Legal Medicine 32 (2018) 37–42

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Legal Medicine
journal homepage: www.elsevier.com/locate/legalmed

Short Communication

Analysis of forensic odontological examinations at the National Forensic T

Service of Korea from 2011 to 2015
⁎
Byung-Yoon Roha, Won-Joon Leeb, Jeong-Uk Seoa, U-Young Leec, Sang-Seob Leea,
a
Section of Forensic Odontology, Medical Examiner’s Office, National Forensic Service, 10, Ipchun-ro, Wonju, Gangwon-do, Republic of Korea
b
Department of Forensic Medicine Investigation, National Forensic Service Seoul Institute, 139, Jiyang-ro, Yangcheon-gu, Seoul, Republic of Korea
c
Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, 222, Banpo-daero Seocho-gu, Seoul, Republic of
Korea

A R T I C L E I N F O A B S T R A C T

Keywords: The National Forensic Service (NFS) of Korea is a government agency responsible for examining and evaluating
National Forensic Service evidence obtained at crime scenes. The Section of Forensic Odontology of the Medical Examiner’s Office con-
Forensic dentistry ducts forensic odontological analyses of human remains, and mainly criminal cases are handled. In this study,
Age determination by teeth 588 forensic odontological cases referred to NFS during 2011–2015 were analyzed for referral pattern, evidence
Human Identification
material, examination criteria, and other factors and were compared with respective data from 2007 to 2010.
Majority of the requests were internal (further dental examinations after autopsy) rather than external (direct
requests from other agencies such as police departments). Regarding evidence materials, “Teeth” (including
teeth and resected jaws) were dominant evidences. Due to the seasonal effects in Korea, the highest number of
requests was in September of each year, but the number of requests in April has recently increased. Evidence
materials were mostly found in suburban and rural area, especially in mountainous area due to the geographic
characteristics of Korea. Regarding specific examinations, profiling, including age estimation, accounted for
majority of the requests; this number had increased relative to the findings of a previous study, whereas the
number of requests for dental identification and bite mark analysis had decreased. With this analysis, trends in
forensic odontology can be observed, and we expect that these trends would be served as a reference for de-
signing study and making training protocol for forensic odontology.

1. Introduction
The Fédération Dentaire Internationale defines forensic odontology
as the branch of dentistry that, in the interest of justice, deals with the
proper handling and examination of dental evidence and the evaluation
and presentation of dental findings [1].
Tooth enamel is the hardest substance in the human body and is
highly resistant to decomposition, water immersion, fire, etc. [2]. The
presence, arrangement, shape, and restoration of teeth are character-
istic of individuals and thus useful in forensic odontological examina-
tions to identify individuals particularly in the event of massive ca-
sualties [3–6]. Age estimation using teeth shows high accuracy;
therefore, forensic odontology has been widely used in age estimation
[7–10]. Moreover, with the increasing trend of immigration around the
world, forensic odontology has been widely applied to estimate the age
of immigrants [11–15].
The National Forensic Service (NFS) was established to conduct
forensic analysis and research crime evidence in 1955 and is now
affiliated with the Ministry of the Interior and Safety of Korea. NFS
conducts most forensic examinations of criminal cases in Korea. The
Section of Forensic Odontology of NFS was established in 1969 to
conduct dental examinations of crime evidence. The Section of Forensic
Odontology is usually responsible for identification, age estimation, and
bite mark analysis as well as for forensic anthropological examinations
[16].
In 2011, Lee et al. [17] analyzed forensic odontological cases re-
ferred to NFS from 2007 to 2010. They reported majority of their ex-
amination was “postmortem profiling” and proposed multi-team ap-
proach in examination, education of law enforcement personnel and
making antemortem database for improving the quality and quantity of
forensic dental analysis. There are some researches that analyzed au-
topsy cases [18,19], but no report that analyze forensic odontological
examinations, especially performed at national level, was published
internationally. This study, which is a succeeding research of Lee et al.’s
study (2011), analyzed forensic odontological cases from 2011 to 2015
referred to NFS. With comparing the present data with those from 2007

⁎
Corresponding author.
E-mail address: sslee1418@gmail.com (S.-S. Lee).

https://doi.org/10.1016/j.legalmed.2018.02.007
Received 28 October 2017; Received in revised form 22 February 2018; Accepted 26 February 2018
Available online 02 March 2018
1344-6223/ © 2018 Elsevier B.V. All rights reserved.
B.-Y. Roh et al.
Fig. 1. Origins of requests of cases (Internal request means the request from other departments in NFS after autopsy, while external request means the request directly from police
departments or prosecutor). (A) Distribution of origins of request in 2011–2015 (n = 588). (B) Comparison of the percentage of origins of requests in 2011–2015 (n = 588) with the
results in 2007–2010 (n = 502) [17].
to 2010 [17], we attempted to observe and confirm trends of practical
cases in forensic odontology.
2. Materials & methods
All materials analyzed in this study were submitted to the Section of
Forensic Odontology from 2011 to 2015 as evidence in suspected
criminal cases, mainly those involving unidentified bodies, especially
skeletonized remains. Materials from a total of 588 cases were ex-
amined, and the results were compared with those of Lee et al.’s study
(2011) [17]. The examined data of the evidence materials included the
origin of request, yearly and monthly distributions, regional distribu-
tion, types of evidence, discovery locations, requested examination
criteria, and examination results. With regard to annual and monthly
distribution, Mann–Whitney test was conducted to compare annual
distribution and monthly distribution between 2007–2010 and
2011–2015 using SPSS software (ver. 23.0; SPSS Inc., Chicago, IL,
USA).
Among 588 cases, three cases consisted of evidences from two in-
dividuals. Therefore, when analyzing the examination results, each
evidence in these cases was regarded as an independent material. And
six cases were identified by fingerprint and DNA analyses during ex-
aminations, and forensic dental analyses of these cases were not com-
pleted. Therefore, they were excluded from the analysis of examination
results, but these cases were included for analysis of referral pattern
only.
2.1. Origins of request
The origins of request were classified as either “internal” (from
other departments in NFS for the purpose of further dental examination
after autopsy) or “external” (directly from police departments or pro-
secutors).
2.2. Types of evidence materials
The evidence materials were categorized as one of four types:
“Teeth”, “Bone”, “Bone and Teeth”, and “Other”. The categories
“Teeth” included loose teeth and resected jaws. “Bone” included ske-
letal remains, with the exception of skulls with teeth. If examinations of
teeth and bone were both requested, the material was classified into
“Bone & Teeth” categories. Likewise, for examinations of a skull with
teeth, the material was also classified into “Bone & Teeth” categories.
The category “Other” included bite marks and dental records (i.e.,
dental charts, insurance information, and X-ray images). The dental
evidence was separately subdivided in terms of type of material.
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Legal Medicine 32 (2018) 37–42
2.3. Yearly and monthly distributions
The yearly and monthly distributions were classified according to
the date of request.
2.4. Regional distribution
The regions where the evidence was found were classified based on
police districts.
2.5. Discovery locations
The locations of the recovered evidence were classified as ground or
water. Ground was classified as mountains, buildings, flat land (i.e.,
roadside, paddy fields, etc.), and other (i.e., automobiles). Water was
classified as either freshwater or saltwater. Water tanks and other lo-
cations were classified as other.
2.6. Requested examination criteria
The criteria of the requested examinations were classified as dental
identification, bite mark analysis, or postmortem biological profiling,
such as estimation of age, sex, and/or stature.
2.7. Examination results
The distributions of age and sex according to the examination re-
sults were analyzed.
3. Results
The examination objects were mostly unidentified bodies, especially
skeletonized remains. Most cases were internally referred for further
examination after autopsy (447 cases), while there were significantly
fewer cases that were directly referred from requesting agencies, such
as police departments (141 cases; Fig. 1-A). Compared with the pre-
vious study [17], internal requests increased from 54.5% to 77.0%
(Fig. 1-B).
The yearly distribution of requests from 2011 to 2015 is shown in
Fig. 2-A with the result of previous study (Fig. 2-B) [17]. The number of
case requests increased in 2011 and 2012, decreased in 2013 and 2014,
and recovered in 2015. The number of annual requests were similar to
those in the past [17] (p = 0.556, > 0.05).
The monthly distribution of the accumulated requests from 2011 to
2015 is shown in Fig. 3-A with the data in 2007–2010 (Fig. 3-B) [17].
From 2011 to 2015, cases were mainly commissioned in April (11.9%)
and September (14.6%), with few in the winter season (December to
B.-Y. Roh et al. Legal Medicine 32 (2018) 37–42

Fig. 2. Yearly distribution of requested cases. (A) Yearly distribution of cases referred in 2011–2015 (n = 588). (B) Comparison of the average of number of cases referred in 2011–2015
with those in 2007–2010 [17].

February). Compared to Lee et al.’s study [17], the monthly requests Table 1
increased significantly in April (p = 0.016, < 0.05) from 6.37% to Number and percentage of type of evidence in 2011–2015 compared with the results in
11.90% (Fig. 3-B). 2007–2010 [17].

The most common examination materials were “Teeth” (273 cases), Types of Evidences Number of cases
followed by “Teeth and Bones” (250 cases). The materials of relatively
few cases were only “Bone” (47 cases). Compared with previous studies, 2011–2015 2007–2010
the requests of “Teeth” increased from 37.65% to 46.43% (Table 1).
Bone 47(7.99%) 47(9.36%)
When the dental evidence was classified separately in detail, ex- Teeth 273(46.43%) 189(37.65%)
amination of the entire skull containing the mandible of the skeleto- Bone & Teeth 250(42.52%) 239(47.61%)
nized body was most commonly requested (147 cases), followed by Other 25(4.25%) 27(5.38%)
resected both jawbones (117 cases). Requests for examination of loose Total 588 502
teeth (31 cases) and bite mark analysis (5 cases) were relatively few.
Some dental records (19 cases) for identification purposes were com-
missioned. With regard to the criteria of the examinations, most requests were
Most requests originated in the regions of Gyeonggi-do (24.7%), for postmortem profiling (age, sex, and stature estimation) of uni-
followed by Incheon (12.2%), Seoul (10.4%), Jeollanam-do (8.3%), dentified bodies (94.0%; Fig. 4-A), and compared with the results from
Gangwon-do (7.5%), and Gyeongsangbuk-do (7.1%), while few re- 2007 to 2010 (84.5%) [17], the number of requests has considerably
quests originated in Busan (2.7%) and Ulsan (0.3%). The proportions of increased in 2011–2015 (Fig. 4-B). In particular, most requests were for
requests from metropolitan cities (Seoul, Incheon, Gwangju, Daejun, age estimation with few requests for identification using dental records
Daegu, Ulsa and Busan) were 28.9%, and those from small- and (3.4%), and those for bite analysis were very rare (0.9%; Figs. 4 and 5).
medium-sized cities, suburban, and rural area were 71.7%. The requests Requests to determine the cause of death (3.1%) and postmortem in-
(28.9%) from metropolitan cities in present study slightly decreased terval (4.0%) were very rare, as were commissions for differentiation of
compared to those in 2007–2010 (34.4%). [17]. human from animal bones (1.4%; Fig. 5).
Regarding the location of found evidence, 348 cases were recovered Among the examination results, the estimated age was 40–49 years
from the ground and 186 from the water. Among the materials found on in 32.7% of cases and 50–59 years in 28.4%. More than 50% of the
the ground, 195 were recovered from mountains, with a similar number identification results were for bodies aged 40–59 years and this pro-
found on flat land and in buildings. In many cases, the material was portion was similar to that in the results from 2007 to 2010 (54.8%;
exposed on the surface rather than buried. Among the bodies found in Fig. 6-A). Among the requests for sex discrimination, 83.5% of cases
water, most were recovered from the sea (126 cases). were identified as males and 16.5% as females. Identification of males

Fig. 3. Monthly distribution of the accumulated cases. (A) Monthly distribution of the accumulated cases in 2011–2015 (n = 588). (B) Comparison of the proportion of monthly
distribution in 2011–2015 (n = 588) with those in 2007–2010 (n = 502) [17].

39
B.-Y. Roh et al.
Fig. 4. Examination criteria (“Profiling” means that cases without antemortem records were requested for age/sex/stature estimation, whereas “Identification” means that cases with
antemortem data were requested to compare between antemortem and postmortem data). (A) Distribution of the examination criteria in 2011–2015 (n = 588). (B) Comparison of the
proportion of examination criteria in 2011–2015 with the data in 2007–2010 (n = 502).
was fivefold greater than that of females, and compared to past studies
(77.2%) [17], it had slightly increased (Fig. 6-B).
4. Discussion
This study analyzed cases referred to the Section of Forensic
Odontology of NFS from 2011 to 2015 and compared it with the results
from 2007 to 2010 [17]. A total of 588 cases were examined and most
materials were from suspected crime victims, as NFS of Korea mainly
handles evidence in criminal cases. When there is a need for the esti-
mation of a living individual’s age in South Korea, the estimation is
usually performed at a university dental hospital. Furthermore, in South
Korea, there are fewer requests for the identification of immigrants and
refugees compared with European countries [20–23].
Regarding the origin of requests, there were many internal requests
(77.0%; Fig. 1). In the past, skeletonized bodies were often directly
referred to the Section of Forensic Odontology for identification pur-
poses from requesting agencies. However, the number of internal re-
quests has recently significantly increased because the perception of
bone evidence by police departments has changed from being con-
sidered as examination materials to now being regarded as human
bodies. The increase in the number of autopsies in Korea may have also
contributed to this increase. Meanwhile, regarding types of evidence
materials, most of the evidence was “Teeth,” and due to the increase in
the number of autopsies, the proportion of “Teeth” has increased and
Fig. 5. Distribution of the proportion of the requested examinations according to their type in 2011–2015 and comparison with the results in 2007–2010 (The examination types were
overcounted when multiple referrals are made in a case).
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Legal Medicine 32 (2018) 37–42
there were many resected maxilla and mandible. However, entire skulls
were also frequently commissioned for forensic odontological and an-
thropological examinations. Considering the routes of requests and
types of evidence materials, for an accurate and effective forensic
odontological examination, close cooperation with the other forensic
experts, especially forensic anthropologists as well as forensic pathol-
ogists, is needed. It is also important to share information about the
examination methods with other forensic experts.
With regard to yearly distribution, there was no significant differ-
ence between the present and previous study [17]. However, a slight
decrease in the number of cases occurred in 2013 and 2014, which may
have been due to some confusion caused by relocation of the NFS head
office from Seoul to Wonju. In 2015, the number of examinations re-
turned to the previous levels (Fig. 2). The increase in the number of
examinations conducted in 2015 was also likely influenced by the in-
crease in the number of autopsies after the identification case of Yoo
Byung-eun, who was the de facto owner of the ferry MV Sewol, which
sank in April 2014. After the accident, he went into hiding and was
found dead 2 months after his disappearance. There were strong doubts
about his identity and cause of death, which caused severe social con-
fusion [24]. After that case, the police department decided to refer all
decomposed and skeletonized remains to NFS for autopsy; thus, there
was a great increase in the number of autopsy and forensic odontolo-
gical cases. Regarding monthly distributions, the distribution of
monthly examinations was high in the warm season. Two peaks in the
B.-Y. Roh et al.
Fig. 6. Distribution of estimated ages (separated in eight different age groups) and sexes. (A) Percentage of estimated age in 2011–2015 and comparison with the results in 2007–2010
[17]. (B) Percentage of estimated sexes in 2011–2015 compared with the results in 2007–2010 [17].
number of cases occurred in April and September from 2011 to 2015,
suggesting that more cases tended to be requested in the spring and
autumn when many people participate in outdoor activities, which is
likely to increase the chance of coming across skeletal human remains
(Fig. 3). Compared with the results from 2007 to 2010, in spring,
especially in April, requests increased considerably. It is considered that
a relatively small number of requests in April from 2007 to 2010,
particularly in 2009 and 2010 caused this result. Further observation
will be needed to clarify this tendency. On the contrary, there were
fewer requests in the winter season from November to February when
outdoor activities are more commonly avoided. Annual and monthly
statistics are considered to be a reference for effectively allocating
manpower and resources to efficiently perform forensic dental ex-
amination.
Regarding regional distributions, although metropolitan cities
(Seoul, Incheon, Gwangju, Daejun, Daegu, Ulsa and Busan) have large
populations and high population densities, the proportion of requests
from these areas was relatively lower than those from other regions.
This is due to the high population density and many developments in
metropolitan cities, which suggests that the frequency of discovering
skeletonized remains is lower. Because suburban and rural areas have
relatively lower population densities and have more mountains and
fields, it is more likely that severely decomposed bodies are discovered.
It is believed that manpower should be deployed to take into con-
sideration regional distribution for effective examination.
Meanwhile, the discovery location of evidence materials was mainly
mountains. This is related to the geographical characteristics of Korea,
since more than half of the terrain is mountainous and abandoning a
dead body or committing a homicide or suicide in such remote areas is
not uncommon. Because remains in mountainous areas are usually
found too late, they are often badly decomposed or skeletonized.
Therefore, the proportion of requested examinations from mountainous
areas seems to be relatively higher than that from other locations. This
is similar with the result of the previous report [17]. Since evidence
materials were collected mostly in mountainous areas, it is believed
that training is required for more accurate collection.
As a result of age estimation and sex determination, most remains
were from bodies aged from 40 to 50 years with a much greater per-
centage of males. These results were consistent with the gender and age
of suicide and murder victims in Korea [25]. In these days, age esti-
mation with dental developments in various demographic groups is
actively being studied, but these results suggest that more research
about age estimation for adult group including the elderly is also ne-
cessary to increase the accuracy of estimation.
With regard to the criteria of the requested examinations, the pro-
portion of requests for profiling, such as age estimation, was over-
whelmingly high (94.0%), while requests for dental identification were
few (3.4%) and those for bite mark analysis were very rare (0.9%).
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Legal Medicine 32 (2018) 37–42
Compared to the results of a past study (84.5%) [17], this tendency has
been intensified. The decrease in dental identification is considered to
be due to the fact that DNA matching is mainly performed for human
identification and regarded as the first choice in Korea. DNA analysis
provides quantitative results, and it is easy for police, lawyers, and
general public to understand. In Korea, the cost of DNA analysis in
criminal cases is borne by the government. Moreover, the process for
collecting evidences is relatively simple for the police in Korea. Ac-
cording to “Medical Service Act” of Korea, medical information, in-
cluding dental data, is regularly protected. The medical records can be
revealed only patients or their family with documents verifying that
they are their family. Even if the data will be used for the identification
practice, the only way to get dental information for non-family member
is getting warrant from court. It means it will take time to get dental
information from local clinic. However, the DNA sample can be ob-
tained more easily from family member. Therefore, it is assumed that
DNA analysis is widely used in Korea. We consider that this tendency is
similar to that in other countries. The tendency in examination criteria
in this study seems to suggest that future training and research in for-
ensic odontology should focus on profiling, especially age estimation.
5. Conclusion
The analysis of forensic odontological examinations in Korea
showed that forensic profiling, especially age estimation, of uni-
dentified bodies accounted for the overwhelming majority of cases and
even the proportion has increased more than the past. Such trends can
provide a good reference for designing study and making training
protocol to forensic odontologists.
Conflict of interest
The authors declare that they have no conflict of interest.
Acknowledgments
This work was supported by National Forensic Service
(NFS2016MED04), Ministry of the Interior and Safety, Republic of
Korea.
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