Microsoft®, Redmond, EUA), com finalidadede identificação humana. Relato de caso: um cadáver parcialmente carbonizado foi examinado para determinação da causa mortis e identificação humana. Diante da inexistência de registrosmédico/odontológicos, os supostos familiares foram orientados a apresentarem fotografias em que apessoa desaparecida aparecesse sorrindo, a fim de que essas fossem comparadas com fotografias análogas produzidas a partir das arcadas dentárias do cadáver. Por meio da delimitação das linhas incisais dos dentes inferiores utilizando o Power Point®(Microsoft®, Redmond, EUA) e comparação comlinha semelhante produzida a partir das fotografias de sorriso fornecidas, foi possível a identificaçãopositiva do cadáver. Conclusão: Apesar de a técnica ilustrada poder ser realizada com outros programasde computador, o Power Point®(Microsoft®, Redmond, EUA) permite a obtenção do delineamento incisalcom maior facilidade e com a mesma confiabilidade de programas mais complexos, em casos de análisepericial do sorriso.

Criminality increased in Brazil in the last years. Consequently, human identification cases involvingcharred and putrefied bodies, as well skeletal remains, became more prevalent. In this context, forensic dentistry played an important role enabling several pathways to aid human identifications, including the analysis of smile photographs. Objective: To report a case of human identification illustrating the techniqueused for tracing the contour of incisal borders using Power Point®(Microsoft®, Redmond, USA) softwarepackage in smile photographs. Case report: An unknown partially charred human body was referred fordental identification and investigation on the cause of death at the local medico-legal institute. In the lackof ante-mortem (AM) medical/dental data potential relatives of the victim were asked to provide socialphotographs showing the teeth of the victim (smile photographs). The obtained photographs were used forcomparison with photographs produced post-mortem (PM). In both AM and PM photographs the contour ofthe incisal borders were traced using Power Point®(Microsoft®, Redmond, USA) software package andqualitatively matched for a positive identification. Conclusion: Extracting the incisal contour of human teethis feasible through commonly used software packages and may support forensic investigations based onidentity.

Human identification through the analysis of smile photographs.

The comparison between antemortem and portmortem data comprehends the basis of the dental identification process. High-tech devices allow for optimal manipulation of postmortem data. However, in especial situations, the victims do not have records of dental treatments, making necessary the search for antemortem data from personal belongings. Smile photographs are one of the most common sources of dental information detected from personal belongings. In this context, the present study reports a forensic case in which a charred body was positively identified through the application of 3 techniques for the analysis of smile photographs.

Dental Identification Through Endodontic Radiographic Records: a Case Report.

OBJECTIVE OF WORK: The present study aims to report a case of successful human identification based on the comparison of ante-mortem and post-mortem records of endodontic treatment. Based on these, the legal value of storing and updating clinical records is highlighted throughout the text. CASE REPORT: An unknown body was recovered from a traffic accident site. Forensic examination was conducted in order to establish the identity of the victim. Based on the absence of ante-mortem fingerprint registration in the national database, the search for AM data was performed using periapical radiographic records from private dental clinics. A positive dental identification was achieved analyzing evidence of endodontic treatment. CONCLUSION: Dental radiographs play a valuable role as legal tools supporting the criminal demands on the daily forensic practice. Specifically in endodontics, periapical radiographs are essential for a proper treatment. In forensics, these radiographs represent a solid source of ante-mortem data for human identifications.