Year : 2020 | Volume
: 31 | Issue : 4 | Page : 662--665
Forensic endodontics and national identity programs in India
Navdeep Jethi1, Karandeep Singh Arora2,
1 Department of Conservative Dentistry and Endodontics, Daswani Dental College and Research Centre, Kota, Rajasthan, India
2 Department of Oral Medicine and Radiology, Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India
Dr. Karandeep Singh Arora
House No.: 1078, Sector 19 - B, Chandigarh - 160 019
National identity programs like Aadhaar in India can play an unique role in identification of an individual and has numerous beneficial applications for the government and the citizens. The biometric records of finger prints and iris provided in the database can be useful for the forensic purpose. In unfortunate incidence of disasters, accidents, and criminal cases such as severe burnings, the identification of the victims is possible through dental profiling where fingerprint matching is not possible. Endodontic treatment includes the radiography for diagnosis of the lesion, during working length determination, obturation, and various other procedures. The variations in tooth anatomy and morphology, post-endo restorations, root canal fillings, and sometimes, endodontic mishaps are recorded in these radiographs. This record can play an important role in identification of a person in case of unfortunate happenings. So, it is suggested to include dental profiling in National Identification programs, and the purpose of this article is to highlight the role of root canal procedures in dental profiling.
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Jethi N, Arora KS. Forensic endodontics and national identity programs in India.Indian J Dent Res 2020;31:662-665
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Jethi N, Arora KS. Forensic endodontics and national identity programs in India. Indian J Dent Res [serial online] 2020 [cited 2020 Nov 30 ];31:662-665
Available from: https://www.ijdr.in/text.asp?2020/31/4/662/298398
Forensic dentistry/odontology is a specialty branch of dentistry which applies dental knowledge and expertise to legal cases for both humanitarian and juridical issues. The comparison of classic dental features and previous dental treatments against those of a post-mortem dentition is among the special task carried out for identification and is considered essential for both humanitarian and judicial reasons.
Evidences of the use of dental profiling for identification are present in ancient history. One such example from the first-century BC includes the contract killing of Lollia Paulina, by Agrippina, the mother of the then Roman Emperor Nero. To ensure completion of the contract, she had ordered that Paulina's head be brought to her. The confirmation was based on the dental features which included dental anomalies and peculiar alignments of Paulina's teeth.
In case of severely burnt bodies when identification is next to impossible, teeth will provide positive data for such cases. One such source of identification are the radiographs that are taken during and after completion of endodontic treatment. They provide a vast source of features for identification as alterations in endodontic treatment are less frequently encountered when compared with coronal restoration.
With increasing trends of dental records being accepted in the court of law, the maintenance of accurate dental records of the dental procedures has become more important. Various researchers have highlighted the usefulness of endodontic records for human identification and the usefulness of root canal anatomy, advanced imaging, and newly introduced biomaterials in endodontic practice.
Hence, dental profiling in national identity programs can boost the ante-mortem record easily available to come with post-mortem records of an individual, and endodontic imaging and biomaterials can play instrumental role in these records.
When the tooth remains are provided from a severely decomposed, decayed, or burned body, it can be the key for identification of a person. The status of teeth changes with age throughout life. The measurable status is for decayed, missing, and restored teeth. Also, with the availability of digital records due to common practice of radiography with RVG, OPG and IOPAR in endodontic treatment make it easy for forensic investigations.
In endodontically restored teeth, some distinguishing features can be looked for while comparing the forensic data, which include the following:
Variation in tooth morphology and anatomy.Identification of obturating materials.Identification of post-endo restorations.Three-dimensional (3D) imaging for root canal space and age estimation.Use of periapical radiographs.Instrumental mishaps.
Variation in tooth morphology and anatomy
Hess studied branching, anastomoses, intricate curvatures, shape, size, and number of root canals in different teeth. Mostly, the root canals are equal to the roots, but on occasions they may vary. Most of the times, endodontic treatment of the apical part is difficult due to the presence of accessary or lateral canals, secondary dentin, pulpal stones, and so on. The different varieties of curvature and shape of roots and variations in tooth size and morphology can be recorded on radiographs.
In different individuals, variation can be seen in the presence of pulp horns, pulp calcifications, and location of the apical foramina. Sometimes, there may be presence of supernumerary roots, fused, or lesser number of root canals as well.
Thus, these anatomical variations when recorded and stored in the form of radiographs contribute to the formation of ante-mortem record of an individual, which can be compared with the post-mortem records, when needed. With the advancements in the field of dental radiology by the introduction of cone-beam computed tomography (CBCT), the architecture of the root and root canals can be precisely recorded and can strengthen the process of identification.
In postgraduate programs, photographic records of routine and special cases are maintained, so that preoperative work may be compared with the postoperative work. These photographs can be helpful in serving as the ante-mortem record, to be compared with the post-mortem record, when in need.,
For example, unique features of dentition get recorded in preoperative photographs such as midline diastema, or stains on the teeth, which can help in comparing the shape, size, color, and contours of the dentition.
Identification of obturating materials
The database of endodontic filling material may serve as an immediate reference for forensic odontologists. Teeth are protected by soft tissues and bones, so often they survive the heat and fire of incineration. The available fragments of teeth and their radiographs are of utmost importance.
The thermal behavior of obturating materials has been examined in studies and found that obturation material is recognizable till 1100°C. However, an increase in temperature over 600°C results in softening of the material, after which a honeycomb pattern is observed. This indirectly fills the missing root canals.
However, gutta percha when combined with sealers such as zinc oxide eugenol or resin based cements has a tendency to convert into a chalk-like whitish hue when heated at a temperature above 800°C which makes it difficult to distinguish from incinerated dentin.
There are studies which carried out surface and elemental analysis of the obturation material using scanning electron microscopy or energy-dispersive X-ray analysis before and after exposure to high heat. Other endodontic materials such as endodontic files, ProRoot MTA, and Apexit have also shown a positive elemental fingerprint.
Identification of post-endo restorations
After obturation of root canals, the post-endo restorations are required to achieve the objective of hermetic seal. The commonly used materials for post-endodontic restorations are amalgam, GIC, composites, cast metal restorations, and so on. In a study, these materials were exposed to incineration temperatures and found that in case of composite resins, on varying temperatures a color change from off-white to white was evident. They appeared chalky white, along with consistent shrinkage and loss of marginal seal with high temperatures. Most of the crown was crushed above 600°C, whereas the shape of the composite resin restorations was maintained until 800°C, which got dislodged at 1000°C temperature. On the contrary, studies conducted by Moreno et al. demonstrated intact restoration even above 1000°C temperature. This is an indication to narrow the spectrum of identification.
On the other hand, GIC demonstrated discoloration from marble white to chalky white at normal temperatures, and at higher temperatures it demonstrated dark brown cracks, along with loss of marginal seal. On the contrary, amalgam restoration was intact even at 1000°C. Initially, amalgam restoration exhibited granularity along with loss of marginal seal at temperatures as low as 200°C owing to alloy dissociation, where mercury evaporates from the alloy conglomerate.,
Cast metal inlays incineration and crowns are often used as post-endodontic restorations which can survive the high heats of incineration and can be identified easily as the metal ceramic restoration is heat-treated during normal preparation process. Identification of European tourists in tsunami was done by gold inlay, crown, bridge work, and dental implants.
3D imaging for root canal space and age estimation
A reduction in pulp dentine complex size due to secondary dentine deposition is a physiological marker of progressing age and is used by forensic experts for age identification of a person. When 3D pulp is radiographed in two dimensions of paranomic radiographs, the edges became blurred, and these diffuse edges could thus cause biased measurements by different observers for the same tooth. For this, measurement of pulp chamber volume is more reliable than the area, because of uneven formation of secondary dentin. Currently, 3D diagnostic modalities are being used to examine the relationship between age and age-related changes in pulp–tooth volume ratio. Studies prove that CBCT allows for the accurate calculation of tooth volumes, and the method is highly reproducible because of the good interexaminers' agreement.
Use of periapical radiographs and RVG images
IOPAs are the normal part of endodontic treatment and with advancement in digital radiography. Digital sensors are very commonly available at every endoclinic and are used to take radiographs during the procedures. The best part about radiovisiography is that the images can be saved in computer and can be used for forensic purpose; also, they do not fade away with time as in IOPAs. The original conditions of ante-mortem records are tried to be duplicated as closely as possible in post-mortem radiographs, and the similarities between the two images are confirmed by superimposition. Obturating materials such as gutta percha, sealer, and silverpoints can be identified easily. The metallic restoration like post, inlays, and crowns can be pointed out comfortably in the periapical radiographic records. Post-design and placement, core material, and coronal restorations' complexity, and variability provide further individuating features in such cases. The anatomical features such as maxillary sinus, bone loss, and impacted teeth are normally present in various periapical radiographs, and also the information about untreated teeth can be collected from these IOPAs.
Instrument breakage or separation is a common accident while performing root canals, and often dentist tend to bypass the instruments, or leave it as it is. The dental profiling about the broken instrument or bypassed instrument present within the canal can play a role in forensic identification of a person.
Ethical contributions of an endodontist in forensic endodontics
As root canal treatment (RCT) is the most popular and common procedure today, endodontic treatment records can be easily approachable in unfortunate burning and fire victim identification. So ethically it is our duty to keep in mind the forensic part associated with this treatment, and research is needed to increase the scope; the following contributions of a clinician can help in identification of a person in unfortunate burning or decaying cases:
Radiographic or digital image record protection as it provides valid identity information of a person despite some limitations with two-dimensional (2D) images.Mentioning information about brand name of the endodontic materials used in the treatment.The research over thermal behavior, physical, and chemical changes when exposed to high temperatures is still needed and endodontist should conduct studies to improve the field.Identification DNA information can be collected from dead pulp remnants, dentine, cementum, and enamel of an RCT-treated tooth. Preservation of avulsed tooth is also very helpful.Medical and past dental information about hereditary feature and habits of a person is an essential part of case record whether in endodontics or any other branch of dentistry; the digital record of such information should be encouraged.
Proposal of Merging Dental Records With Aadhaar in India
The National Identification programs in a densely populated country like India should be encouraged for dental and medical profiling, as it is the easiest way of obtaining information for a person today. The use of this document is commendable in lost children and mentally challenged persons. The use of fingerprints data is helpful in such cases if the person is registered in Aadhaar database.
The dental profiling at the time of registration can be helpful in case of burned or decomposed bodies and can be identified for a purposed person or criminal's body and other medicolegal lawsuits. The individuals can be asked to submit the data based on the missing, restored, and artificial prosthesis during enrolment in Aadhaar.
For this purpose, the Indian Academy of Forensic Odontology (IAFO) has stated the National Registry of Forensic Odontology in which a request has been made by the association to various dental colleges to maintain dental records of patients and keep them updated at regular intervals. Also, Arora and Bansal have proposed a meticulous plan for linking dental records with Aadhaar database and also other aspects including maintaining and updating the records at regular intervals.
Although at present dental record maintenance is only followed by a hand full of dentists, time is near when they will be regularly updated in our country just like the developed countries. This article explains as to how endodontics can play a key role in personal identification when dental records have been made.
It can be concluded that endodontic radiographic imaging, case history records, and information regarding endodontic materials can be important forensic and identification tools in case of burnt, decayed, or unidentified bodies. Endodontics should be encouraged to keep this record in their ethical practice. National Identification programs in India like Aadhaar should be encouraged to include dental and medical profiling of a person in their database, which can be a first piece of easily available ante-mortem information about a person in unfortunate tragedies.
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Conflicts of interest
There are no conflicts of interest.
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