The panoramic radiograph archive of the human craniological collection housed at the Human Anatomy Museum in Turin.

The craniological collection at the Human Anatomy Museum of the University of Turin consists of 1090 skulls and 64 postcranial skeletons prepared mostly during the second half of the nineteenth century. The collection presents individuals of both sexes and of different age groups and includes 712 skulls of known age and sex and 378 of which only the sex is known. Most individuals are associated with a documentation that includes sex, age-at-death, dates of birth and a death certificate. The collection comes from several regions of Italy, between 1880 and 1915, received by the former Anatomical Institute of the University of Turin from city's prisons and hospitals. The whole craniological collection of known age was subjected to panoramic radiographs. The craniological collection combined with the panoramic digital X-ray images represents an important contribution in anthropology and forensic odontology, as there is now no craniological collection available in the world available from a radiological perspective, for investigating dental age assessment and sex dimorphism using radiographs as well as other research and teaching potentials.

Identification of Skeletal Remains Using Genetic Profiling: A Case Linking Italy and Poland.

Forensic genetics is a rapidly evolving science thanks to the growing variety of genetic markers, the establishment of faster, less error-prone sequencing technologies, and the engineering of bioinformatics models, methods, and structures. In the early 2000s, the need emerged to create an international genetic database for forensic purposes. This paper describes a judicial investigation of skeletal remains to identify the subject using various methods. The anthropological examination of the remains allowed identification of the Caucasoid (European) ethnic group, a height of 156 ± 4 cm, and an age between 47 and 50 years. The genetic profiles obtained from typing several microsatellites made it possible to evaluate the compatibility between the skeletal remains and the suspected decedent. To identify the remains, the two extrapolated genetic profiles were compared. The case described highlights the central role of forensic genetics in identifying skeleton remains by means of comparison.

Under the lens: a report on global dental morphology modules / Bajo la lupa: un reporte sobre los módulos de morfología dental a nivel global

SUMMARY: Dental morphology (DM) is the first introduction of dental graduates towards the identification of tooth; hence it is an important component of the dental curriculum. Traditionally, it is taught by manual carving of wax blocks, but the limitations of this method have been highlighted. There is a need to adopt innovative teaching methodologies to invigorate the concepts of dental anatomy (DA) and reduce the stress in teaching and learning with a proposal in standardization of training methodologies worldwide. Methods: A three-phased project was designed with an aim to collect global data related to teaching dental morphology within the dental curriculum. One dental professional actively involved in university teaching of DM subject was invited from 11 countries. The present study involved compilation of data from phase 1 questionnaire responses, followed by its discussion and analysis, and generation of preliminary report. Results: It is universally acknowledged that acquiring dental morphology knowledge by dentists is a prerequisite before they commence clinical practice. Our data points that no uniformity in DA course modules exists throughout the world and globally the subject requires curriculum redesigning. Conclusions: Consensus should be achieved amongst academicians in DM teaching and learning context. Innovative and standardized DM modules with component of computer-based and remote learning techniques should also be introduced.

La morfología dental (MD) es el primer contacto de los estudiantes de odontología con la identificación del diente; por lo tanto, es un componente importante del plan de estudios de la carrera. Tradicionalmente, se enseña mediante el tallado manual de bloques de cera, pero se han destacado las limitaciones de este método. Existe la necesidad de adoptar metodologías de enseñanza innovadoras para dinamizar los conceptos de anatomía dental (AD) y reducir el estrés en la enseñanza y el aprendizaje con una propuesta de estandarización de metodologías de formación, a nivel mundial. Métodos: Se diseñó un proyecto de tres fases con el objetivo de recopilar datos globales relacionados con la enseñanza de la morfología dental dentro del plan de estudios dental. Se invitó a un profesional de la odontología de cada uno de 11 países que participa activamente en la enseñanza universitaria de la MD. Esto incluyó la recopilación de datos de las respuestas a un cuestionario en la fase 1, seguida de su discusión y análisis, y la generación de un informe preliminar. Resultados: Se reconoce universalmente que la adquisición de conocimientos de morfología dental por parte de los odontólogos es un requisito previo antes de comenzar la práctica clínica. Nuestros datos indican que no existe uniformidad en los módulos del curso de AD en todo el mundo, por lo que el tema requiere un rediseño del plan de estudios. Conclusiones: Debe lograrse consenso entre los académicos en el contexto de enseñanza y aprendizaje de MD. También se deben introducir módulos innovadores y estandarizados de MD con componentes de aprendizaje remoto y de base digital.

The need for a complete dental autopsy of unidentified edentulous human remains.

In December 2017, a decomposed unidentified body was found near the river Tronto in Teramo, Italy. The corpse was found without any identifying documents or specific personal belongings, except for a packet of cigarettes. The medical examiner determined a gastric perforation from the intake of hydrochloric acid to be the cause of death. A jar of muriatic acid found near the body led to suicide being considered the manner of death. The Penal Court in Teramo appointed two forensic odontologists to complete the postmortem assessment and collect dental data for personal identification. The corpse was found wearing a complete set of upper and lower dentures. The dental autopsy and 42 periapical X-ray images helped generate a biological profile of a man totally edentulous with upper and lower dentures, as well as an osteosynthesis with two plates and screws in the left ascending ramus of the mandible. In March 2018, the sister of a missing person reported the disappearance of her brother, and a presumptive identification was performed through visual recognition of the decomposed body. The sister confirmed the presence of two dentures and the location of the maxillo-facial surgery for the treatment of the fractured mandible. A complete dental autopsy was able to establish his identity without any DNA comparison needed. This case highlights the importance of performing a complete dental autopsy inclusive of dental radiographs, and its value in the identification of all unknown human remains even when totally edentulous. A complete dental autopsy should be performed in all cases of human identification.KeypointsDespite a corpse being edentulous, a complete dental autopsy can still be useful.Dental radiographs, such as bitewings, periapical images, panoramic radiographs, and CT scans, are recommended in all identification autopsies.

Diagnostic accuracy of the third molar maturity index (I3M) to assess the age of legal majority in Northern Brazil-population-specific cut-off values.

International guidelines for dental age assessment have recommended the use of methods based on available population-specific data. The Third Molar Maturity Index (I3M) was previously validated in several populations worldwide. This was the first study to evaluate the I3M in a northern Brazilian population and to test the diagnostic accuracy of the method to distinguish between minors and adults. The sample consisted of 1.070 panoramic radiographs retrospectively collected from females (n = 595) and males (n = 475) with ages between 16 and 22 years. I3M's original cut-off value of 0.08 was used to classify individuals below and above the age of 18. Receiver operating characteristic (ROC) curves were plotted to assess the accuracy (ACC) of the method. In females and males separately, the overall ACC was 73.1% and 80%, respectively. The overall ACC for the combined sample was 76.1%. For northern Brazilian males, the best cut-off value remained 0.08, while for females, an adjustment to 0.12 showed optimal outcomes. The new cut-off value led to an ACC of 98.5% for females, which reflected an increase of 25.5% compared to the original cut-off value. The original cut-off value proposed by I3M was applicable to the present sample of northern Brazilian individuals. Adjustments to 0.12, however, may be encouraged to enhance the performance of the method among females.

VIRDENTOPSY: Virtual Dental Autopsy and Remote Forensic Odontology Evaluation.

The identification of human remains relies on the comparison of post-mortem data, collected during the autopsy, with the ante-mortem data gathered from the missing persons' reports. DNA, fingerprints, and dental data are considered primary identifiers and are usually collected during any human identification process. Post-mortem dental data should be collected and analyzed by forensic odontologists, as a dental autopsy must not be confused with a dental examination. The virdentopsy project was inaugurated in 2020, during the COVID-19 pandemic, to allow the correct process of human remains by collecting dental data from teeth and jaws, which was then transmitted to forensic odontologists remotely for an expert opinion to achieve a generic profile of the unidentified human remains. The post-mortem dental biography is paramount to narrow the search for compatible missing persons but requires knowledge and experience of forensic odontologists. The virdentopsy process uses radiographic imaging (periapical X-rays, CT scans, panoramics), 2D/3D photos and video recording, photogrammetry documentation, 3D scanning, and live streaming where possible. This registered term was created by merging the terms "virtual" and "dental autopsy" but with no commercial benefits. The proposed process combines research topics under the field of the human rights of the dead and humanitarian forensic odontology services. It should enhance and accelerate the human identification process of the deceased, age estimation of the living, analysis of panoramic X-ray images, and be an educational tool for remote live training in forensic odontology and anatomy of skulls. This paper presents an overview of the virdentopsy process in the field of forensic odontology as a remote consultation as well as an educational tool for undergraduates and postgraduates.

iDENTIfyme Informative Campaign: Raising Forensic Dental Identification Awareness in the Community.

The identification of human remains can be performed visually through families and next-of-kin, but it is not advisable to rely only on visual recognition; instead, it is preferable to conduct a forensic comparison of antemortem and postmortem data for primary identifiers (fingerprints, DNA, and dental data). A dental autopsy is particularly valuable in the identification process of skeletonized, carbonized, saponified, and fragmented human remains. The principal challenge in the identification process is the search and collection of antemortem data. To this end, all dental information held on a missing person can represent a precious source of individualizing information that families should share with the police or investigating agencies after reporting a disappearance.

Sweet tooth: DNA profiling of a cranium from an isolated retained root fragment.

Sampling of healthy multi-rooted teeth is recommended for the genetic identification of human skeletal remains. However, this may not always be possible, as in the reported case consisting of an isolated human cranium found in an aggregate crushing and processing plant in Piedmont, Northwest Italy. The cranium displayed significant weathering, suggesting a post-mortem interval of several years, and was edentulous with the exception of the apical root fragment of the upper left canine, consequence of an antemortem horizontal fracture. Prolonged decalcification of the root fragment followed by powder-free DNA extraction from ~10 mg of root tip tissue led to the recovery of >10 ng of high molecular weight human DNA, in comparison with ~0.01 ng of DNA per mg of bone powder obtained from the petrous portion of the temporal bone. Quantity and quality of DNA isolated from apical tooth tissue enabled multiple genotyping, including a reportable female STR profile, mitochondrial DNA analysis, and ancestry-informative insertion/deletion polymorphisms. Although the cranium remained unidentified after DNA comparisons, our findings confirm that apical tooth tissue is a promising source of DNA, easily obtained through a powder-free extraction protocol. Results also indicate that root tips should not be overlooked in challenging identification cases, even in the presence of compromised tooth specimens.

Minor migrants' age estimation: Comparison of two dental methods.

In case of minor migrants, absence of valid identification documents that clearly define age is a critical issue, because without these data the child cannot enjoy the rights provided by the Convention on the Rights of the Child. Differentiation between minors and adults is fundamental when age is disputed in human identification, asylum seeking, criminal liability, and child abuse fields. Few indications are available about qualitative/statistical agreement of different age estimation methods. Ages of 301 individuals were estimated through two dental methods in order to: determine quantitative and statistical agreements in legal age definition; identify practical recommendations. The study pointed out discrepancy between the two methods in 7/301 cases. From a statistical point of view, this finding corresponded to an almost perfect agreement. Thus, authors suggested that the two methods can be alternately used for legal age assessment, but operators should use both methods when the estimated age is 18.5 years.

Dental autopsy recommendations in SARS-CoV-2 infected cases.

Unidentified human remains with unknown medical history can always pose biological hazards to forensic pathologists and odontologists, including hepatitis C, HIV infection, Middle East respiratory syndrome (MERS), hemorrhagic fever viruses such as Ebola, meningitis and now Sars-Cov2. The pandemic of the new coronavirus disease (COVID-19) has reached 185 Countries with an increasing number of deaths. Forensic pathologists and odontologists may find themselves having to perform an identification autopsy to confirmed or suspected Sars-Cov2 positive deaths. By respecting the entire set of universal precautions and recommendations the highlighted risks can be minimized, and best practice in human identification should always be a priority for human rights of the dead. The following article is a summary of the recommendations for conducting dental autopsies and management of suspected COVID-19 cases.

Causes of death shortly after delivery and medical malpractice claims in congenital high airway obstruction syndrome: Review of the literature.

Congenital High Airway Obstruction Syndrome is a rare pathology that may conduct the baby to death shortly after delivery. This outcome may cause emotional distress in the parents but it may also generate expensive medical malpractice claims about the reasons why the syndrome was not identified and/or correctly treated. The authors conducted a review of the cases in which Congenital High Airway Obstruction Syndrome caused death of the baby shortly after delivery. Then, they pointed out these ultrasonographic and anatomical reasons why the syndrome may be not identified and/or correctly treated: negative prenatal ultrasonography, recurrence of non-specific findings at prenatal ultrasonography, connection of respiratory and gastrointestinal tracts, tracheal agenesis or atresia, parent's refuse of post-partum therapeutic procedures, multiple malformations of the fetus/child. In conclusion, the authors highlighted that death shortly after delivery is usually caused by specific conditions that are not influenced by healthcare team's practice.

Establishment of the forensic odontology department: A proposed model for the basic infrastructure and forensic odontology kit.

The importance and the application of dental science and forensic odontology in the legal system are gradually increasing in India. In a long-term vision, there is a need for a specialized forensic training curriculum not only for the undergraduate and postgraduate dental students but also for the experienced dental surgeons. Dental experts opinion is sought most commonly in forensic casework of human identification, age estimation, and sexual assault cases with patterned injury, by the legal and forensic authorities. As a consequence, there is a demand for dentists trained in forensic and legal dentistry and experienced in forensic, capable of dealing and managing medicolegal cases in dental institutes or state hospitals. Several guidelines and protocols for forensic odontology procedures are drafted and proposed by forensic odontology organizations. However, there are no specific guidelines or recommendations for the establishment of a specialized forensic odontology department or unit in dental institutes. Hence, this article addresses the necessity and requirements for a forensic odontology unit, proposing a model to follow. A comprehensive list of forensic odontology armamentarium and case dependent forensic odontology kits is also highlighted here.

Under the lens: Dental expert witnesses in Brazil, Croatia, Indonesia, Italy, Saudi Arabia, and the United Kingdom.

The dentists' main job is to restore health and function to the oral cavity. However, dental professionals can also be involved in medico legal activities as forensic odontologists or by being Expert Witnesses (EW) to testify in professional liability cases, car accidents and work-related injuries. When called to act as an expert witness by the Court, the appointed dentist has to combine both biological and technical knowledge with equivalent medico-legal and forensic knowledge. Spontaneous involvement in medico-legal matters without an adequate training and experience can lead to mistakes with irreversible consequences. As an expert witness, the dentist has precise responsibility with civil and/or penal consequences, depending on the national judicial system. Dental Expert Witness, working either privately or appointed by the Court, has defined responsibilities and is subjected to civil or criminal proceedings (depending on the judicial system) if found wanting. Keeping in mind that there are significant differences regarding the requirements of becoming eligible to be a Dental Expert Witness in different legal systems. In this work the authors investigated the Judicial Systems regarding the appointment of Dental Expert Witnesses in Brazil, Croatia, Indonesia, Italy, Saudi Arabia and the United Kingdom (Table 1), in order to marshal knowledge towards harmonization and the attainment of best practice. This premise acknowledges the fact that forensic odontology must encompass the necessity for robust systems of audit and accreditation for it to be accepted as an "evidence based" forensic discipline. Further steps to ensure quality assurance in legal dentistry and forensic odontology training should be considered to prevent the spontaneous involvement of inappropriately trained dentists to become involved in making decisions that are beyond their competence and expertise.

Dental autopsy for the identification of missing persons.

Unidentified human remains require the complete collection of data during the autopsy stage to achieve, even belatedly, a positive identification. The very large number of people reported as missing in Italy (36,902) may represent an obstacle in the investigative process leading to the potential identity of the corpse, considering that 76.98% are foreigners. Add to this, the high number (1868) of "unidentified corpses" yet to be identified. A single case of a skeletonized corpse, listed in the list of nameless bodies is presented, with particular attention to odontology assessment. The case presented allows a broader definition of dental autopsy, which can no longer be considered a mere odontogram recorded by the medical examiner and/or a dentist with no forensic background. The case presented is not yet been identified also because no ante mortem (AM) identified data of compatible profiles has not been shared by the Police and consequently, no comparison of AM, and post mortem data could be possible. The failure to routinely employ forensic odontologists in the postmortem collection of identifying data of human remains of uncertain nationality and the reconciliation process will result in a reduction of additional findings, which, together with other circumstantial evidence and DNA profiles, can lead to a delay in positive identification.

Could the screening for correct oral health reduce the impact of death due to bolus asphyxia in adult patients? A forensic case report.

INTRODUCTION: "Bolus death" or "Café Coronary syndrome" refers to death due to asphyxia caused by an occlusion of the upper airways due to food. In this kind of asphyxia, the food bolus obstructs the larynx or the bronchial branches. This kind of event often affects subjects with acute intoxication due to alcohol or drugs, or with edentulism and with neurological or psychiatric diseases. CASE REPORT: An elderly woman, suffering from schizophrenia, was found dead in her house due to food bolus asphyxia. The post-mortem toxicological analysis on the deceased's biological fluids revealed the presence of tricyclic antidepressants, antipsychotics and neuroleptics. Study of the oral cavity showed the presence of partial edentulism and periodontal disease. HYPOTHESIS: We hypothesize that this kind of asphyxia in adults can be prevented. We believe that there are two major preventable factors: edentulism and salivation disorders in elderly and neuropsychiatric patients. The primary prevention of these pathologies would deal with the basic physician, similarly to other screenings already effectively in place. CONCLUSIONS: It is possible to prevent fatal asphyxia in subjects who suffer from this kind of diseases through appropriate screening. This prevention strategy would greatly reduce the amount of choking deaths in adults.

Selfie identification app as a forensic tool for missing and unidentified persons.

Social media applications can be valuable investigative tools in the search for missing and unidentified persons. As yet, no forensic App exists with the aim of assisting the human identification process, through the search of antemortem data to be used as adjunct data in the comparison with postmortem data collected. The aim of this article is to introduce a new application for Smartphones called "Selfie Forensic ID" App which will employ selfie and face photographs as an archive of dental data and dental features of the front teeth of missing persons sharing with Instagram, Tumblr, and Twitter Social Networks (available for free download from both Android and Apple store at http://onelink.to/selfieforensic). Features such as diastema rotated or wrongly positioned teeth, lip anomalies, recognizable fixed prosthetics, dental crown discolorations, dental or cutis piercing could represent strong identifiers in the comparison of AM and PM data. The increased number of terrorist attacks and natural disasters which result in the premature death of innocent people underlines the importance of storing personal identification data to avoid bodies remaining unidentified. The authors believe there will be an increased public willingness to share personal ID information through understanding of the ethical and administrative consequences to the families of deceased persons should bodies remain unidentified.

Child protection: legal and ethical obligation regarding the report of child abuse in four different countries.

Child protection is the duty of every single member of the society. Health professionals who work with children, such as members of dental team, are in the unique position to recognize signs of physical, sexual and emotional abuse as well as (dental) neglect. They should report any suspected case where a child is or may be in need of welfare. The professional responsibility is regulated by legal and ethical obligations. In this preliminary work the authors investigate the legal and ethical Acts, and the similarities vs. differences in obligations regarding reporting child abuse and neglect (CAN) cases in four countries: Croatia, United Kingdom, Italy and Canada. In all four countries all health professionals have a duty to report their suspicion if a child is in a harmful situation. All of them who fail to report, or even neglect or delay to report a suspicion, are liable on conviction to a pecuniary fine which varies from country to country. Depending on the country, if a professional has reasonable grounds to suspect that a child is or may be in need of protection, must report to: CAS (children's aid society), to CSS (center for social services), to police, to a Juvenile Court, or to the ombudsman. In all four countries, dentists are not asked to diagnose 'child maltreatment', but simply report the suspicion with supportive evidence. Ethical obligation comes from medical and dental ethical codes regulated by the Chamber or Council of Dentists. In all four countries legal and ethical obligations in reporting CAN are similar. Differences are related mostly to fines for nonreporting or a delay in reporting. Expanded investigation through other European countries and standard operational procedures is needed, in order to harmonize policies and guidelines for reporting CAN and maximize children protection.

Expert witnesses in dentistry: a comparison between Italy and Croatia.

A dentist is frequently required to translate dental trauma into monetary value, for example after car accidents and/or work-related injuries. When called to act in this capacity a dentist should combine his/her biological and technical knowledge with a quality medico-legal knowledge. Calculation of economic (pecuniary) damages and non-economic (non-pecuniary) damages requires specific training in medico-legal matters and awareness of the inherent pitfalls. Expert Witnesses registered in Court are usually asked to perform this duty. Nevertheless, European countries have differences regarding dental damage evaluations as well as significant differences in the conditions required for registration as an Expert Witness in Court. A dental Expert Witness has precise responsibilities and is subject to civil or criminal proceedings (depending on the judicial system) if found wanting. In forensic/legal dentistry a medico-legal doctor should not work in isolation from a dentist in dental cases nor is it wise for a dentist to work in the courts without having had specific training regarding judicial disciplines relating to dental damages. In this preliminary work the authors investigate the principal differences in the judicial systems regarding the appointment of Expert Witnesses in both Italian and Croatian courts. The next step will expand this investigation through to European countries in order to marshal knowledge towards harmonization, best practice and a common ground for dental evaluation and claim compensations (in accordance with the Council of Europe Resolution 75 ­ 7 Compensation for physical injury or death).

Oral health awareness in Croatian and Italian urban adolescents.

Purpose of this study was to investigate and compare differences in oral health awareness between Croatian and Italian urban adolescents. The sample consisted of primary school last grade students aged between 13 and 15 years, 300 children from Zagreb (Croatia) and 298 children from Bari (Italy). Oral health awareness was evaluated using a self-administered standardized questionnaire. Self-perception of oral health proved to be different between the two groups (p < 0.001). The Croatians reported that their oral health was "excellent" or "very-good" more often than the Italians (68.6% vs. 50.2%). The reasons given for visiting a dentist were different (p < 0.001). The Italians cleaned their teeth more often than the Croatians ("two or more times a day", 83.1% vs. 72.2%, p < 0.003). Wooden toothpicks were preferred by the Croatians (p < 0.001), while floss was preferred by the Italians (p = 0.03). The awareness regarding the use of fluoridated toothpaste was higher in the Italian group (95.6% vs. 72.5%, p < 0.001). The Croatians were consuming sweetened foods more often than the Italians (p < 0.001). Croatian adolescents reported more indicators of a lower level of oral health awareness than the Italians, while on the contrary Croatians had higher esteem of their oral health. Defining national preventive strategies is essential for improving adolescents' attitudes toward oral health in both countries, particularly in Croatia.