Primary Tooth Development in Infancy

PRIMARY TOOTH
DEVELOPMENT
IN INFANCY
A Text and Atlas
P. Sema Aka Murat Yagan

Nergis Canturk Rukiye Dagalp
PRIMARY TOOTH
DEVELOPMENT
IN INFANCY
This book is dedicated to the memory of our greatest Turkish leader,
MustafaKemalATATRK (18811938) and to our dear families who have supported
the authors during the completion of this work with great patience.
PRIMARY TOOTH
DEVELOPMENT
IN INFANCY
A Text and Atlas
P. Sema Aka, BDS, PhD
Independent Researcher; Retired Professor, University of Ankara, Faculty of
Dentistry, Department of Prosthodontics and Faculty of Medicine, Department
of Forensic Medicine, Branch of Forensic Odontology; Head of the Forensic
Odontology Committee of the Turkish Forensic Scientists Society, Ankara, Turkey
Murat Yagan, MD
Forensic Medicine Specialist, Institute of Forensic Medicine, Directorship of
Afyonkarahisar Agency Department, Afyonkarahisar, Turkey
Nergis Canturk, MD
Forensic Medicine Specialist; Associate Professor, University of Ankara, Institute
of Forensic Sciences, Head of Department of Criminalistics, Ankara, Turkey
Rukiye Dagalp, PhD
Statistician; Assistant Professor, University of Ankara, Faculty of Science,
Department of Statistics, Ankara, Turkey
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Contents
Foreword....................................................................................................................................................................................... vi
Preface.........................................................................................................................................................................................vii
Acknowledgements.....................................................................................................................................................................viii
About the Authors......................................................................................................................................................................... ix
Abbreviations................................................................................................................................................................................. x
Chapter 1 Human Dentition and Notation................................................................................................................................ 1

Human dentition....................................................................................................................................................... 1
Dental development.................................................................................................................................................. 1
Dental structures....................................................................................................................................................... 6
Functions of dental structures.................................................................................................................................. 9
Dental discrimination, notation and recording....................................................................................................... 10
Chapter 2 Photographing and Measuring Techniques for Dental Evidence........................................................................... 12

Forensic importance of dental evidence................................................................................................................. 12
Scaling.................................................................................................................................................................... 12
Photographing technique........................................................................................................................................ 12
Measuring techniques............................................................................................................................................. 12
Chapter 3 Morphology and Development of Primary Dentition............................................................................................ 19

Discrimination of dentition.................................................................................................................................... 19
Morphology of primary dentition........................................................................................................................... 41
Development of the primary dentition................................................................................................................... 41
Chapter 4 Dental Identification and Age Estimation from Teeth......................................................................................... 295

Obtaining dental evidence from oral autopsy....................................................................................................... 295
Identification from teeth....................................................................................................................................... 296
Age estimation software....................................................................................................................................... 299
References................................................................................................................................................................................. 304
Glossary.....................................................................................................................................................................................310
Appendix....................................................................................................................................................................................313
Index...........................................................................................................................................................................................315
v
Foreword
This Atlas, a first in the world in its field, has been meticu- in text books thus far. However, a visual source, including
lously prepared by a group of four people, each proficient comparable photographs taken under the same conditions,
in their own scientific field. As a colleague who has closely is necessary to provide realistic information for the reader
followed their preparation process, I am greatly pleased and on the process of deciduous tooth growth and development.
proud of the completion of this Atlas, which provides an Iam fully confident that the authors have produced a flawless
undeniable contribution to the scientific world. I know all work that will fulfill the expected requirements in the field
the members of this team very well, especially Prof. Sema of forensic dentistry and identification studies, and enlighten
Aka, who is the leader of the team. Dr. Aka and I established the world of science with this Atlas.
Turkeys first Forensic Odontology Unit at Ankara University Science, is wealth in good times; a shelter and good
together in 2003 and organized certified courses for our col- guide in bad times.
leagues in the field of Forensic Odontology, which was a great Aristotle (384322 BC.)
honor for me. Dr. Murat Yagan is not only a very competent
forensic medicine specialist, but also a very talented photog- Prof. I. Hamit Hanci
rapher, as you will see in the contents of this Atlas. I have Professor, Forensic Medicine Specialist
witnessed the efforts and sacrifice of my colleague, foren- Head of the Institute of Forensic Sciences, Ankara
sic medicine specialist Assoc. Prof. Nergis Canturk, in this University
well qualified and experienced autopsy study. Assistant Prof. Previous President of the Ankara University, Faculty of
Rukiye Dagalp provided a valuable and active important con- Medicine, Department of Forensic Medicine
tribution to the mathematical and statistical part of this team President of the Forensic Scientists Society, Ankara,
study. The development and morphology of primary teeth Turkey
in infancy has generally been illustrated by hand drawings
vi
Preface
This color Atlas describes the initial phase of human denti- palatinal, 3. mesial; 4. distal; 5. incisal/occlusal; and 6. root
tion, which visually corresponds to primary teeth develop- direction surfaces and illustrations. As a supplement, user-
ment in infancy. The steps of these developmental phases friendly age estimation software is included for quick and
are shown in photographs, which were taken under equal easy age estimation from both direct manual and indirect vir-
conditions, and the concise text of this book explains the tual dental measurements taken from the computed tomog-
photographs. raphy images.
The Atlas consists of study of the deciduous teeth of The hope is that Primary Tooth Development in Infancy
fetus and infant autopsy cases, from the seventh intrauterine will be of use for general dentists, forensic odontologists,
month to the age of 1 year, showing their monthly develop- forensic medicine specialists, dental anthropologists, foren-
ment. Legal permission was granted by Ankara University sic scientists, pediatricians, obstetricians, anatomists, embry-
and the Council of Forensic Medicine, Ministry of Justice.1 ologists and in pedodontics and jurisprudence. Should the
This book contains 1570 photographs of deciduous teeth book achieve this goal, it would give the authors great pro-
taken from six different aspects: 1. labial/buccal; 2. lingual/ fessional pleasure.
vii
Acknowledgements
The preparation of this Atlas extends back to the year 2005 Sibel Ozkan; biologist Hilal Topbas; Prof. Suat Fitoz; Ipek
starting with the legal and ethical permissions, the autopsy Kedici, MSc; Mr. Beytullah Kuyun; Dt. Pinar Yagan; Dr. Itir
phase, following with the direct and indirect measurements Aydintug; Assoc. Prof. Ayse Tuba Altug; Erdoan Oncun,
and photographs from all the surfaces of primary teeth and BSc; Mr. Fahrettin Okur; and Mrs. Gulseren Salini, for their
obtaining computed tomography images, statistical analysis unique contributions. Furthermore, the authors thank the
of all these data, determination of the neonatal line and age computer engineer, Emine Tug Ilcin, MSc, for the computer
estimation formulas, and finally the preparation of a software software program she wrote specifically to provide quick age
age estimation program, which took nearly a decade. The estimation from dental measurements.
authors of this work are grateful to the Council of Forensic The authors would also wish to thank the following indi-
Medicine for the legal permission and to Ankara University viduals: Gizem Ozbayrac, MSc and Mr. Serkan Ozbayrac;
for the ethics committee approval to conduct this research. Mrs. Sezen and Mr. Kaan Aytemizel; Assoc. Prof. Nergis
The authors wish to express their spiritual gratitude and Canturk and Prof. Gurol Canturk; Assist. Prof. Rukiye
indebtedness to the little angels whose teeth photographs Dagalp and Mr. Volkan Dagalp; Bahar Aka, MSc; Mrs.
contributed to the scientific knowledge of humanity. Esrin and Mr. Caglar Sendil; Assoc. Prof. Ozlem Aydog;
The authors would like to offer their grateful thanks to the MD Banu Bayar and Prof. Sancar Bayar; Mrs. Ozlem and
Senior Editors Henry Spilberg and Robert Peden; to the edi- Mr. Ozgur Ceridhan; and their children: Kanat Ozbayrac;
torial assistants, Julia Molloy, Rachael Russell, Emily Pither, Daghan Aytemizel; Gulin and Haldun Kemal Canturk; Ece
Nicola Streak and Al Staropoli; to the project coordinator, Dagalp; Doruk Iper; Cagla Sendil; Doga and Sera Erdogan;
Joselyn Banks-Kyle; to the project manager, Kate Nardoni; Ipek Bayar; and Gokturk Ceridhan, who allowed the authors
and to the copyeditor, Ruth Maxwell. The authors also thank to display their beautiful, pearly white teeth.
their valuable colleagues: Prof. I. Hamit Hanci; Prof. Yavuz Finally the authors thank their respected elder Mrs.Turkan
Sinan Aydintug; Prof. Om Prakash Jasuja; Prof. Rakesh K. Satir Aka and their beloved family members who have
Gorea; Prof. Ruma Purkait; Dr. Gagandeep Singh; Mr. Kadir supported this long-term study.
Turkmetin; MD Caglar Uzun; Prof. Saadet Saglam Atsu; Dr.
viii
About the Authors
P. Sema Aka graduated from the Dental Faculty of Ankara Assoc. Prof. Nergis Canturk graduated from the Istanbul
University in 1979. She earned her PhD under the supervision University, Faculty of Medicine in 1998. She earned her
of Prof. Husnu Yavuzyilmaz in 1983 with her doctorate the- Forensic Medicine Specialist degree in 2003 with a thesis
sis entitled Comparison of Techniques Applied to Increase entitled The Psychiatric Profile and Socio-Demographic
the Resistance of Crown and Bridge Prosthesis Over Features of Sexual Offenders from the Council of Forensic
Tooth Structures that show Excessive Loss. Prof. Dr. Aka Medicine, supervised by Prof. Dr. Sermet Koc, at Istanbul
earned her Associate Professorship in 1986 at the Ankara University, Cerrahpasa Faculty of Medicine, Department
University. She was awarded full Professorship in 1993. She of Forensic Medicine. She became Associate Professor in
is the founder of the Forensic Odontology Unit at the Ankara 2010.
University, in the Department of Forensic Medicine in 2003
and Laboratory of Facial Reconstruction in 2006. Dr. Canturk was first employed by KASDAV (Kadikoy Saglik
Prof. Aka has published internationally in the field of Dayanisma Vakfi) Foundation, affiliated to the Kadikoy
dental science on subjects including restoration of endodon- Municipality during 19992000. She then worked at Istanbul
tically treated teeth, dental ceramics and dental alloys. She University, Cerrahpasa Faculty of Medicine, Department of
also has publications on forensic odontology subjects, such as Forensic Medicine (20002003), and the Council of Forensic
personal identification, dental age estimation, bite marks and Medicine, Ankara Group Presidency Morgue Department
odontometrics. In addition to her dental career, she has an (20032010). Dr. Canturk has been working at Ankara
interest in sculpture. She completed her art education at the University, Institute of Forensic Sciences, as the Head of the
Art Education Faculty of Gazi University, graduating with Department of Criminalistics since 2010.
a Master of Arts degree in 2000. She continues her creative
works, and also studies the subject of facial reconstruction. Assist. Dr. Rukiye Dagalp graduated from Gazi University,
She is head of the Forensic Odontology Committee of the Faculty of Science, Department of Statistics in 1987. She
Forensic Scientists Society in Ankara, Turkey. Additionally, gained a Masters Degree in the field of statistics at Gazi
she is the Vice President of the Indo Pacific Association of University, Ankara, Turkey in 1992, a second Masters
Forensic Odontologists. She is also one of the editors of the Degree from Michigan State University in the United States
Turkish Journal of Forensic Sciences. Prof. Aka retired from in 1997, and a PhD from North Carolina State University in
the Ankara University, Faculty of Dentistry, Department of the United States in 2001. Dr. Dagalps PhD thesis was enti-
Prosthodontics and Unit of Forensic Odontology in 2007. She tled Estimators for Generalized Linear Measurement Error
is now working as an independent researcher. Models with Interaction Terms, supervised by Prof. Leonard
A. Stefanski.
Murat Yagan, MD graduated from Ankara University,
Faculty of Medicine in 1997 as a Medical Practitioner. He Dr. Dagalp was employed by the following corporations
achieved his Forensic Medicine Specialist degree with his and universities: Turkish Coal Enterprises as a statistician
thesis entitled Deaths among the Homeless in Ankara, from (19871990); Gazi University, Department of Statistics,
Gazi University, Faculty of Medicine, Department of Forensic as a research assistant (19901993); Gebze Institute of
Medicine under the supervision of Prof. Birol Demirel in Technology, Department of Mathematics (19932003);
2009. He was employed by the Ministry of Justice (1997 Michigan State University, Inter Library Loan Office, as
2000), Ministry of Justice, Prison Personnel Training Centre an Office Assistant (1995 1997); and North Carolina State
(20002005) and Gazi University, Faculty of Medicine, University, Department of Mathematics as a Supervisor and
Department of Forensic Medicine (20052009). Dr. Yagan Research Assistant (20002001). She has been working at
has been working at the Council of Forensic Medicine in Ankara University, Department of Statistics, as an Assistant
Afyonkarahisar since 2009. Professor since 2003.
ix
Abbreviations
ABFO American Board of Forensic Odontology M molar
ADA American Dental Association MD mesio-distal
BL bucco-lingual MDCT multidetector computed tomography
C canine MRI magnetic resonance images/imaging
CAPMI Computer-Assisted Post mortem Identification NL neonatal line
CH crown height NR neonatal ring
CrT crown thickness PH pulp height
CT computed tomography PM premolar
d deciduous Postn postnatal
DNA deoxyribonucleic acid Pren prenatal
DVI disaster victim identification R2 coefficient of determination
FDI Federation Dentaire Internationale RH root height
HC head circumference SEM scanning electron microscope
I incisive TH tooth height = crown height (CH) + root height (RH)
ICD International Classification of Diseases TTVI Thai tsunami victim identification
ISO International Standards Organization U upper
IU intrauterine UL upper left
L lower UR upper right
LL labio-lingual/lower left XRMA X-ray microanalysis
LR lower right
x
1 Human Dentition and Notation
HUMAN DENTITION to the cap stage by the 11th week. This phase is followed by
an invagination that initiates in the germ; beneath the inner
Human dentition exists on both maxillary (upper jaw) and enamel epithelium the mesenchyme layer starts to form the
mandibular (lower jaw) bones, which develops in two stages: formative cells, which originate from the mesoderm. The
primary dentition (deciduous, transitory, milk, lacteal, enamel organ subsequently takes the shape of a bell, which
baby dentition) including 20 teeth and permanent dentition starts the so-called bell stage. This tissue forms the dental
(secondary, successional dentition) including 32 teeth. These papilla that transforms to the dentin and pulp of the tooth
teeth are denominated as: central incisor (di1), lateral incisor (Figs 1.11.3). The tissue condensation in contact with the
(di2), canine (dc), first molar (dm1), second molar (dm2) for outside border of the bell produces a dental sac (follicle) that
primary (deciduous) dentition and central incisor (I1), lateral also originates from the mesoderm. This follicle partially
incisor (I2), canine (C), first premolar (P1), second premolar encompasses the dental papilla plus a part of the enamel
(P2), first molar (M1), second molar (M2), and third molar organ and later will transform to the cement, periodontal
(M3) for permanent dentition.1,2 The primary dentition com ligament and alveolar bone tissues of the dental structure.
prises two incisors, one canine and two molar teeth, whereas This stage later differentiates and forms the ameloblasts,
permanent dentition has two incisors, one canine and three which are the enamel forming cells. In this stage the cells of
molar teeth and additionally two premolar teeth in each the tooth germ begin to specialize and show histodifferentia
quadrant. There are four quadrants, each covering five teeth tion; the periphery cells of the dental papillastart to differ
for primary dentition and eight teeth for permanent dentition; entiate into odontoblasts, which will convert into the dentin,
these are placed in an imaginary plus sign that separates the and the deeper enamel epithelium turns into ameloblasts and
right and left teeth with a vertical midsagittal line, and upper finally to enamel. The organization of the specialized cells
and lower teeth by the horizontal occlusal line. Theincisor initiates the morphodifferentiation phase, which dictates the
tooth that is closest to the midline is called the central certain form and size of the tooth structure for each tooth
incisor, the teeth distal to the central incisors are the lateral with the development of the enamel, dentin, pulp, cement and
and canine incisors. Similarly, both premolar and molar teeth periodontal ligament tissues. At this stage the appositional
are labeled according to the midsagittal guideline. The clos activity replaces the proliferative activity, and the amelo
est teeth to this plane are labeled and ordered first, the teeth blasts and odontoblasts start to deposit regular incremental
distal to the first are labeled second and the furthest teeth to layers of enamel and dentin matrix.4
the midsagittal plane are labeled third molars.3 The developing dental lamina then produce an exten
sion at the lingual side of the buds, called the successional
lamina, which will similarly grow in the sequence of bud,
DENTAL DEVELOPMENT cap and bell stages and will finally form the permanent
incisors, canine and premolar teeth. However, the acces
Dental development consists of the activities of two types sional permanent molar teeth grow from the posterior part
ofcells: the oral epithelial cells, which are the predecessor of the primary molars in the general lamina, which does
of the enamel tissue, and mesenchyme cells, which gen not succeed or replace any primary teeth. In brief, the
erate the dental papilla and later form the dentin tissue.
Thisdentalformation of primary teeth is initiated at approxi
mately the sixth week of intrauterine life, with the prolif
erative activity of the organized basal cell layer of the oral
epithelium, which originates from the outer embryonic germ
layer, the ectoderm. These cells invaginate into the under
lying mesenchyme layer by the seventh week, forming the
dental lamina, which is the first phase of dental development.
Bythe eighth week of prenatal life, a budding process starts in
the 20 areas of the dental lamina, referred to as the bud stage;
this will later form the 20 primary teeth. The dental lamina
starts to form at the anterior midline and spreads towards the
molar region on 10 sites of both the maxilla and mandible,
where all primary teeth are located. During the progressing
morphogenesis, the deepest part of the bud takes a concave
form and makes a depression that transforms the bud stage FIG. 1.1 Germ tissue prenatal, labial direction.
1
2 Primary Tooth Development in Infancy: A Text and Atlas
FIG. 1.2 Germ tissue prenatal, mesial direction. FIG. 1.3 Germ tissue prenatal, distal direction.
FIG. 1.4 Eruption process of central teeth.
g eneral laminacontinuously produces a total of 52 teeth of it may cause calcification irregularities and interrupt the
bothdentitions from the prenatal sixth week to the postnatal process of tooth development (see neonatal line).
10th year.510 Tooth development continues with the crown and then
The calcification stage initiates when inorganic calco root formation. After the root height (RH) reaches one-third
spherites (minerals of calcium and phosphorus) mineralize in or two-thirds of its final length, the tooth begins to erupt and
the dental tissue matrix, forming the first macroscopic den contacts its antagonist. However, tooth eruption is a complex
tal presence. This occurs during the prenatal 13th and 15th occurrence that may be caused by: cell proliferation, muscle
weeks for females and males, respectively, for the maxillary pressure, bone and connective tissue remodeling, jaw growth,
incisor teeth, and during the prenatal 14th and 17th weeks fibroblast traction or the hydrostatic pressure in the periodon
for females and males, respectively, for mandibular incisor tal ligament.12,13 The first erupting primary teeth are the lower
teeth.11 The precipitation of enamel starts at the cusps and centrals after approximately the sixth or seventh postnatal
incisal edges and continues regularly over a long period. month (Fig. 1.4); the developmental period of primary denti
Ifany specific systemic disturbance occurs during this phase, tion ends with the root competition of the second primary
Human Dentition and Notation 3
molars at the third year of postnatal life.8,10,12,14 The dental caused by the eruptive pressures of the successor permanent
cast, and clinical and panoramic views of maxillary and teeth, which stimulates the osteoclast activity and resorp
mandibular primary dentition are seen in Figures 1.51.11. tion process of the roots.15 The primary dental development
Subsequently, all the primary teeth exfoliate throughout
the mixed dentition during the sixth and tenth years of life,
Labial
Central Incisor
Incisal Lateral Incisor
Buccal Canine
1st Molar
Palatinal 2nd Molar
MAXILLA
Occlusal
FIG. 1.7 Labial view of primary dentition at age 5 years.

PRIMARY
DENTITION
Occlusal
MANDIBLE
2nd Molar
Buccal Lingual
1st Molar
Incisal Canine
Lateral Incisor
Labial Central Incisor
FIG. 1.5 Maxillary and mandibular casts of primary dentition. FIG. 1.8 Occlusal maxillary view of primary teeth at age 5 years.
FIG. 1.6 Primary teeth at age 3 years. FIG. 1.9 Occlusal mandibular view of primary teeth at age 5years.

Lateral Incisor
Incisal
Canine
1st Premolar
2nd Premolar
Palatinal
1st Molar
Buccal
MAXILLA 2nd Molar
Occlusal
FIG. 1.10 Panoramic X-ray image of primary dentition, 5-year-
old boy.
PERMANENT
3rd Molar
DENTITION
Occlusal 2nd Molar
MANDIBLE 1st Molar

2nd Premolar
Buccal Lingual
1st Premolar
Canine
Incisal
Lateral Incisor
FIG. 1.11 Panoramic X-ray image of initiation of mixed d entition,
5-year-old girl.
FIG. 1.12 Maxillary and mandibular casts of permanent d entition.
period can also be observed in Chapter 3, which comprises

cases aged from prenatal 7 months to postnatal 12 months,
with all tooth facets.
The permanent dentition also starts to develop with the
initial evidence of the upper and lower first molar teeth at
birth, and erupts in the sixth year of life. The development
period of permanent dentition ends with the root completion
of the third molars at 1825 years of postnatal life. The per
manent molars erupt at 6 year intervals, which is an inter
esting phenomenon and can be regarded as a clue for age
estimation. The dental cast, clinical and panoramic views of
maxillary and mandibular permanent dentition are seen in
Figures 1.121.16. In between the two stages of dentition a
mixed dentition phase takes place during the ages of 612
years, including both deciduous and permanent teeth. Mixed
dentition starts with the eruption of the permanent first
molars, continues with the incremental growth and develop FIG. 1.13 Labial view of permanent teeth, age 59 years.
ment of permanent dentition and ends after the replacement
of the deciduous dentition.16,17 The dental cast, and clinical
and panoramic views of maxillary and mandibular mixed dental developmental chronology usually show approximate
dentition are seen in Figures 1.171.21. time estimations and diversity depending on genetics, gen
Dental developmental tables aid in age estimation studies der, ethnic differences, geographic factors and misuse. An
and are an important indicator for general dentistry, pedodon example of chronologic diversity can be seen in Figures1.10
tics, pediatrics, obstetrics, embryology, forensic odontology, and 1.11, where the girls dental development is in a more
forensic medicine and forensic sciences. The timetables of advanced stage, although the boy is 1 month older. Generally,
Permanent Central Incisor

Labial Permanent Lateral
Incisor
Incisal
Primary Canine
Buccal Primary 1st
Palatinal Molar
Primary 2nd
MAXILLA Molar
Permanent
Occlusal
1st Molar
MIXED
DENTITION
FIG. 1.14 Occlusal view of maxillary permanent teeth.
Occlusal
MANDIBLE Permanent
1st Molar
Buccal
Lingual
Primary 2nd Molar
Incisal Primary 1st Molar

Primary Canine
Labial Permanent Lateral Incisor
Permanent Central Incisor
FIG. 1.17 Maxillary and mandibular casts of mixed dentition.
FIG. 1.15 Occlusal view of mandibular permanent teeth.
FIG. 1.18 Labial view of mixed dentition, age 10 years.
FIG. 1.16 Panoramic X-ray image of permanent dentition,

17-year-old male. primary canines and molars have the longest duration in the
oral cavity: nearly a decade. However, brushing of these lat
the chronology of human dentition tables consists of calcifica eral and posterior teeth is usually neglected during childhood,
tion, crown completion, eruption and root completion times; due to a lack of dexterity in children, which may cause early
in fact, the average tooth life expectancy is also an i mportant loss of these teeth. Figures 1.7 and 1.11 show caries lesions
matter, as seen in Table 1.1 for primary and permanent den of primary dentition. For permanent teeth, the first molars
tition (modified from Reference 18). For primary dentition, and incisors have the longest duration in the oral cavity, in
and the early adolescent period, a period of active lifestyle

(Fig. 1.22). Preventive measures, such as using mouthguards,
face and/or head shields, are advised during athletic activities
as these may reduce the severity of dental trauma and avoid
early medical and dental treatment (Fig. 1.23).19,20 Wearing
a customized mouthguard that has been fitted by a dentist
is strongly recommended. Additionally, nutrition with hard
foods, poor eating habits such as nut cracking, using the teeth
as tools as to open bottles and habits including nail, pencil, or
pipe biting and smoking, abrade the tooth facets and disturb
the dental attachments, resulting in luxation and finally loss
of teeth.
Science and medicine aim to increase the quality and
length of life; similarly, dental health has a vital role in this
regard and places a great deal of responsibility on the dentist.
FIG. 1.19 Occlusal view of maxillary mixed dentition. The life of a tooth initiates from intrauterine period and is
affected by various factors, as explained in the following text.
For this reason, the preservation and sustainability of dental
health must start during the prenatal period; with adequate
dental care, teeth can be maintained throughout a persons
life without the need for restoration or prosthesis.
DENTAL STRUCTURES
A human tooth is composed of four main tissues: the enamel,

dentine, cementum and dental pulp, supported by gingiva
(gum), periodontal ligaments and bone tissues.21 These struc
tures can be seen in Figure 1.24.
Enamel
Enamel tissue covers and protects the entire surface of
FIG. 1.20 Occlusal view of mandibular mixed dentition. the tooth crown. It is the hardest, most durable and most
intenselymineralized tissue of the body, with an inorganic
mineral content of 96% organized calcium phosphate,
hydroxyapatite mineral crystals [(Ca5(PO4)3(OH-,Cl-,F-)],
which gives the enamel its radiopaque appearance. Enamel
also consists of 4% organic material and water. Although
enamel tissue is very hard, it may show non-functional wear
patterns due to various reasons including a hard food diet,
occlusal interferences or a stressful lifestyle. However, teeth
remain intact after death, which is an important piece of
evidence for forensic and archeological cases. Figures 1.25
and 1.26 show severe tooth wear that has exposed the
dentintissueon all teeth and the pulp chamber in tooth 21
(See Federation Dentaire Internationale [FDI] notation
below)on 300-year old skeletons excavatedat the Auersperg
FIG. 1.21 Panoramic X-ray image of mixed dentition, 10-year- tomb, a 17th century archeological site in Ljubljana,
old girl. Slovenia.22,23
The structure of enamel is semi-translucent, and therefore
acts as a screen that transmits, absorbs, or reflects the light
line with the human life span, as these teeth erupt earlier beams; however, this light refractive index changes over time,
than the others. Unfortunately permanent incisors and their related to the mineral accumulation. Enamel shows variable
supporting tissues are prone to traumatic forces due to their thickness over the entire surface of the crown, which also
locations, especially in mixed dentition during childhood changes due to ageing.24
Table 1.1 Numerical development and average tooth life expectation (ATLE) diagram for primary and
permanantteeth
Primary Eruption time Root fully formed Exfoliation time Average tooth life
teeth (months) (years) (years) expectation
1 710 12 67 56
2 811 2 78 67
Upper 3 1619 3 912 710
4 1216 2.5 911 810
5 2529 3 1012 810
1 68 12 67 56
2 913 12 78 67
Lower 3 1720 3 912 710

4 1216 2.5 911 810
5 2027 3 1012 810
Permanent Eruption time Root fully formed Average tooth life expectation Upper
teeth (years) (years)
1 78 1011 Average life expectancy at birth across the member

2 89 1112 states of the European Union in 2011 have reached
82years for women and 77 years for men, with a
3 1113 1315
steady increase of 10years since 197018
4 1012 1213 As an example:
Upper
5 1012 1214 Female: 82 6 = 76 for 1st M
82 25 = 57 for 3rdM
6 67 910
Male: 77 6 = 71 for 1st M
7 1113 1416 77 25 = 52 for 3rdM
8 1721 1825 (Under normal and hygienic conditions, minimum
1 67 910 lifeexpectation for a permanent tooth is 1/2 century,
maximum life expectation for a permanent tooth is
2 78 1011
3/4century)
3 910 1214
4 1012 1213
Lower
5 1113 1314
6 67 910
7 1113 1415
8 1721 1825
ATLE for primary teeth = exfoliation time eruption time.
ATLE for permanent teeth = average life expectancy at birth tooth eruption time.
In this modified table the lowest and highest limits of the eruption, root formation and exfoliation times are based on: Avery JK, Steele PF, Averey N.
Oral Development and Histology, 3rd edn. Stuttgart: Thieme, 2002;15 Berkowitz BKB, Holland GR, Moxham BJ. Oral Anatomy, Histology and
Embryology, 4th edn. Edinburgh: Mosby Elsevier, 2009;17 Ash MM, Nelson SJ. Dental Anatomy, Physiology and Occlusion, 8th edn. St Louis:
Saunders, 2003.62
Dentin Cementum
Dentin is a substance that is harder than bone but softer than The cementum a specialized avascular bone-like connec
enamel. Moreover, the dentin of permanent teeth is harder tive tissue. Two-thirds of the root is covered with acellular
than the dentin of primary teeth. It is located between the cementum at the cemento-enamel junction, but one-third
crown enamel, root cementum and the pulp tissue. Dentin of it is cellular at the root apex, which is more permeable.
supports the enamel tissue with its composition of 67% It consists of approximately 45% inorganic calcium phos
hydroxyapatite mineral and 33% organic matrix of collage phate, hydroxyapatite mineral crystals and 55% organic
nous proteins and water. The lower mineral content of dentin collagenous material and water. Its hardness is less than
makes this tissue more radiolucent than enamel. the dentin and its thickest part is located at the root apex.
FIG. 1.22 Trauma case age 10 years. FIG. 1.25 Wear patterns. (Courtesy of Assist. Prof. Zupanic
Pajnic and Rudi Bevc.)
FIG. 1.23 Restoration of fractured teeth, age 10 years. FIG. 1.26 Wear patterns. (Courtesy of Assist. Prof. Zupanic
Pajnic and Rudi Bevc.)
Enamel
Dentino-enamel Dental Pulp

junction The pulp tissue of a tooth is usually called the nerve of
Dentin
the tooth and is located at the core of the teeth. The pulp
Cemento-enamel is mainly composed of soft connective tissue that contains
junction blood vessels and nerves that enter the tooth from a hole at
the apex of the root. All the pulp organs of primary and per
Pulp
manent dentition resembles the shape of the respective tooth
that has similar morphological features.
Cementum
Dental Supporting Structures

The tooth structure is supported by the periodontium c omplex
FIG. 1.24 Structure of a tooth section. that provides an attachment between the cementum tissue
ofthe tooth and the alveolar socket, by way of specialized con
The cementum has a role to serve as a medium for the nective supporting tissues called the periodontal ligaments,
attachment of collagen fibers that suspend the teeth in the which covers the root of the tooth within the bone. These
alveolar socket. ligaments have a width of 0.150.38 mm, which decreases
in size over time.4 This area of tissue c ombination allows correlation between the function of the teeth and the struc
the sensation of contact, pressure and temperature variations ture of the alveolar bones. When teeth are present, there is
during biting or chewing as the tooth moves slightly in its a reciprocal protecting and supporting action between the
socket and puts tension on this area.25 The perception data teeth and the alveolar bones, but after the loss of teeth, the
are then transmitted to the central nervous system via the alveolus starts to resorb due to dysfunctional atrophy. If the
receptors and nerve fibers for interpretation, which finally mechanical stimulus is lost, then the structure and the mass
affects the biting force. The alveolar bone of this supporting of the alveolar bones will also be lost. The bones continu
complex encompasses the tooth root and shows remodeling ously remodel according to the size, frequency and rate of
due to the changes in compressive forces exerted on the teeth the applied load, where the information is transmitted from
under functioning or dysfunctioning atrophies after tooth the tooth via the periodontal ligament. To preserve the bone
extraction. Another component of the periodontium com mass, the functional stimulation must be suitable.17
plex is the gingiva, which is the mucosal overlaying tissue
around the teeth and over the jaws. There are three types of
epithelium associated with the gingiva: gingival, junctional Dental Structures as Indicators
and sulcular. The gingival epithelium (visible in the mouth) Tooth morphology, number, alignment and surface texture
and the non-keratinized sulcular epithelium on the gingiva may be an indicator of some types of pathologies such as
are not directly associated with tooth attachment; however, enamel hypoplasia, amelogenesis imperfecta, dentinogen
the junctional epithelium forms an attachment and supports esis imperfecta, PraderWilli syndrome, Cornelia de Lange
the tooth.4,9 syndrome, Down syndrome, syphilis, etc. Enamel hypopla
sia is a developmental abnormality caused by a systemic
disorder and may occur through hereditary or acquired.31
FUNCTIONS OF DENTAL STRUCTURES Hypoplastic enamel tissue develops very thin, and there
fore the color of the dentin layer underneath the enamel is
Teeth have important functions for humans, including biting, reflected. Amelogenesis imperfecta is a congenital defect,
chewing, esthetics, phonation, conservation of the alveolar characterized by hypocalcification, hypoplasia, local loss of
bone structure and supporting the face. Additional functions enamel, yellowbrown and chalky appearance and spot-type
include indicating pathologic conditions and serving as evi pitting hypoplasia defects. Dentinogenesis imperfecta, is an
dence for forensic investigations. The specific functions of inherited structural disorder of the dentin tissue that displays
dental structures will be given below. an opaque, bluebrown appearance due to early calcification
of the pulp tissue.32,33 PraderWilli syndrome is a rare genetic
disorder characterized by oral abnormalities including tooth
Biting and Chewing wear, dental caries and periodontitis.3436 Cornelia de Lange
Each tooth has a different morphology that fulfils the biting syndrome shows contracted maxilla, malaligned teeth, and
and chewing functions. The blade type incisors are respon multiple impacted and missing teeth.37 Down syndrome is an
sible for cutting, wedge shaped canines for shredding and autosomal chromosomal disorder with a higher percentage
molars for grinding the food with their uneven occluding of dental anomalies, caries and poorer p eriodontal health.38,39
surfaces. Teeth can also be used to bite as an act of violence Syphilis is an infectious illness that can beacquired from an
or defence that may cause physical, emotional and/or social infected mother in the uterus. It is seen very rarely in ancient
damage to the victim. Human biting behavior is assumed to populations, dating back to the 17th19th centuries.40 This
be based on the survival instinct, as with animal behavior, disease is diagnosed by the specific dental lesions includ
but is still under investigation.2630 ing thin enamel, reduced tooth dimensions, premature loss
of primary teeth, Hutchinsons incisors with notches on
the incisal edges of the upper incisors, pitting hypoplasia,
Esthetics and Phonation apical hypoplasia of the permanent canines and permanent
The morphological design and the ordered alignment of the first mulberry molars showing infolding of the rudimental
teeth on the dental arches provide an esthetic appearance cusps.4143
and proper phonation of the sounds. Malformed, malaligned, Tooth staining is also an indicator for some toxic and
decayed, missing teeth or diastemas between the teeth and metabolic reactions. For example, eritropoetic porphyria is
dental restorations usually cause a lack of esthetics and dis a genetic disorder, which causes the accumulation of por
ruption of phonation. phyrin pigments in the developing dentin as redbrown dis
colorations.44 Erythroblastosis fetalis is a severe hemolytic
disease in newborns that originates in the uterus because of
Conservation of the Alveolar Bone a maternalfetal blood incompatibility. It results in enamel
Structure and Face Support hypoplasia and dark, greenish-blue-brown pigmentation of
Dental structures have an important role in the preserva the teeth, caused by hemolysis and destruction of the blood
tion of surrounding alveolar bones because there is a direct cells and the accumulation of bilirubin in the dentin tissue.45,46
Medications such as tetracycline cause diffuse or band-type charting is the designation of the tooth localization in these
yellow, yellowish-brown, blue or gray discolorations, due to four quadrants.
the chelating process with calcium during odontogenesis, The orientation of the chart should be from the patients
which occurs mostly in dentin.47 perspective; thus, the right side of the chart corresponds to
Elements such as fluorine, lead, iron, copper, mercury, the patients left, and vice versa. Zsigmondys chart num
silver, nickel, chrome, and cobalt also cause intrinsic stains bering system is still used; however, errors can occur dur
due to the accumulation of these toxic agents in the tooth ing the computer registration and recording of the teeth.
structure over their threshold doses.32,4851 Endemic fluo Later, other coding systems were introduced, including
rosis causes opaque discolorations and pitting hypoplasia Dr. Cunninghams Universal System (1883), which was
as white spots to yellowish-brown stains and facets with adopted by the American Dental Association (ADA), where
erosion.52 Some tooth discolorations occur after trauma as 32 teeth of permanent dentition were numbered starting from
a result of accumulation of the hemorrhagic products in the the upper right third molar and ending with the lower right
dental tubules, which causes red, yellow, yellowish-brown, third molar, and primary teeth were labeled with letters from
brown, gray, or black intrinsic stains. This situation may also A to T in the same manner.2,61 Numbering with this univer
occur after an endodontic treatment. Apart from the pulpal sal system requires attention when any tooth is extracted or
hemorrhagic products, some canal treatment medications
missing; for example, where third molars are missing then
containing barium, iodine, silver, and gutta percha cause red, the first number will be 2 instead of 1, acknowledging the
dark red, orange, gray and black stains.53 missing tooth; if any other tooth is missing, then the missing
teeth should be numbered, as well. As noted above, some of
these systems caused confusion and therefore should be con
Dental Structures as Evidence sidered impractical.
Dental structures are valuable evidence for the positive iden The most preferred notation worldwide is the two-
tification of forensic investigations concerning unknown digit tooth numbering system of the Federation Dentaire
individuals. Each tooth has five surfaces that make 100 facets Internationale (FDI), developed by Dr. J. Viohal and accepted
for 20 deciduous teeth and 160 facets for 32 adult teeth, show by FDI in 1971, which is an advanced modification of the
ing a special heritable or acquired feature. Therefore, each Zsigmondy system. This coding system is also known as the
dental structure is unique and not likely to resemble another; International Standards Organization Designation System
thus, comparing the premortem (before death) and postmor (ISO 3950 System) and The World Dental Federation Notation,
tem (after death) dental records of an individual can lead the and is the most favoured in the field of forensic odontology.
researcher to identifying the individual. All the structure, FDI notation relates a specific number to each tooth; the
size, color, surface texture and layers of the tooth provide a first number represents a tooths quadrant and the second
clue for identification; in addition, the genetic memory of number represents the number of the tooth from the midsagit
each tooth is kept in the soft and hard tissues of the teeths tal line, which is the imaginary midline that divides the body
deoxyribonucleic acid (DNA) molecules.11,5460 into right and left. For permanent teeth, the upper right teeth
begin with the number 1, the upper left teeth begin with the
number 2, the lower left teeth begin with the number 3, and
DENTAL DISCRIMINATION, the lower right teeth begin with the number 4 in a clockwise
NOTATION AND RECORDING direction. For primary teeth, the sequence of numbers fol
lows 5, 6, 7, and 8 for the teeth in the upper right, upper left,
Identification from dental records is one of the important lower left, and lower right, respectively, in the same manner.
issues of forensic odontology that may lead a forensic odon When a certain tooth, such as the permanent maxillary right
tologist to prove the identity of a person. For this reason, an lateral incisor is recorded, the notation is pronounced as one,
easily recordable, universal, descriptive precise charting sys two but written as 12.61
tem and nomenclature is essential. The FDI two-digit notation design of Dr. J. Viohal is a
Several nomenclature and marking systems have been very user friendly, globally preferred notation, as seen in
introduced to the dental practice since Dr. Adolph Zsigmondy Table 1.2. However, the reader may ask why the primary
first announced and published his tooth numbering system teeth quadrants are not coded with 1,2,3,4 and the permanent
in 1861.61 This system was based on numbering the perma teeth quadrants coded with 5,6,7,8 when the primary teeth
nent dentition with Arabic numerals from 18 and primary erupt before the permanent teeth? It is a known fact that it is
dentition with Roman numerals from IV, which are placed not easy to change well adopted information that has been
starting from the midline of a plus sign that represents the valid for many years; however, a modified notation table that
four quadrants (four directions: upper, lower, right, left) was developed with this logic is proposed for the readers by
of the oral cavity. The most important attribute of dental P.S. Aka in Table 1.3.
Table 1.2 Viohals FDI two-digit notation

Permanent teeth Primary teeth
Upper right Upper left Upper right Upper left
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 55 54 53 52 51 61 62 63 64 65
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 85 84 83 82 81 71 72 73 74 75
Lower right Lower left Lower right Lower left
Table 1.3 Akas modified two-digit notation

Primary teeth Permanent teeth
Upper right Upper left Upper right Upper left
15 14 13 12 11 21 22 23 24 25 58 57 56 55 54 53 52 51 61 62 63 64 65 66 67 68
45 44 43 42 41 31 32 33 34 35 88 87 86 85 84 83 82 81 71 72 73 74 75 76 77 78
Lower right Lower left Lower right Lower left
2 Photographing and Measuring
Techniques for Dental Evidence
FORENSIC IMPORTANCE OF in justifying any measurable plane and help to c ompensate
DENTAL EVIDENCE for distortion resulting from oblique camera angles. The
scale also has a gray centimetrical section accurate to 1
Human identification and determining age at death are mm, which ensures perfect photographic color reproduction.
important roles for forensic sciences, including forensic cases Measurements within the image are then made relative to
of fetuses and infants. Age can be estimated from various the inscribed 1 cm grid lines to compensate for any distor-
bones such as pubic symphyseal surfaces, sternal extremity tion resulting from non-parallelism between the film and the
of the ribs, intervertebral discs and especially from teeth, object planes. The authorized ABFO No. 2 scale is a fun-
which provide more accurate age results than known anthro- damental piece of equipment especially for dental casts and
pometric measurements.16 tooth samples (Fig. 2.1) and may be considered a milestone
Dental identification contributes to identification of foren- that made a permanent contribution to the forensic sciences.15
sic cases that are especially difficult when the remains are
decomposed and skeletonized. It is stated that in most cases,
forensic odontology procedures leads to personal identifica- PHOTOGRAPHING TECHNIQUE
tion and have been found to be as important as fingerprints
in resolving such cases.7 There are numerous cases of indi- For this Atlas, photographs of teeth samples preserved
viduals or mass disaster victims being identified by forensic in tubes filled with 10% formalin solution were taken
odontology, including those of the fire in the Iroquois the- under aspotlight on a table with infinite black background
atre, Chicago, in 1903 where 602 people out of 1842 audience (Figs 2.2, 2.3). The shots were taken with a professional
members died and hundreds of people were identified from digital c amera fixed on a mini tripod apparatus to prevent
their dental charts and victims of the September 11th 2001 the vibration of the camera. Teeth were attached using putty
terrorist attacks in the USA, where 534 out of 2753 people paste to the end portion of a thin metal rod, which was
were identified from their dental structures and radiographs perpendicularly located the same distance from the camera
(305 individuals were identified from their fingerprints). In (12.5 cm), due to the macro focus distance of the camera.
2004, waves killed 250,000 people on the western coast of More than one photograph was taken from each tooth surface
Indonesia in a tsunami due to an earthquake; of 3650 vic- and the photographs were then transferred to a computer for
tims, 46.2% were identified mainly from their dental records selection, identification and coding procedures. Photographs
by means of the Thai tsunami victim identification (TTVI) selected in this manner were reorganized according to visible
database; the rest could not be identified because of insuf- light adjustments and were adjusted to 300 dpi JPEG format
ficient records.812 for appropriate printing.
Thus dental identification is increasing in significance
since the early pioneering work of Saunders in 1837 on the
tooth eruption times of children and Gustafsons dental age MEASURING TECHNIQUES
estimation method for adults in 1950.6,13,14
Scientific database studies primarily require data collection
from healthy subjects to find the standard deviation of the
SCALING data, thus enabling determination of differential from nor-
mal. Therefore, to provide a visual database on age develop-
The photographing procedures of forensic evidences require ment, healthy fetuses and infant teeth were incorporated into
scaling for dimensional standards, in order to determine this source of reference. For identification purposes, dental
the actual size of the object photographed. This technique evidence samples must be measured by direct techniques;
generally employs a two-dimensional, American Board of however, all dental images as X-rays, computed tomogra-
Forensic Odontology (ABFO) No. 2 forensic scale, essential phy (CT) and scanning electron microscope (SEM) images
for close-ups, which is a L-shaped measuring tool designed are measured by indirect techniques to obtain accurate
by an engineer and physicist, Bill Hyzer in 1986. He designed dentaldata.
this photomacrographic scale to allow forensic investigators
to measure the evidence and human bite marks, either present
on the bodies of the victims or on materials; he was honored Direct Measuring Techniques
by the ABFO for his work. The scale consists of a right-angle Tooth measurements must be taken with two types of
two-sided ruler with circles at each of its three points and is calipers depending on the location of the measurement.

used for taking exact photographic records. Circles are useful As a matter of course the digital Vernier caliper, which is
12
Photographing and Measuring Techniques for Dental Evidence 13
sensitive to 0.1 mm (Mitutoyo 7117057, Japan), is used for the caliper on the incisal edge or occlusal surface and
most of the measurements, including: bucco-lingual (BL), coincides with the midsagittal line. This length can be
labio-lingual (LL), mesio-distal (MD), crown height (CH), measured until the initiation of the RH and after this
root height (RH) and tooth height (TH) dimensions (Figs2.4, period the RH can be measured but not the CrT.
2.5).16 However, for the crown thickness (CrT) dimension
of a tooth, a special thickness measuring caliper, sensi- When using a digital Vernier caliper, first, the compass must
tive to 0.1 mm (Fara Dental, Taster Zirkel Nach Iwanson, be reset to zero and the measuring unit must be selected as
Ref.21821, Ellwangen, Germany) is proposed by the authors either metric (mm) or imperial (inch = 25.4 mm). During
until root development is initiated (Fig. 2.6).17,18 The fol- measurements, the caliper must be fully opened before posi-
lowing m easurements are essential for age determination tioning over the tooth and then slowly closed until it contacts
calculations: the surface of the tooth, to be able to measure the widest
BL or LL dimension: the maximum width between the dimension. At this stage care must be exerted when using
buccal or labial and lingual surfaces on the midsagittal the caliper not to damage the primary teeth, which are very
location. delicate. Two measurements should be taken from each tooth
MD dimension: the maximum width between the face and the arithmetical average should be calculated to pro-
mesial and distal surfaces. duce the data and find the relation between the tooth mea-
CH dimension: the maximum measurement from surements and age.
cervical to incisal edge on the midsagittal line. If a standard Vernier caliper is used, reading this tool
RH dimension: the size between the cervical line to the requires attention (Fig. 2.5). The first number to be read is
edge of the developing root on the buccal or labialroot seen on the left side. For example, if the slide passes 10, this
surface to coincide with the midsagittalline. means 10 mm. Then the number on the trunk of the caliper,
TH dimension: CH + RH. which coincides with 0 on the moving slide (placed to the
CrT dimension: the length from the inner to the outer left of 0) must be recorded. If it is located to the right of the
surfaces of the tooth, which lies in between the tips of number 3, but not close to the number 4, the next number
FIG. 2.1 Adult dental cast (left) and exfoliated primary teeth (right) in ABFO scale.
is 3 mm. The line that exactly lines up with the number on

the trunk of the caliper above it (here number 7) will be the
third number to be added to the previous measurements.
Theresultwill be the summation of all three measurements
as: 10 + 3 + 0.70 = 13.70 mm.16,17
The head circumference (HC), which is a reliable age
estimation measurement, has a high correlation with dental
measurements to calculate the age of a case. HC is a circular
measurement that passes over the glabella and the external
occipital protuberance and can be taken with a metric tape in
centimeters (Fig. 2.7).18
Indirect Measuring Techniques

Dental identification studies may be accomplished by sev-
eral indirect measuring methods in forensic odontology.
Recently, virtual examination with X-ray, CT, magnetic
resonance imaging (MRI) and SEM digital images has been
used instead of traditional oral autopsy procedures for iden-
tification purposes, to determine the age and gender from
teeth.1924 Dental evidence can be examined and measured
indirectly from the digital images, in addition to providing a
comparison of the ante- and postmortem records.
Indirect dental measuring can be carried out on the maxil-
lofacial and neck images created by a 16-multidetector com-
FIG. 2.2 Standardized photographing technique. puted tomography (16-MDCT) scanner (scan parameters:
FIG. 2.3 Infinite background for dental photographing.

16 0.625 collimation, 1.3 helical pitch, 1.25 mm section pulp height (PH) can be measured from the sagittal and coro-
thickness, 0.625 mm reconstruction interval, 120 kV, 80 mA nal reformatted images, where PH is the measurement from
and 1.0 second rotation time). For each tooth, perpendicu- the apex of the crown pulp to the border of the developing
lar axes should be reconstructed with double oblique refor- root (Fig. 2.8). As for direct measurement, repeated measure-
matted technique for sagittal, coronal and axial planes. For ments should be taken from each tooth face and the arithmet-
the measurements electronic calipers of 0.01 mm precision ical average must be calculated to produce the data and find
can be used on triple magnified images, adjusting the bone the relationship between the tooth measurements and age.
window level settings (W 2500, L 480). The dental dimen- Anewly developed indirect age estimation software program
sions can be taken in millimeters in two directions: the LL can be accessed in Chapter 4.
measurement can be achieved and measured from both the SEM image studies, which provide accurate micrometric
sagittal and axial planes, MD can be achieved and measured data, also greatly contribute to forensic identification in
from both the coronal and axial planes. The CrT, TH and which teeth are the only evidence. The age of the individual
FIG. 2.4 Dental measurements with a digital Vernier caliper.
FIG. 2.5 Dental measurements with a standard Vernier caliper.

is closely related to the micro changes in the various tooth n eonatal line (NL) or neonatal ring (NR), which can be seen
structures over time and can be detected and measured pre- in a vertical section (longitudinal = cross-section) or hori-
cisely in SEM images. Research has shown that tooth enamel zontal sections (transverse = ground sections), respectively.
thickness, structural differentiation of dentine, retraction of DuringSEM examination the specimens must be observed
the pulp tissue and the apposition of the cementum depends under different magnifications. The thickness of the NL
on chronological age.2528 and NR can be measured micrometrically with scales at
The micrometric dental SEM studies not only provide 20kV; repeated dental measurements of the NL thicknesses
clues to indicate the status of birth (live or still birth), but must be obtained and their arithmetical averages calculated
also shows the mode of delivery (vaginal or cesarean s ection (Fig.2.9).29
for newborns) using comparison of the thickness of the
FIG. 2.6 Crown thickness measurement with a Fara Dental

gauge.
FIG. 2.7 Direct head circumference measurement.

FIG. 2.8 Cranial, labio-lingual (LL), mesio-distal (MD), tooth height (TH), crown thickness (CrT) and pulp height (PH) indirect
measurements from CT images.
FIG. 2.9 Neonatal line SEM samples from infants experiencing live vaginal birth, cesarean section and stillbirth.
3 Morphology and Development
of Primary Dentition
DISCRIMINATION OF DENTITION mesio-palatinal cusp of first maxillary molars (16 and 26)
and second maxillary primary molars (55 and 65), known as
Each tooth of the dentition can be differentiated by evalu- Carabellis trait (Fig.3.1).13
ating the features and location, which may be coded into After selecting the tooth number according to the cusps
various numbers, letters and signs. A tooth can be precisely and roots, first the group of the tooth (cluster) and then the
identified after responding to the following questions: specific tooth examined can be discriminated as seen in
Table 3.3. Furthermore, the chosen specific tooth can be
Q 1: classification: which cluster and which specific studied in detail from the morphology (Tables 3.43.14 and
tooth? Figs 3.23.11).4
Q 2: affiliation: which dentition does the tooth pertain
to: primary or permanent?
Q 3: quadrant dependency: which one of the four
quadrants does the tooth belongs to?
Q 4: supplementary coding: are there any anomalies
present?
Classification
Each tooth consists of two parts: the crown, which is posi-
tioned in the oral cavity; and the root, which is suspended
in the alveolar bone structure by means of periodontal liga-
ments. When discrimination of a dental structure is required,
the dental classification can be initially made according to the
number of the cusps and roots of the tooth (Tables 3.1, 3.2).
However, variations may be present in the examined tooth.
For example, accessory cusps may occur on the permanent FIG. 3.1 Carabellis trait.
Table 3.1 Premise dental classification based on the number of cusps present on the crown
CUSP 1* 2 3 4*** 5
53, 52, 51 61, 62, 63 55, 54 64, 65

PRIMARY
83, 82, 81 71, 72, 73 84 74 85 75
13, 12, 11 21, 22, 23 15, 14 24, 25 18** 28** 17, 16 26, 27
PERMANENT
33, 32, 31 41, 42, 43 44 34 45 35 48, 47 37, 38 46 36
* If the tooth has one cusp, it is called cingulum.
** 50% of the third permanent maxillary molars may have four cusps. (Van Beek GC. Dental Morphology: An Illustrated Guide, 2nd edn. Philadelphia:
Wright Elsevier, 2008.)13
*** An accessory cusp may occur on the mesio-palatinal cusp of the permanent first maxillary molars (16 and 26) and on the mesio-palatinal cusp of
the second maxillary primary molars (55 and 65), called Carabellis trait (see Fig. 3.1).
19
Table 3.2 Subsidiary dental classification based on the number of roots

ROOT 1 2* 3
53, 52, 51 61, 62, 63 55, 54 64, 65

PRIMARY
83, 82, 81 71, 72, 73 85, 84 74, 75
15, 13, 12, 11 21, 22, 23, 25 14 24 18, 17, 16 26, 27, 28
PERMANENT
35, 34, 33, 32, 31 41, 42, 43, 44, 45 48, 47, 46 36, 37, 38
* The roots of permanent maxillary first premolars (14 and 24) and both the mandibular molars of primary (74, 75, 84, 85) and permanent dentition
(36, 37, 38, 46, 47, 48) have two roots. However, the direction of the first premolars roots are in the buccal-palatinal direction whereas the roots of
the mandibular molars are in the mesio-distal direction.
Table 3.3 Tooth classification for the selection of a specific tooth in a tooth cluster
Incisor Premolar Molar
CLUSTER
Tooth Primary Permanent Tooth Primary Permanent Tooth Primary Permanent
51 61 11 21 - - 14 24 54 64 16 26
Central First First
81 71 41 31 - - 44 34 84 74 46 36
SPECIFIC 52 62 12 22 - - 15 25 55 65 17 27
Lateral Second Second
TOOTH 82 72 42 32 - - 45 35 85 75 47 37
53 63 13 23 - - 18 28
Canine Third
83 73 43 33 - - 48 38
Lingual Distal Incisal Mesial Labial
51
61
Labial Mesial Incisal Distal Lingual
FIG. 3.2 Morphology of primary dentition.

Morphology and Development of Primary Dentition 21
Table 3.4 Morphology of tooth 51 Right Upper/61 Left Upper

Calcification Crown Eruption Root Exfoliation
completion completion
CHRONOLOGY 34 mo (intrauterine) 4 mo 710 mo 1.52 y 67 y
Labio-lingual Mesio-distal Crown height Root height Tooth height
DIMENSIONS 5 mm 6.5 mm 6 mm 10 mm 16 mm
Bulbous trapezoidal labial surface, tapering from the incisal edge to the cervical line and from the mesial to distal
surfaces
No projections or indentation are present
Mamelons are rare
Mesio-incisal angle: sharp; disto-incisal angle: well rounded
Mesio-distal width > cervico-incisal height
Labial Rounded cervico-labial bulk
Concave surface
Triangular in shape with its base at the incisal surface
Prominent cingulum
Palatinal Slightly pronounced marginal ridges
Triangular in shape with its base at the cervical margin
Mesial Cervical margin has a deep curve towards the incisal edge
Distal Cervical margin has a slight curve towards the incisal edge
Incisal Straight, diamond shaped, centred over the bulk of the crown
Conical single root that tapers to a blunt apex

Root Tilts distally and slightly labially
Discrimination: Upper Lower central tooth has a wedge shape
or Lower Smallest in the permanent dentition
Primary Tooth
Tooth structure gradually narrows from labial to palatinal aspect

Mesial angle is closer to the occlusal plane and steeper than the distal angle
Discrimination: Right Mesio-labial edge is straighter and longer than the disto-labial edge
or Left From the mesial, other surfaces cannot be seen, but from the distal all tooth surfaces other than mesial can be
Primary Tooth partlyseen
Rounded contours pronounced near the cervical line
Triangular crown and root structure of primary teeth are similar to permanent teeth but smaller than
permanent11and12
Roots are longer in crown/root proportion
Mesio-distal length of primary teeth > cervico-incisal length
Cervical margin more pronounced but less curved
Two grooves and three lobes (mamelons) present when erupted then lost by attrition
Discrimination: Primary or Cervico-incisal length of permanent teeth > mesio-distal length (crown longer)
Permanent Cervical margin curved
Permanent Calcification Crown completion Eruption Root completion
Maxillary Central Teeth 34 mo 45 y 78 y 1011 y
Chronology
(Teeth: 11, 21)
Table 3.5 Morphology of tooth 52 Right Upper/62 Left Upper

CHRONOLOGY 4.5 mo (intrauterine) 5 mo 811 mo 1.52 y 78 y
DIMENSIONS 4.8 mm 5.1 mm 5.6 mm 10.2 mm 15.8 mm
Similar but smaller than central incisor except the cervico-incisal length > mesio-distal length (crown longer)
Acute mesio-incisal angle and more rounded disto-incisal angle
Labial Rounded cervico-labial bulk
More concave than central incisors
Less pronounced marginal ridges than central incisors
Palatinal Cingulum lower than the central incisor
Mesial Cervical margin has a deep curve towards the incisal edge
Distal Cervical margin has a slight curve towards the incisal edge
Incisal Circular than the central incisor
Conical single root similar to central incisor but longer in proportion to the crown
Root Root tapers to a blunt apex, which tilts distally and slightly labially
Discrimination: Upper Primary maxillary lateral incisor is similar but larger than primary mandibular lateral incisor
or Lower
Mesial angle is closer to the occlusal plane and steeper than the distal angle
Mesial surface is bigger and longer than the distal surface
Tooth structure gradually narrows from labial to palatinal and from mesial to distal surfaces
From the mesial other surfaces cannot be seen, but from the distal all tooth surfaces other than mesial can be
Discrimination: Right or Left partlyseen
Discrimination: Primary or Primary maxillary lateral incisor is similar but smaller than the permanent maxillary lateral incisor
Permanent

Maxillary Lateral Teeth
1012 mo 45 y 89 y 1112 y
Chronology
(Teeth: 12, 22)
52
62

Table 3.6 Morphology of Tooth 53 Right Upper/63 Left Upper

DIMENSIONS 7 mm 7 mm 6.5 mm 12.5 mm 19 mm
Wedge-shaped structure, which narrows from labial to palatinal surface and from incisal edge to cervical margin
Bulkier in appearance with well developed labial lobes
A longitudinal ridge extends from the cusp towards the cervical margin
Mesial arm of the incisal margin is shorter than the distal arm
Labial Disto-incisal angle is more rounded than the mesio-incisal angle
Has a well developed cingulum and distinct mesial and distal marginal ridges
A longitudinal ridge from the cusp towards the cingulum separates the palatinal surface and forms the mesio-lingual
Palatinal and disto-lingual fossae
Convex surface that converges towards the cervical margin and forms a straight line with the root
Mesial Mesial root surface has a longitudinal groove
Markedly convex surface that converges towards the cervical margin and forms an obtuse angle with the root
Distal Distal root surface has a longitudinal groove
Asymmetric rhomboidal outlook
Prominent longitudinal ridges start from the cusp tip and descend to the labial and palatinal surfaces
Incisal The tip of the cusp is located distally
Single root twice as long as the crown
The stoutest and longest root, which has a triangular cross-section.
Root The curve of the cervical margin is less pronounced but has a slight sinuous curve at the mesial
Primary maxillary canine is longer than the primary mandibular canine
Discrimination: Upper Mesio-incisal edge is longer than the distal edge
orLower Buccal ridge is located close to the distal edge
The mesio-incisal length is longer than the disto-incisal length
The root apex slopes towards to the distal direction
Discrimination: Right or Left Tooth gradually narrows from labial to lingual surface
The longest tooth among primary dentition but smaller than the permanent maxillary canine
Discrimination: Primary More prominant ridges and grooves than the permanent maxillary canine
orPermanent More slender than the permanent maxillary canine, but much wider than the primary central and lateral incisors
Maxillary Canine Teeth
45 mo 67 y 1113 y 1315 y
Chronology
(Teeth: 13, 23)
53
63


Buccal surface narrows from the occlusal edge to cervical margin and from mesial edge to distal edge
Buccal Strong bulbous surface that protrudes at the mesial direction
Palatinal Gradually narrows from mesial to distal direction and occlusal to cervical margin
Mesial Gradually narrows from buccal to palatinal surface and from cervical margin to occlusal edge
Distal Similar to mesial surface but smaller and more convex
Three cusps: two major cusps (mesio-buccal and mesio-palatinal) and one minor (disto-buccal) cusp
Mesio-palatinal cusp is the longest and sharpest, mesio-buccal and
disto-buccal are smaller, in decreasing order
Occlusal Variation: may have four cusps, two in buccal and two in lingual direction
There are three roots, two at the buccal and one larger root at the lingual direction
Roots are long, slender and divergent
The lingual root is longer and more curved, which tips back towards the buccal root at the apex
The mesio-buccal root is the second longest and the disto-buccal is the shortest and straightest
Root Each root has a single root canal
It is the smallest of the deciduous molars in crown height and in the mesio-distal dimension
Primary maxillary 1st molars have three roots, two in the buccal and one in the lingual direction, but primary
Discrimination: Upper mandibular 1st molars have two roots, in the mesial and distal directions
orLower The mesial root has two root canals
Primary maxillary 1st molars gradually narrow from buccal to palatinal aspect and from mesial to distal direction
Mesio-palatinal cusp is the biggest and disto-palatinal cusp is the smallest
Discrimination: Right orLeft Two roots at the buccal and one root at the lingual direction
Discrimination: Primary Primary maxillary 1st molars are smaller and their roots are more divergent than the permanent 1st maxillary molars
orPermanent The root trunk of primary maxillary 1st molars is shorter than that of the permanent 1st maxillary molars

Maxillary
Birth 2.53 y 67 y 910 y
1st Molar Teeth Chronology
(Teeth: 16, 26)
Lingual Distal Incisal Mesial Buccal
54
64
Buccal Mesial Incisal Distal Lingual


CHRONOLOGY 67 mo (intrauterine) 1012 mo 2529 mo 3y 1012 y
DIMENSIONS 10 mm 8.2 mm 5.7 mm 11.7 mm 17.4 mm
Buccal surface has a rhomboidal outline, which gradually narrows from occlusal edge to cervical margin and from
mesial to distal surface
There are two equal sized buccal cusps and a buccal groove in between on this surface
Buccal This tooth is larger than the 1st primary maxillary molar
Palatinal The palatinal view shows three cusps, mesio-palatinal, disto-palatinal and Carabelli cusp
Convex surface, which narrows from cervical margin to occlusal edge

Mesial Mesio-palatinal cusp is large but the mesio-buccal is more spinous
Distal Similar to mesial but more convex
Has four well developed cusps, mesio-palatinal being the most prominent where often the Carabelli trait is present
(If ranked from largest to smallest: mesio-palatinal, mesio-buccal, disto-buccal, disto-palatinal and Carabelli)
Mesio-palatinal cusp makes a joint with the disto-buccal cusp with an oblique ridge similar to maxillary
Occlusal 1stpermanentmolar
There are three slender and divergent roots, two of which are located in buccal and one in palatinal direction
Root The roots are larger than the 1st primary maxillary molar
Primary maxillary 2nd molars have four cusps (two in buccal and two in palatinal direction), and three roots (two buccal
and one palatinal)
Discrimination: Upper Primary mandibular 2nd molars have five cusps (three in buccal and two in lingual direction), and two roots in
orLower mesio-distal direction
The crista joins the mesio-palatinal cusp to the disto-buccal cusp
Mesio-palatinal is the biggest cusp where Carabelli trait may be present
Discrimination: Right or Left Two roots are located in the buccal side and one in the palatinal side
It looks like a 1st permanent molar but is smaller in size
Discrimination: Primary Buccal surface bulges on the cervical part more than the maxillary 1st permanent molar
orPermanent Roots of primary maxillary 2nd molars are more divergent than the maxillary permanent molars
Maxillary
2.53 y 78 y 1113 y 1416 y
2nd Molar Teeth Chronology
(Teeth: 17, 27)
Lingual Distal Incisal Mesial Buccal
55
65
Buccal Mesial Incisal Distal Lingual

Table 3.9 Morphology of Tooth 71 Left Lower/81 Right Lower

DIMENSIONS 4 mm 4.2 mm 5 mm 9 mm 14 mm
Flat, with a slight convexity

Mesial and distal edges are equal
Gradually narrows from incisal edge to cervical margin
Labial Distinct mamelons and grooves
Concave
Tapers towards the cingulum, which is less pronounced
Lingual A slightly concave lingual fossa is present among the mesial, distal, incisal edges and cingulum
Mesial Triangular in shape with its base at the cervical margin
Distal Similar to the mesial surface but smaller and more convex
Incisal Incisal ridge centred over the root
Root Long, very narrow, conical single root, which is twice the crown height
Discrimination: Upper Lower centrals are the smallest tooth among the primary incisors
orLower It has less pronounced marginal ridges than maxillary central incisors
Gradually narrows from labial to lingual surface

The mesio-incisal angle is steeper than the disto-incisal angle
Discrimination: Right orLeft There may be a longitudinal groove on the distal side of the root
Crown appears wider than permanent mandibular central tooth
Cervical contours are more sinuous in the mesial than the distal surfaces
Discrimination: Primary More convex than the permanent mandibular central tooth
orPermanent Lower mandibular central tooth is the smallest in both the primary and permanent dentition
Mandibular
34 mo 45 y 69 y 910 y
Central Teeth Chronology
(Teeth: 31, 41)
Lingual Mesial Incisal Distal Labial
71
81
Labial Distal Incisal Mesial Lingual


DIMENSIONS 4 mm 4.1 mm 5.2 mm 10 mm 15.2 mm
Labial Mandibular lateral incisors are wider and longer than the primary mandibular centrals
Lingual Cingulum is more developed than the primary mandibular centrals

Mesial Wider than primary centrals in the labio-lingual direction
Distal From the distal side all surfaces except the mesial can be partly seen
Incisal Labio-incisal edge is longer than the primary mandibular centrals
Single root
Root Longer, narrower and more tapered than the primary mandibular centrals, but less blunt at the apex
Discrimination: Upper Mandibular lateral is bigger than the primary mandibular centrals, but smaller than primary maxillary laterals
orLower
Incisal ridge slopes distally and distal margin is more rounded

There is a longitudinal groove on the distal side of the root
Mesial surface is longer and mesio-incisal angle steeper than the distal
Discrimination: Right orLeft The root apex slants to distal direction
Discrimination: Primary Gradually narrows from labial to lingual and mesial to distal surfaces
orPermanent Primary mandibular lateral incisors are bigger, wider and longer than the permanent mandibular centrals

Mandibular
34 mo 45 y 78 y 1011y
Lateral Teeth Chronology
(Teeth: 32, 42)
72
82


DIMENSIONS 4.8 mm 5 mm 6 mm 11.5 mm 17.5 mm
Labial Wedge-shaped surface, which narrows towards the crown apex and cervical margin from the mesial and distal edges
Lingual Narrower than the labial side and has a taper towards the cingulum
Mesial Triangular in shape with its base at the cervical margin
Distal Triangular in shape with its base at the cervical margin
Straight incisal ridge centred labio-lingually

Labial side presents a flat surface with a slight convexity
Incisal Lingual side has a concave surface
Narrow and long single root, twice the crown height
Root Thicker than the central and lateral incisors
Smaller than the primary maxillary canine labio-lingually
Labial surface is flatter with shallow developmental grooves and has a longer distal cusp ridge
Mandibular canine has a single concave lingual fossa, whereas the primary maxillary canine has two fossae
onthelingual
Mandibular primary canine has a shorter root than the primary maxillary canine, which tapers towards to the
lingualside
Discrimination: Upper The disto-incisal length is longer than the mesio-incisal length
orLower The root apex slopes towards to the distal direction
The mesio-incisal edge is shorter than the disto-incisal edge
Distal edge is more convex than the mesial edge
Discrimination: Right orLeft The root apex slants to distal direction
Discrimination: Primary The second longest tooth among primary dentition but smaller than the permanent mandibuler canine
orPermanent Mesio-incisal edge of primary mandibular canine is shorter than the distal edge, as in permanent mandibular canines

Mandibular
45 mo 67 y 910 y 1214y
Canine Teeth Chronology
(Teeth: 33, 43)
73
83

Table 3.12 Morphology of Tooth 74 Right Lower/84 Left Lower

DIMENSIONS 7 mm 7.7 mm 6 mm 9.8 mm 15.8 mm
There is a strong bulbous enamel bulge buccally at the mesial direction

There are two buccal cusps with a slight groove inbetween
Mesial cusp is larger than the distal cusp
Buccal The mesio-distal width is > than the occluso-gingival height
Lingual Lingual surface is smaller and shorter than the buccal surface
Mesial outline is rather flat and straight

There is an extremely bulbous curvature on the cervical third of the buccal surface
Mesial Mesio-buccal cusp is longer than the mesio-lingual cusp
Distal outline is convex converging towards the cervical line
Distal Distal surface is shorter than the mesial surface
There are four cusps, of which the mesio-lingual cusp is the highest and largest (If ranked from largest to smallest:
Occlusal mesio-lingual, mesio-buccal, disto-buccal, disto-lingual)
There are two divergent roots in mesial and distal direction
Mesial is longer, larger and has two root canals
Additionally there is a longitudinal groove on the mesial root
Root Distal root is shorter, thinner and has one root canal
Primary mandibular 1st molars has four cusps and two roots in mesial and distal direction
Discrimination: Upper or Although primary maxillary 1st molars has four cusps, it has three roots, two at the buccal and one larger root at the
Lower lingual direction
The tooth gradually narrows from mesial side to distal side
Mesio-lingual cusps are the largest
Discrimination: Right or Left Mesial root is larger and longer
Primary mandibular 1st molars have four cusps
Permanent mandibular 1st molars have five cusps (three in the buccal and two in the lingual direction)
Discrimination: Primary or Both primary and permanent mandibular 1st molars have two roots in mesial and distal direction, but the roots of
Permanent primary teeth are more divergent
Mandibular
Birth 2.53 y 67 y 910 y
1st Molar Teeth Chronology
(Teeth: 36, 46)
74
84


CHRONOLOGY 6 mo (intrauterine) 1012 mo 2027 mo 3y 1012 y
Resembles the lower first permanent molar but smaller in size and has a bulky primary tooth characteristic at the
cervical margin
Buccal There are three cusps seen on the buccal: mesio-buccal, disto-buccal and distal
Lingual On the lingual side there are two cusps seen of about equal size
Mesial side shows a bulge at the cervical margin

The mesial marginal ridge is higher
Mesial The mesio-lingual cusp is longer than the mesio-buccal cusp
Distal surface is narrower than the mesial surface
Distal Distal marginal ridge is lower and shorter
There are five cusps, three of which are located at the buccal side
Occlusal The mesio-distal width of buccal cusps > than the mesio-distal width of the lingual cusps
There are two roots
The three buccal cusps are all about the same size
This is in contrast to the lower first molar where the distal cusp is smaller than the mesio-buccal and
disto-buccalcusps
Mesial root is wide, flat and blunt at the apex and has two root canals
Root Distal root is more tapered than the mesial root and has one root canal
Primary mandibular 2nd molars have five cusps (three in buccal and two in lingual direction), and two roots in
mesio-distal direction
Discrimination: Upper Primary maxillary 2nd molars have four cusps (two in buccal and two in palatinal direction), and three roots (two buccal
orLower and one palatinal)
The tooth gradually narrows from buccal to lingual and from mesial to distal direction
There are three cusps in the buccal and two cusps in the lingual direction
Discrimination: Right orLeft Has two roots, the mesial root being larger and longer
Primary mandibular 2nd molars have five cusps
Permanent mandibular 2nd molars have four cusps
Discrimination: Primary Both primary and permanent mandibular 2nd molars have two roots in the mesial and distal directions, but the roots of
orPermanent primary teeth are more divergent
Mandibular
2.53 y 78 y 1113 y 1415 y
2nd Molar Teeth Chronology
(Teeth: 37, 47)
75
85

Table 3.14 Permanent Successional 1st and 2nd Premolars and Accessional 3rd Molar Teeth
Maxillary
1.51.75 y 56 y 1012 y 1213 y
1st Premolar
Teeth Chronology
(Teeth: 14, 24)

Mandibular
1.752 y 56 y 1012 y 1213 y
1st Premolar
Teeth Chronology
(Teeth: 34, 44)

Maxillary
22.5 y 67 y 1012 y 1214 y
2nd Premolar
Teeth Chronology
(Teeth: 15, 25)

Mandibular
1.252.5 y 67 y 1113 y 1314 y
2nd Premolar
Teeth Chronology
(Teeth: 35, 45)

Maxillary
79 y 1216 y 1721 y 1825 y
3rd Molar
Teeth Chronology
(Teeth: 18, 28)

Mandibular
810 y 1216 y 1721 y 1825 y
3rd Molar
Teeth Chronology
(Teeth: 38, 48)
Affiliation process was not applied to avoid impairing the

There are important differences between primary and per- originality of the tooth specimens.
manent dentition, including number, range, morphology, Enamel thickness of 0.51 mm, with wider aprismatic
color, surface texture, and period of existence, as described surface enamel.
below. Straight but prominent cervical margin, which is
excessive at the mesio-buccal site.
Spherical anterior crowns.
Primary dentition (see Figs 1.51.11) Shorter and weaker roots which are lighter in color.
Comprises 10 maxillary and 10 mandibular teeth, for Roots of the posteriors are more divergent (see Figs 3.5,
a total of 20 teeth, including two incisors, one canine 3.6, 3.10, 3.11).
and two molar teeth. Shows definite morphology with fewer variations.
Eruption of primary dentition starts at 6 months and Incisors shows slightly rounded incisal eminences,
continues until approximately 30 months. The roots called mamelons.
are completed by 3 years of age and teeth exfoliate at Depending on the growth of the jaw and facial bones of
612 years of age. Therefore, a primary tooth will be the child, a space occurs between the primary dentition.
functional at approximately 510 years (Table 1.1). The enamel and dentine tissues of all primary teeth
Overall smaller than permanent dentition. exhibit neonatal lines (NLs).5,6
Enamel is whiter, opaque, permeable and soft, and is Shedding: all primary teeth are replaced by permanent
subjected to discoloration and wear, especially before teeth. Central, lateral and canine teeth are replaced
root resorption, as demonstrated in the section on by permanent teeth; primary molars are replaced by
Development of the primary dentition. The bleaching permanent premolar teeth.
Permanent dentition (see Figs 1.121.16) the jaw to which the tooth belongs must be determined as
Consist of 16 maxillary and 16 mandibular teeth, for upper (maxillary) or lower (mandibular), then the right or left
a total of 32 teeth, including two incisors, one canine, side to which the tooth belongs must be assigned. Finally,
two premolar and three molar teeth. the tooth is labelled according to the quadrant as: upper right
Eruption starts at 6 years and is completed by (UR), upper left (UL), lower right (LR) or lower left (LL)
approximately 21 years of age (including the third (see Chapter 1, section Dental discrimination, notation and
molars). As can be seen in Table 1.1, a permanent tooth recording).
will be functional for approximately 5075 years under
normal and hygienic conditions. All permanent teeth
are larger than primary dentition. Supplementary coding
Enamel is harder. The notation of anomaly cases must be considered with a
Teeth during long-span usage will show some specific description or extra signs for any abnormality of both
differentiations in color, form and texture. Due to aging, primary and permanent dentition, such as hyperdontia, super-
the following changes occur on dental structure, which numerary mesiodens, fused teeth and fourth molar. There
are clues for age determination: the enamel thickness are different symbols used for this purpose as International
shows a steady decrease, the color chroma increases, Classification of Diseases (ICD) codes, Computer-Assisted
the mineral content increases, root transparency Post-Mortem Identification (CAPMI) notations or Sarjeevs
increases, incisal edge and surface texture becomes supernumerary tooth notation system.1012 However, a novel
smoother and gingival tissues and pulp tissue recess international supplementary coding system, which can
related to chronological age.79 be easily adopted and save time is a requirement for the
Do not show NLs, except the first molars. Federation Dentaire Internationale (FDI) notation system.
Curved but less bulky cementoenamel junction.
Non-spherical anterior crowns.
Longer and stronger roots that are darker in color. MORPHOLOGY OF PRIMARY DENTITION
Roots of posteriors are more convergent.
More variations can be seen on permanent morphology. The morphology of primary dentition shows different char-
Mamelons can be seen after eruption but abrade over acteristic features to permanent dentition, as presented
time. above. These specifications can be seen in Tables 3.43.14
No space occurs between the permanent dentition. and Figures 3.23.11.
The permanent teeth (incisors, canines and premolars)
replace primary teeth and therefore are called
succedaneous teeth, which means, to replace. In dental DEVELOPMENT OF PRIMARY DENTITION
science, permanent teeth that replace primary teeth
are called successional teeth. The permanent molars Along with the structure and location of a tooth, its develop-
that are added distally to the primary dentition and mental stages are accepted as a precise indicator of growth
do not replace any former teeth are called accessional and development for humans. This staging method is more
(additional) teeth. reliable for children than adults. This atlas is based primarily
No shedding but extraction when required. on fetus and infant teeth; therefore in this section the monthly
developmental stages from 7-month-old prenatal fetus to
1-year-old postnatal infant cases will be illustrated, includ-
Quadrant dependency ing all six different aspects: buccal, lingual, mesial, distal,
Teeth can be specified by determining the location in one incisal and the root direction (Figs 3.123.263).
of the four quadrants of the oral cavity. For this aim, first,
PRIMARY UPPER RIGHT CENTRAL TOOTH 51

AGE PRENATAL 7 MONTHS
LABIAL PALATINAL
MESIAL DISTAL
INCISAL ROOT DIRECTION

FIGS 3.12.13.12.6
PRIMARY UPPER RIGHT LATERAL TOOTH 52

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.13.13.13.6
PRIMARY UPPER LEFT CENTRAL TOOTH 61

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.14.13.14.6
PRIMARY UPPER LEFT LATERAL TOOTH 62

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.15.13.15.6
PRIMARY LOWER LEFT CENTRAL TOOTH 71

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.16.13.16.6
PRIMARY LOWER LEFT LATERAL TOOTH 72

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.17.13.17.6
PRIMARY LOWER RIGHT CENTRAL TOOTH 81

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.18.13.18.6
PRIMARY LOWER RIGHT LATERAL TOOTH 82

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.19.13.19.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.20.13.20.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.21.13.21.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.22.13.22.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.23.13.23.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.24.13.24.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.25.13.25.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.26.13.26.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.27.13.27.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.28.13.28.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.29.13.29.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.30.13.30.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.31.13.31.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.32.13.32.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.33.13.33.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.34.13.34.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.35.13.35.6

AGE PRENATAL 9 MONTHSPOSTNATAL 1 MONTH
LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.36.13.36.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.37.13.37.6
PRIMARY UPPER RIGHT FIRST MOLAR TOOTH 54

BUCCAL PALATINAL
MESIAL DISTAL
OCCLUSAL ROOT DIRECTION

FIGS 3.38.13.38.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.39.13.39.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.40.13.40.6
PRIMARY UPPER LEFT FIRST MOLAR TOOTH 64

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.41.13.41.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.42.13.42.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.43.13.43.6
PRIMARY LOWER LEFT FIRST MOLAR TOOTH 74

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.44.13.44.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.45.13.45.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.46.13.46.6
PRIMARY LOWER RIGHT FIRST MOLAR TOOTH 84

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.47.13.47.6

AGE PRENATAL 9 MONTHSPOSTNATAL 2 MONTHS
LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.48.13.48.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.49.13.49.6
PRIMARY UPPER RIGHT CANINE TOOTH 53

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.50.13.50.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.51.13.51.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.52.13.52.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.53.13.53.6
PRIMARY UPPER LEFT CANINE TOOTH 63

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.54.13.54.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.55.13.55.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.56.13.56.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.57.13.57.6
PRIMARY LOWER LEFT CANINE TOOTH 73

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.58.13.58.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.59.13.59.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.60.13.60.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.61.13.61.6
PRIMARY LOWER RIGHT CANINE TOOTH 83

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.62.13.62.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.63.13.63.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.64.13.64.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.65.13.65.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.66.13.66.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.67.13.67.6
PRIMARY UPPER RIGHT SECOND MOLAR TOOTH 55

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.68.13.68.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.69.13.69.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.70.13.70.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.71.13.71.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.72.13.72.6
PRIMARY UPPER LEFT SECOND MOLAR TOOTH 65

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.73.13.73.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.74.13.74.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.75.13.75.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.76.13.76.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.77.13.77.6
PRIMARY LOWER LEFT SECOND MOLAR TOOTH 75

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.78.13.78.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.79.13.79.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.80.13.80.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.81.13.81.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.82.13.82.6
PRIMARY LOWER RIGHT SECOND MOLAR TOOTH 85

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.83.13.83.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.84.13.84.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.85.13.85.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.86.13.86.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.87.13.87.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.88.13.88.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.89.13.89.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.90.13.90.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.91.13.91.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.92.13.92.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.93.13.93.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.94.13.94.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.95.13.95.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.96.13.96.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.97.13.97.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.98.13.98.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.99.13.99.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.100.13.100.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.101.13.101.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.102.13.102.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.103.13.103.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.104.13.104.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.105.13.105.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.106.13.106.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.107.13.107.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.108.13.108.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.109.13.109.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.110.13.110.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.111.13.111.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.112.13.112.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.113.13.113.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.114.13.114.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.115.13.115.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.116.13.116.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.117.13.117.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.118.13.118.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.119.13.119.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.120.13.120.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.121.13.121.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.122.13.122.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.123.13.123.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.124.13.124.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.125.13.125.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.126.13.126.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.127.13.127.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.128.13.128.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.129.13.129.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.130.13.130.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.131.13.131.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.132.13.132.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.133.13.133.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.134.13.134.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.135.13.135.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.136.13.136.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.137.13.137.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.138.13.138.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.139.13.139.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.140.13.140.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.141.13.141.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.142.13.142.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.143.13.143.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.144.13.144.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.145.13.145.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.146.13.146.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.147.13.147.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.148.13.148.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.149.13.149.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.150.13.150.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.151.13.151.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.152.13.152.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.153.13.153.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.154.13.154.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.155.13.155.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.156.13.156.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.157.13.157.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.158.13.158.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.159.13.159.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.160.13.160.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.161.13.161.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.162.13.162.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.163.13.163.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.164.13.164.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.165.13.165.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.166.13.166.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.167.13.167.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.168.13.168.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.169.13.169.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.170.13.170.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.171.13.171.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.172.13.172.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.173.13.173.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.174.13.174.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.175.13.175.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.176.13.176.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.177.13.177.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.178.13.178.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.179.13.179.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.180.13.180.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.181.13.181.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.182.13.182.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.183.13.183.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.184.13.184.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.185.13.185.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.186.13.186.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.187.13.187.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.188.13.188.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.189.13.189.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.190.13.190.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.191.13.191.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.192.13.192.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.193.13.193.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.194.13.194.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.195.13.195.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.196.13.196.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.197.13.197.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.198.13.198.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.199.13.199.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.200.13.200.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.201.13.201.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.202.13.202.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.203.13.203.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.204.13.204.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.205.13.205.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.206.13.206.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.207.13.207.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.208.13.208.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.209.13.209.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.210.13.210.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.211.13.211.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.212.13.212.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.213.13.213.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.214.13.214.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.215.13.215.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.216.13.216.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.217.13.217.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.218.13.218.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.219.13.219.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.220.13.220.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.221.13.221.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.222.13.222.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.223.13.223.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.224.13.224.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.225.13.225.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.226.13.226.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.227.13.227.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.228.13.228.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.229.13.229.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.230.13.230.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.231.13.231.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.232.13.232.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.233.13.233.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.234.13.234.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.235.13.235.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.236.13.236.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.237.13.237.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.238.13.238.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.239.13.239.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.240.13.240.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.241.13.241.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.242.13.242.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.243.13.243.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.244.13.244.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.245.13.245.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.246.13.246.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.247.13.247.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.248.13.248.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.249.13.249.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.250.13.250.6

LABIAL PALATINAL
MESIAL DISTAL

FIGS 3.251.13.251.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.252.13.252.6

BUCCAL PALATINAL
MESIAL DISTAL

FIGS 3.253.13.253.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.254.13.254.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.255.13.255.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.256.13.256.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.257.13.257.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.258.13.258.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.259.13.259.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.260.13.260.6

LABIAL LINGUAL
MESIAL DISTAL

FIGS 3.261.13.261.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.262.13.262.6

BUCCAL LINGUAL
MESIAL DISTAL

FIGS 3.263.13.263.6
4 Dental Identification and Age
Estimation from Teeth
OBTAINING DENTAL EVIDENCE dentition and alveolar complex, submental muscle incisions
FROM ORAL AUTOPSY and cutting of the ramus bone are sometimes required. It has
been also stated that modified oral autopsy protocols may
Dental analysis has prime importance during forensic be implemented in special circumstances.48 However, oral
research and the identification of deceased individuals. The autopsy procedures for fetus, infant or child cases, especially
most significant source of dental evidence is the oral autopsy, for dental arches where the teeth are unerupted, require eas-
which comprises extra- and intraoral examinations and com- ier operations than adults, as the muscles are weaker for this
parison of data. For this reason a Forensic Odontology Unit is age group. Such cases have importance from the perspective
a must for all morgue departments. Oral autopsies must con- of miscarriages, criminal abortions and abandoned cases.
tend with difficulties relating to the rigor mortis stage of post- The nomenclature of the AkaCanturk Oral Autopsy
mortem changes, which depend on the age of the deceased Method has been adopted by the authors for the theoretical
and the strength of the muscles that precludes the opening and experimental aspects of the oral autopsy protocol for
of the jaws. identification purposes of this special age group; the germ
The identification by age estimation from permanent adult extraction protocol for teeth in their developmental stages
teeth is a complex procedure and may require the application is well defined.9 Initially, written authorization is essential
of various techniques.13 for the above mentioned oral autopsy examination method.
A screw-type mouth opening apparatus is used for this Incisions must be applied to the maxillary and mandibular
reason. In cases where the oral autopsy accompanies the ridges of the alveolar crests, then the tooth germs can be
forensic autopsy, an horizontal, U-typed, incision parallel elevated from both sides with elevators to avoid damaging
to the lower border of the mandible is applied, or a perioral the tooth during extraction (Fig. 4.1). The tooth germs must
facial incision extending from the comissura of the lips to then be placed in labeled containers filled with preserving
the angulus of the mandible. In order to obtain access to the solution, such as 10% formalin solution. This evidence must
FIG. 4.1 Primary teeth samples from an autopsy case.

295
be preserved for macroscopic and/or microscopic d iagnostic can be seen in the series of growth curves obtained from
identification purposes, especially in the event of burial or direct tooth (labio-lingual [LL], mesio-distal [MD], crown
cremation of the body. However, erupted teeth may be studied thickness [CrT], tooth height [TH]) and HC measurements
in situ and the measurement data can be recorded. Finally, an for both genders (Fig. 4.2). It is apparent that gender is not
autopsy report with labeled radiographs, photographs, charts, a significant factor for age estimation in the age groups that
impressions, models and tooth samples must be prepared, include the first year of life (after birth) (p>0.05), although
ideally by a forensic odontologist who will perform compari- calcification starts (before birth) at the 13th week for females
son of the ante- and postmortem records. This method is an and 15th weeks for males for maxillary central incisors, and
accurate, reliable and simple oral autopsy protocol for fetus 14th weeks for females and 17th weeks for males for mandib-
and infant cases, which requires only minor operations for ular central incisors.10 Also, the head and tooth dimensions
achieving dental evidence.10,11 have a very high correlation that generates the best model for
age estimation. The authors of this Atlas have created spe-
cific regression formulas, including variables of direct and
IDENTIFICATION FROM TEETH indirect dimensions for age estimation. The formulas of the
direct method encompass both prenatal and postnatal terms
Teeth provide a unique environment for protecting the (fetuses and infants), but the indirect method only focuses
deoxyribonucleic acid (DNA) molecules that provide
on the postnatal period. All these formulas are combined in
excellent evidence for forensic research. Tooth structures are an age estimation software program and given in the sec-
very hard tissues and resistant to postmortem changes and tion below (Age estimation software). These formulas for
maintain their integrity over time (see Chapter 1). Dental direct or indirect measurement techniques are applicable
DNA can be obtained from the soft tissues of the dental pulp from 7 months prenatal (fetus) to 18 months postnatal, as
and the hard tissues of the tooth. There are various methods the growth pattern of dental structures stabilizes and finally
available to take samples from the teeth; two methods that stops; therefore, after crown completion (4 months postnatal),
are superior in terms of the amount and quality of the DNA root and tooth height are a more certain dental measurements
sample are the retrograde technique of Cobb et al.12 and the for age estimation, where the results may show 2 weeks
orthograde technique of Alakoc and Aka.13 error. In age estimation formulas, gender is an effective
In addition to DNA analysis, identification studies may factor in prenatal dentition (before birth), which is not the
be performed by either direct or indirect measurement tech- case in infants (after birth). Below, two examples of age
niques, as described in Chapter 2. These techniques include estimation formulas of this program are applied as follows
different methods for primary and permanent dentitions, (NB: 1 = boys; 2 = girls):
which are explained in the following section. Both of these Example 1: Age of a 9 month (36 weeks) fetus, male (1),
techniques should be applied as the precursor phase of the with upper central tooth measurements; LL = 3.7, CrT = 1.95,
identification process, before the application of molecular can be confirmed from the following direct measurement
biologic techniques. DNA analyses require laboratory time formula:
and expertise and are time consuming and expensive. These
techniques are therefore used for the identification of liv- Age = 17.785 2.026 Gender + 4.978 LL + 0.744 CrT10
ing individuals, human remains and biologic materials that
are found in mass disasters, mass graves, aircraft accidents, Age = 17.785 2.026 1 + 4.978 3.7 + 0.744 1.95
holocausts, and mass death cases where large number of Age = 35.63 weeks prenatal fetus.
individuals from the same family or close relatives have lost
their lives.1416 Example 2: Age of an 8 month (32 weeks) fetus, with upper
central tooth (CH) measurement = 4.4 can be confirmed from
the following direct measurement formula:
Direct Identification from Primary Teeth
Generally a variety of direct tooth, head and body measure- Log(Age) = 0.533 + 0.664 CH12
ment records are used for identification purposes during the
live examination or autopsy procedures. Identification meth- Log(Age) = 0.533 + 0.664 4.4
odology has been studied by many researchers.1727 However, Log(Age) = 3.4546.
literature discussing the fetus and infant age group is rare in
comparison with studies on adults. Among these studies, all Age = e(3.4546)
upper central teeth dimensions and the head circumference Age = 31.65 weeks prenatal fetus.
(HC) measurements are most reliable, especially for identifi- Please note that, in this equation, the obtained result is
cation from age estimation.10,11 The tooth dimensions and HC a logarithmic number; therefore, this number must be con-
of infants show a maximum linear increase over a certain verted to an exponential (anti-log) number: Y = log(X) is con-
time and then continue at a slow rate until maturation, which verted X = eY where the exponential base (e) = 2.718.
Dental Identification and Age Estimation from Teeth 297
6 8
7
5
6
4
5
MD
3 4
LL
3
2
2
1 Boy Boy
1
Girl Girl
0 0
10 20 30 40 50 60 70 80 90 100 10 20 30 40 50 60 70 80 90 100
AGE AGE
8 12
7
10
6
5 8
CrT
TH
6
3
4
2
Boy Boy
1 2
Girl Girl
0 0
10 20 30 40 50 60 70 80 90 100 10 20 30 40 50 60 70 80 90 100
AGE AGE
55
50
50
45
45
40
40
35
35 30
HC
HC
30 25
25 20
20 15
Boy Boy
15 10
Girl Girl
10 5
10 20 30 40 50 60 70 80 90 100 0 2 4 6 8 10 12
AGE TH
FIG. 4.2 Growth curves of direct primary tooth and head measurements (LL, MD, CrT, TH and HC).
Direct Identification from Permanent Teeth estimation from direct dental measurements of adults is also
Human teeth undergo regular development and the age of an possible (Fig. 4.3).36
individual can be determined from teeth with an error margin
of 1 year until the age of 15 years, and an error margin of
2 weeks for fetuses and infants. The status of dental develop- Indirect Identification from Primary
ment is more precise than all other anthropological measure- Teeth and Neonatal Line
ments,28 due to the fact that tooth mineralization stages are Indirect identification by estimating the chronological age
not excessively affected by nutritional and endocrine condi- from the images of primary dental structures is also pos-
tions, when compared with bones.29 The first fundamental sible using radiological techniques such as X-rays, magnetic
research on dental age estimation of adults was implemented resonance imaging (MRI) and CT, that are appropriate for
by Gustafson, where the secondary age related changes were the examination of hard oral structures such as bones and
coded on a cross-section of the examined teeth to determine teeth. Recently, the term virtopsy has been applied to the
the age of the individual. Many researchers have studied the analysis of digital images, as a composite term from virtual
identification of adult dental aging as a guide using differ- autopsy.3740
ent techniques, such as X-rays, light microscope, biochemi- Another compound abbreviated term that has been
cal racemization, scanning electron microscope (SEM) and created and proposed by the authors is VirDent-ID,
computed tomography (CT).1,2,14,28,3035 Additionally, gender meaning virtual dental identification and includes the
FIG. 4.3 Direct measurement obtained from permanent dentition.
ante- and postmortem comparisons from virtual digital Log(Age) = 1.682608 + 0.82963 LL + 0.14228
dentalimages. TH 0.0071538 (LL TH)
Identification from CT images is a conservative and non-
invasive method for forensic odontological identification Log(Age) = 1.682608 + 0.82963 4.8 + 0.14228
studies when compared with oral autopsy and advanced 10 0.0071538 (4.8 10)
SEM studies, and has been found to be a reliable method by
researchers. CT may therefore be the preferred method for Log(Age) = 3.379
obtaining dental evidence in cases that can be examined and
measured from digital images. Age = e(3.379)
The authors of this Atlas created specific regression Age = 29.34 weeks postnatal.
formulas including variables of indirect dental measurements
for the age estimation of fetuses and infants. In this regard, Further virtual dental identification analyses use the
the best results were obtained from the age estimation formu- detection of the neonatal line (NL). The NL is an irregular
las generated from the TH together with a LL measurement band-type sign of a developmental birth defect that occurs
obtained from the upper central primary tooth. This is the due to the metabolic stress in tooth structures, blocks the
longest vertical dimension in the sagittal plane and produces formation of enamel and dentin tissues during the passage
an error value of e(0.067), equal to 1.07 weeks.40 As with of a fetus to extrauterine life and is regarded as an important
the direct m easurement formulas, these indirect formulas issue in forensic odontology. This effect generates a change
are combined in the age estimation software program. The in the size and direction of the pre- and postnatal enamel
growth curves of indirect primary tooth measurements (LL, prisms and occurs in 90% of every primary tooth and the first
MD, TH, CrT andPH) can be seen in the series of graphics permanent molars. It corresponds to the time of birth and
in Figure 4.4. is traceable under SEM, X-ray microanalysis (XRMA), light
An example using the age estimation formula microscopy and microradiography.4147
derived from the virtual (indirect) dental measurements is If the NL, which can be examined in vertical tooth
as follows: sections,is seen in the horizontal plane it is called the n eonatal
ring (NR). The existence of such a sign of disturbance in a
Age of a 7.5 month old (30 weeks) infant, with upper cen- fetus or infant tooth is regarded as an indicator of a live birth
tral tooth measurements: LL = 4.8 and TH = 10, can be con- that can be proven to the legal authorities.7,48,49 Additionally,
firmed from the following indirect measurement formula: its thickness measured under SEM indicates the mode of
6.5 7
6 6.8
6.6
5.5
6.4
5 6.2
MD
LL
4.5 6
5.8
4
5.6
3.5 Sagittal Coronal
Axial 5.4 Axial
3 5.2
0 20 40 60 80 100 120 0 20 40 60 80 100 120
AGE AGE
15 3.8
3.6
3.4
3.2
3
CrT
TH
10
2.8
2.6
2.4
Sagittal Sagittal
Coronal 2.2 Coronal
5 2
0 20 40 60 80 100 120 0 20 40 60 80 100 120
AGE AGE
12
11
10
9
8
PH
7
6
5 Sagittal
Coronal
4
0 20 40 60 80 100 120
AGE
FIG. 4.4 Growth curves of indirect primary tooth measurements (LL, MD, TH, CrT and PH).
delivery with a statistical significance between all birth panoramic and cephalometric are valuable sources of inves-
conditions (p<0.001), where the NL from infants experienc- tigation. Figure 4.9 shows the identification of an extracted
ing a normal vaginal birth was thicker than those from cesar- maxillary canine tooth root and the edentulous maxilla via
ean cases and was not present in stillbirths (seeFig.2.9).41 X-ray image, after macroscopic examination. In this phase of
a forensic investigation, a forensic odontologist should pre-
fer to work with one of the advanced techniques. Figure4.10
Indirect Identification from Permanent Teeth shows the microscopic image of the root of a maxillary
Indirect dental identification from CT images of various canine tooth, where the age-dependent cement layers are
teeth, including incisors, canines, premolars and molars, has examined with the SEM technique.2
been studied frequently by researchers of the last decade for
age and gender determination (Fig. 4.54.8). It is known that
the reliability of these techniques depends considerably on AGE ESTIMATION SOFTWARE
the teeth variables, such as the correlation between the pulp
to tooth volume ratios. The biological age is strongest for the A special age estimation software program was written by
canine and third molars, but moderate for incisors and lower Ilcin ET with the authors, which encompasses all age estima-
premolars.5056 tion regression formulas derived from the direct and indirect
Generally, dental identification is performed on X-ray techniques by the authors for the fetus and infant age group.
images when the above mentioned advanced data are not The applications directions and installation instructions are
present. Radiographic views, such as periapical, occlusal, given in Appendix 1.
FIG. 4.5 Maxillary 346th and mandibular 281st CT sections.
FIG. 4.6 Cranium CT.

FIG. 4.7 Sign of artefacts showing the presence of a metallic structure on the teeth.
FIG. 4.8 Coronal, sagittal and axial sections of the cranium CT and the pulp measurements (MD, LL) from the dental structures.
FIG. 4.9 Identification from an X-ray image of an extracted maxillary tooth root and the maxilla.
FIG. 4.10 Identification from scanning electron microscope (SEM) image of the maxillary tooth
root.
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Glossary
Abrasion: non-functional wear. or experience in a particular subject, and whose opinion is
Accessional teeth: permanent molars, which do not replace trusted officially and legally within the scope of his/her
any primary teeth. expertise, and whose expert opinion is referred to.
Antemortem: before death. Fetus: development stage of a mammal after the embryonic
Artifact: artificially created manmade structures in biologi- stage and before birth.
cal tissues. Forensic: legal, related to or used in a court of law.
Attrition: functional, physiological wear. Forensic medicine (Jurisprudence medical): the branch
Autopsy: a specialized surgical operation for post mortem of medicine that applies science and medical knowledge to
external and internal examination of a corpse, to determine criminal and civil laws in a justice system.
the cause and manner of death and to perform identification Forensic odontologist: specially trained dentists, who are
techniques to find out the deceaseds identity. highly experienced in dental identification of unknown
Bell stage: the third dental developmental stage where the individuals, human remains or bite marks.
crown form is designated. Forensic odontology (Jurisprudence dental): the branch
Bite mark: a pattern created either by human or animal of dentistry that applies science and dental knowledge to
dentition. criminal and civil laws in a justice system.
Bud stage: the first developmental stage of the dental lamina, Impacted tooth: tooth located in the jaw and unable to erupt
which will later form a tooth. or take its normal position in occlusion.
Cadaver: corpse or dead human body. Incisor teeth: the four anteriorly located teeth, which are
Canine teeth: the longest, pointed tooth of the dentition, used for cutting and tearing food. There are two incisor tooth
used for shredding the food. There is one canine tooth per quadrant in both the primary and permanent dentition.
perquadrant in both the primary and permanent dentition. Intrauterine: located within the uterus (womb).
Cap stage: the second dental developmental stage, where Juvenile: young, teenager, adolescent.
the deepest part of the bud takes a concave form and then Law: a combination of rules and guidelines that conducts
transforms into a cap shape. and governs human behavior through social institutions and
Cremation: degrading and reducing dead animal or human legal systems.
bodies by burning in high temperatures (approximately at Mandibula: lower jaw bone.
9001200C). Maxilla: upper jaw bone.
Deceased: dead, no more living. Molar teeth: the most posterior teeth of the primary and
Deciduous dentition: also named as primary, temporary, permanent dentition with ridges and cusps on their o cclusal
transitory, milk or baby dentition. Primary teeth start to surfaces used for grinding food. There are two molars
develop in the fetus in the uterus and are shed before the per quadrant in the primary dentition but three molars
replacement of secondary permanent teeth. perquadrant in the permanent dentition.
Dental abrasion: non-functional wear of dental structures as Narrative report: descriptive report including all the data
seen in bruxsim. and the result of the findings of a case.
Dental attrition: functional wear, which happens at the Neonatal line: irregular band-type sign of a developmental
contact points of the teeth. birth defect.
Dental lamina: the first structure of the dental germ which Oral autopsy: a significant source of dental evidence, which
takes its origin from the embryonic oral epithelium, ectoderm. consists of examination and evidence collection from the oral
Dental papilla: originates from the mesoderm and forms the cavity of a deceased individual.
initial stage of the dentin and pulp tissues of the tooth. Oro-facial: pertaining to oral structures and face.
Dental sac, follicle: originates from the mesoderm, which Permanent dentition: secondary dentition.
will later transform to the cement, periodontal ligament and Post mortem: after death.
alveolar bone tissues of the dental structure. Prenatal life: intrauterine life.
Dentin (Dentine): one of the four components of a tooth Premolar teeth: also called bicuspids, located between the
along with enamel, cementum and pulp. It is a calcified tissue canine and molar teeth. There are two premolars per quadrant
which shields the pulp. It is covered with the enamel on the in the permanent dentition.
crown and cementum on the root. Primary dentition: temporary dentition.
Enamel: the hardest mineralized tissue of human body, Pulp: unmineralized component of a tooth, composed of
which is one of the four components of a tooth along with soft connective tissue and neurovascular elements in the pulp
dentin, cementum and pulp. chamber, which is located at the center of each tooth.
Expert witness (Professional witness, Judicial expert): Race: lineage, stock.
person who has education, training, specialized knowledge Shed: exfoliate.
310
Glossary 311
Successional lamina: the lingual extension of the dental Trial: examination of facts by a legal court.
lamina, which also grow in the sequence of a bud, cap and Toxic (Poisonous): a substance that causes any disturbance
bell stage and will finally produce the permanent incisors, in an organism.
canines and premolar teeth. Toxicity: the degree to which a substance can effect and
Successional (succedaneous) teeth: the permanent incisor, cause harm in an organism.
canine, and premolar teeth that replace the primary teeth. Verdict: the legal decision.
Supernumerary teeth: teeth in excess. Virtopsy: a combined term for virtual autopsy, which
Temporary teeth: deciduous teeth. defines reaching evidence from the digital images, instead of
Trait: special features, peculiarity, characteristics. traditional autopsy procedures.
Appendix 1
INSTALLATION AND USERS GUIDE The Age Estimation Program consists of three sections:
FOR AGE ESTIMATION SOFTWARE
Section I. Age Estimation Methods: the method of
Supported Operating Systems: Windows application obtaining tooth measurements is selected as Direct or
(Windows Server 2003, Windows Server 2008, Windows Indirect.
Vista, Windows XP, and Windows 7). If a later version is Section II. Variables: the values of various tooth measure-
not installed on your computer, please install the prerequi- ments taken from the same central tooth are entered in the
site components (in the Prerequisite Components folder) program.
prior to downloading this software. Thisprogram can be Section III. Result: in this section, the estimated age is
used after downloading and installing its setup file from calculated according to the age measurement method
the Downloads/Updates tab in the weblink below: and the selected variables. The age value is calculated in
http://goo.gl/sS37mJ accordance with 2 weeks.
Prerequisite Components: Microsoft. NET Framework
3.5 SP1, Windows Installer 3.1. The following points must be considered during the use of
To start the installation, please double-click the the program:
AgeEstimation.msi file. This will run the standard instal-
lation. Follow the instructions on the screen. The installer Use comma (,) instead of dot (.) for decimals of numbers.
will install the Age Estimation Software Program on your Reset before each new age calculation.
computer. The accuracy of the results depends on the number of
The interface of this Age Estimation Software program inserted data.
can be seen in Figure A.1. The age estimation result is valid up to 18 months postnatal.
For the indirect estimation method, either both LL and
TH or only TH must be entered.
AGE ESTIMATION from PRIMARY UPPER CENTRAL TOOTH DIMENSIONS

for FETUS AND INFANTS
AGE ESTIMATION METHODS (Please choose one):
I. DIRECT METHOD: TOOTH and / or HEAD MEASUREMENTS with GENDER
II. INDIRECT METHOD: TOOTH MEASUREMENTS from COMPUTERIZED TOMOGRAPHY
VARIABLES
Name Code Value
Labio Lingual (mm) LL :

Mesio Distal (mm) MD :
Crown Height (mm) CH :
Crown Thickness (mm) CrT :
Root Height (mm) RH :
Tooth Height (mm) TH :
Head Cricumference (mm) HC :
Gender (M/F) SEX : [Select]
Reset Calculate
RESULT
Name Code Value
AGE ESTIMATION AGE :
Attention please!
Use comma (,) instead of dot (.) for decimals of numbers.
Reset before calculation.
The accuracy of the results depends on the number of inserted data.
The age estimation result is valid up to 18 months postnatal.
Enter either both LL and TH or only TH for indirect estimation method.
Age estimation programme designed by; Tug Ilcin E, Aka PS, Yagan M, Canturk N, Dagalp R.
FIG. A.1 Interface of Age Estimation Software.
313
MEDICINE / DENTISTRY
PRIMARY TOOTH
DEVELOPMENT
IN INFANCY
A Text and Atlas
Primary Tooth Development in Infancy: A Text and Atlas describes the initial phase of
human dentition. It includes more than 1,500 photographs of fetal and infant teeth
up to the age of one year.
Steps in the developmental phases are presented in photographs accompanied by
concise explanatory text. Teeth are photographed from six different aspects: labial,
lingual, mesial, distal, incisal, and from the root direction. CT images are also included
in some cases.
Topics covered include morphology and development of primary dentition, discrimination
criteria for human dentitions, forensic importance of direct and indirect measuring
techniques, dental identification and age estimation from teeth, achieving dental
evidence from oral autopsy, and age estimation formulae. Also discussed is the neonatal
line concept of intrauterine life along with corresponding scanning electron microscope
photographs.
A supplementary software program for age estimation from dental measurements
can also be used in conjunction with the material in this text. Meticulously prepared
by a team of experts, this atlas is a valuable tool for odontologists, pediatricians,
pedodontists, forensic scientists, and dental anthropologists.
K23228
ISBN: 978-1-4822-3851-8
90000
9 781482 238518

Primary Tooth Development in Infancy

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Primary Tooth Development in Infancy

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PRIMARY TOOTH

P. Sema Aka Murat Yagan

No claim to original U.S. Government works

International Standard Book Number-13: 978-1-4822-3852-5 (eBook - PDF)

Chapter 1 Human Dentition and Notation................................................................................................................................ 1

Chapter 2 Photographing and Measuring Techniques for Dental Evidence........................................................................... 12

Chapter 3 Morphology and Development of Primary Dentition............................................................................................ 19

Chapter 4 Dental Identification and Age Estimation from Teeth......................................................................................... 295

FIG. 1.4 Eruption process of central teeth.

Palatinal 2nd Molar

FIG. 1.7 Labial view of primary dentition at age 5 years.

Labial Central Incisor

Occlusal 2nd Molar

MANDIBLE 1st Molar

period can also be observed in Chapter 3, which comprises

Permanent Central Incisor

Incisal Primary 1st Molar

FIG. 1.17 Maxillary and mandibular casts of mixed dentition.

FIG. 1.15 Occlusal view of mandibular permanent teeth.

FIG. 1.18 Labial view of mixed dentition, age 10 years.

FIG. 1.16 Panoramic X-ray image of permanent dentition,

and the early adolescent period, a period of active lifestyle

A human tooth is composed of four main tissues: the enamel,

Lower 3 1720 3 912 710

1 78 1011 Average life expectancy at birth across the member

Dentino-enamel Dental Pulp

Dental Supporting Structures

Table 1.2 Viohals FDI two-digit notation

Table 1.3 Akas modified two-digit notation

is 3 mm. The line that exactly lines up with the number on

Indirect Measuring Techniques

FIG. 2.3 Infinite background for dental photographing.

FIG. 2.4 Dental measurements with a digital Vernier caliper.

FIG. 2.5 Dental measurements with a standard Vernier caliper.

FIG. 2.6 Crown thickness measurement with a Fara Dental

FIG. 2.7 Direct head circumference measurement.

53, 52, 51 61, 62, 63 55, 54 64, 65

Table 3.2 Subsidiary dental classification based on the number of roots

53, 52, 51 61, 62, 63 55, 54 64, 65

Lingual Distal Incisal Mesial Labial

Labial Mesial Incisal Distal Lingual

FIG. 3.2 Morphology of primary dentition.

Table 3.4 Morphology of tooth 51 Right Upper/61 Left Upper

Conical single root that tapers to a blunt apex

Tooth structure gradually narrows from labial to palatinal aspect

Table 3.5 Morphology of tooth 52 Right Upper/62 Left Upper

Labio-lingual Mesio-distal Crown height Root height Tooth height

DIMENSIONS 4.8 mm 5.1 mm 5.6 mm 10.2 mm 15.8 mm

Incisal Circular than the central incisor

Permanent Calcification Crown completion Eruption Root completion

Lingual Distal Incisal Mesial Labial

Labial Mesial Incisal Distal Lingual

FIG. 3.3 Morphology of primary dentition.

Table 3.6 Morphology of Tooth 53 Right Upper/63 Left Upper

Labio-lingual Mesio-distal Crown height Root height Tooth height

DIMENSIONS 7 mm 7 mm 6.5 mm 12.5 mm 19 mm

Lingual Distal Incisal Mesial Labial

Labial Mesial Incisal Distal Lingual

FIG. 3.4 Morphology of primary dentition.

Table 3.7 Morphology of Tooth 54 Right Upper/64 Left Upper

Labio-lingual Mesio-distal Crown height Root height Tooth height

DIMENSIONS 8.5 mm 7.3 mm 5.1 mm 10.1 mm 15.2 mm

Distal Similar to mesial surface but smaller and more convex

Permanent Calcification Crown completion Eruption Root completion