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Accuracy of two dental age estimation methods in the Indian population – A meta-analysis of published studies
Harikrishnan Prasad, Nitya Kala
Background: Dental age estimation using radiographic methods have gained considerable attention in the recent past. Although several such methods exist, Demirjian’s method and Willems’ method are very popular and have been used extensively. Whether these methods are applicable to the Indian population is not known.
Methods: A search of Pubmed, Embase and Google Scholar search engines was done using specific keywords to identify studies using Demirjian’s and Willems’ methods in the Indian population. Studies published up to July 2018 were considered, and after thorough review, 20 eligible studies were identified. Meta-analysis of data obtained from these articles was conducted on 3668 children for Demirjian’s method and 3144 children for Willems’ method. The weighted mean differences for both of these methods at 95% confidence intervals were assessed to identify the accuracy of each method in predicting the chronological age.
Results: Demirjian’s method was found to consistently overestimate the age in Indian population, irrespective of the gender. The overestimation was in the order of few months. Willems’ method resulted in underestimation of the age, although this was comparatively minimal in the order of 30 to 40 days.
Conclusion: Willems’ method produced more accurate age which was very close to the chronological age, both in boys and girls. In contrast, Demirjian’s method suffered from marked overestimation. Willems’ method appears to be more suited to use in the Indian population.R
(J Forensic Odontostomatol 2019;37;3:2-11)
Digital tooth reconstruction: An innovative approach in forensic odontology
Abraham Johnson, Gargi Jani, Astha Pandey, Nimesh Patel
In mass disasters, accidents and crime investigations, where human remains are decomposed, charred or skeletonized, teeth may dislodge due to post-mortem loss or due to mishandling of evidence during the manipulation of skeletal and dental remains. Thus, the identification process is hampered due to the loss of dental evidence. In these situations, forensic tooth reconstruction may aid in the identification process. Forensic tooth reconstruction (FTR) refers to the process that aims to reconstruct the morphology of the missing tooth from the skeletal remains from the intra-alveolar morphology of the dental socket. The study is an innovative attempt to develop a digital approach to reconstruct three-dimensional (3D) printed tooth models through recording intra-alveolar morphology of empty dental sockets which simulate the teeth which are missing post-mortem. An experimental study was conducted on the human mandible, where using volumetric scanning, 3D scanning and printing techniques the tooth was reconstructed from the intra-alveolar morphology of the socket. Through metric analysis and qualitative congruency testing it was established that there was minimal discrepancy between natural tooth and 3D printed tooth. It was determined that teeth missing post-mortem do not necessarily invalidate the identification process. Digital FTR gives accurate results with minimum error.
(J Forensic Odontostomatol 2019;37;3:12-20)
Personal identification through digital photo superimposition of dental profile: a pilot study
Santoro Valeria, Mele Federica, Introna Francesco, De Donno Antonio
The usefulness of teeth for personal identification lies mainly in their vast individual variability, making them virtually unique for every subject. Odontological identification represents a reliable and important complement to forensic inquiries, in particular in the event of unidentifiable human remains. However, this technique is based on the availability of ante-mortem records containing significant evidence. In the absence of dental records, the only available ante-mortem elements are often photographs. In the present study, dental profile photographs of selected smiling subjects were compared to the relevant plaster study models through digital image analysis. In order to ascertain the reliability of the technique, the comparison was carried out both in a homologous and heterologous manner with the Facecomp software. The results confirm the ability of Facecomp software to identify even the smallest variations in dental elements to reach a positive identification. The method is useful in forensic practice since a forensic inquiry may obtain plaster models from cadavers for comparison with photographs of missing people’s anterior teeth.
(J Forensic Odontostomatol 2019;37;3:21-26)
Validation of the third molar maturity index (I3M): study of a Dominican Republic sample
Lourdes Gómez Jiménez, Luz A. Velandia Palacio, Stefano De Luca, Yajaira Ramirez Vasquez, Mariel Corominas Capellán, Roberto Cameriere2
This retrospective study aims to test the third molar maturity index (I3M) cut-off value of 0.08 for 18 years old in Dominican Republic population. Orthopantomograms of 513 subjects (284 females and 229 males) were evaluated, intra- and inter-observer agreement, ICC (intra-class correlation coefficient) values were 0.88% (95 % CI 0.86% to 0.91%), and 0.93% (95% CI 0.90% to 0.96%), for the intra- and inter-observer reliability, respectively. Accuracy in females was 0.96 (95% CI: 0.93-0.97); the sensitivity was 0.99 (95% CI: 0.96-0.99) and specificity was 0.92 (95% CI: 0.86-0.95). In males, the accuracy was 0.96 (95% CI: 0.93-0.98); the sensitivity was 0.94 (95% CI: 0.88-0.97) and specificity was 0.99 (95% CI: 0.95-0.99). The PPV (Positive Predictive Value) was 0.93 for females and 0.99 for males. The results of this study show that I3M can be used for discriminating adults from minors in Dominican Republic subjects around the legal age of 18 years old.
(J Forensic Odontostomatol 2019;37;3:27-33)
Patient autonomy as a necessary but limited ethical principle in shaping the dentist-patient relationship
Today, the ethical and legal organization of the therapeutic relationship is determined in large extent by the principle of respect for patient autonomy or self-determination. From it, the patient derives important legally enforceable rights, most notably the right to consent to (or refuse) any proposed dental treatment. And yet, historically and indeed by its very nature, this principle is actually foreign to the health care context. Patients do not seek to defend themselves against their dentists in the same way that citizens need protection against a potentially tyrannical government. We will argue that the principle of patient autonomy sets important legal boundaries to the therapeutic relationship. But it does little to cement the relationship itself. Rather, it is the ethical principles of beneficence and non-maleficence that structure the dentist-patient relationship
(J Forensic Odontostomatol 2019;37;3:34-41)
Review of the dental treatment backlog of people with disabilities in Europe
Inès Phlypo, Lynn Janssens, Ellen Palmers, Dominique Declerck, Luc Marks
Aim: The present research aims at reviewing the oral health conditions and treatment needs of people with disabilities in Europe.
Methods: A comprehensive literature search was conducted using Medline and Embase with a timeframe from January 2008 until December 2017. Subsequently, a citation tracking was undertaken. Articles in English, French and Dutch were included.
Results: Forty-two articles were included. A variety of oral health problems and treatment needs was reported. More untreated carious lesions, less restorations, a higher number of extractions and less prosthetic rehabilitations were seen in people with disabilities compared with other individuals without disabilities. The oral hygiene level and the periodontal conditions were poor. Moreover, a higher risk of dental trauma, orthodontic problems and tooth wear were reported.
Discussion: Different determinants contribute to the oral health condition and treatment needs of people with disabilities. These determinants can be inherent in persons with a disability (biological factors), their lifestyle, the environment or the organization of oral health care. A treatment backlog was a common finding in people with disabilities. However, results need to be interpreted with caution because of the variety of people with disabilities included in this literature review. Proposed solutions can be put at the level of daily oral care, through oral health promotion programs and the creation of a supportive environment, but also at the level of dental attendance, facilitating the access to oral health care services and focusing the training of dental students and dentists.
Conclusion: This comprehensive review clearly shows a dental treatment backlog in people with disabilities. Solutions require efforts from the caregivers and dental professionals.
(J Forensic Odontostomatol 2019;37;3:42-49)