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POSTMORTEM DENTAL CHARTING • Charting of the dental structures is done after appropriate photographs, slides and videotapes are completed. POSTMORTEM DENTAL CHARTING 1. All existing dentition/missing dentition and restorations a. Include types of restorative materials and surfaces restored b. Include evaluation of periodontal status, calculus and stain c. Tipped, rotated, impacted/partially erupted teeth d. Determination of postmortem loss of teeth 2. Fixed, removable and implant prosthetics 3. Identifying marks on any removable prosthetics. 4. Occlusal relationship 5. Unique-intra-and interarch characteristics, including tori 6. Unique individual tooth characteristics 7. Radiographic interpretation from postmortem radiographs including: a. Presence of endodontic therapy b. Unique presentation of normal structures a. dilacerated roots, root morphology b. pulp stones, pulpal anatomy c. trabeculae, enostosis, exostosis d. sinus morphology 8. Photographic and videotape review 9. If indicated, dental impressions should be taken. Soft tissue abnormalities would be an indication for impressions. a. Use an ADA approved silicon impression material b. Pour in dental stone, NOT plaster c. Pour two sets of each impression d. Label each set with date, your name, case number and victim name e. Label to maintain the chain of evidence f. Keep the impression materials in their trays and with the models for future use. RESECTION AND DISSECTION TECHNIQUES • Remember to follow appropriate guidelines regarding blood borne pathogens and handling infectious diseased specimens when handling any human remains.
It is best to assume all deceased human remains are potentially infectious or biohazardous. • Proper use of gloves, gowns, masks and eye protection is indicated. RESECTION AND DISSECTION TECHNIQUES • When working on viewably indentifiable bodies, restricted opening due to rigor will require the utilization of methods to access the oral structures. • The dentition can be accessed by intraoral incision of the masticatory muscles, with or without fracturing of the condyles. • The rigor may be broken with bilateral leverage of the jaws in the retro molar pad area. • Removal of the tongue and/or larynx at autopsy may facilitate the visual examination of the teeth and placement of intraoral films. • When dealing with decomposed, incinerated or traumatized bodies, jaw resection facilitates dental charting, photographic and radiographic examinations. • Careful dissection of the incinerated head, in particular, is required to preserve fragile tooth structures and jaws. • Radiographs should be made prior to manipulation of badly burned fragments. • Mechanical or chemical stabilization of such tissues should be instituted where necessary. • When conducting a dental examination on skeletonized remains, it is usually not necessary to resect the jaws. • The mandible will usually separate from the base of the skull and a full visualization of the oral structures will be present. • With proper authorization, body parts may be resected, preserved and sent to other facilities for additional examination and testing. • If the remains are to be cremated and the body is still unidentified, preservation of the oral structures would be indicated. RESECTION AND DISSECTION TECHNIQUES Extraoral Incisions (facial dissection) • Extend bilateral incisions from the oral commisures to the body of the ramus on a line parallel with the plane of occlusion, through the masseter to bone. • Reflect the soft tissue for access and examination. Inframandibular Incision
Incise the skin inferior and medial to the mandible in a direction from the ear across the midline to the opposite ear. Reflect the tissue superiorly over the body of the mandible to expose the oral structures. This technique can be used for a viewable victim.
Jaw Resection • After the skin and tissues have been exposed and denuded, it is possible to remove the jaws. • Reflect all soft tissue, including muscle and oral mucosa to expose bone. • Then use a Stryker autopsy saw to make a cut on the ascending ramus of the mandible. • This will free the mandible from the skull except for the soft tissue attachments of the tongue and floor of the mouth. • The maxilla can be removed, if necessary, by making an incision in the most superior portion of the maxilla with the Stryker saw blade angled superiorly, again avoiding any impacted third molars. • Start in the most posterior superior part on one side of the maxilla and continue across the midline to the ending spot on the opposite side. • If a Stryker autopsy saw is not available, a mallet and chisel, a piano wire saw or pruning shears make suitable alternatives. The location of the cuts is the same. LABELLING AND PRESERVATION OF DENTAL EVIDENCE • Dental hard structures such as teeth and resected or fragmented jaw segments can be preserved in either 10% formalin or embalming fluid. • They must be placed in sealed and properly labeled containers. • The label must be such that it cannot be smeared, removed or fade over time. • it must include the case number, date and examiner bearing the responsibility for storing the specimen. • The preservation of soft tissue should not include storage in formalin or embalming fluid. • These fluids will cause desiccation and distortion of the tissues, as well as
dissolving pigmentation or blood by products in or under the epidermis. Depending on the environment, some pathologists simply freeze the soft tissue specimens.
be used) paper towels
a. pedestal (autopsy neck rest can b. modeling clay, waded up wet c. string or wax
LABELLING AND PRESERVATION OF DENTAL EVIDENCE Two such mixtures include: Two parts 5% acetic acid, four parts formaldehyde and four parts water. Place tissue is solution, then remove and wrap in towel of solution and store in a labeled ‘Ziplock’ freezer bag and freeze. Campden Solution – which is a fruit preservative available from a local chemist. Place tissue in the solution, remove and wrap in towel soaked in solution, place in a labeled ‘Zip-lock’ freezer bag and freeze. TECHNIQUES FOR POSTMORTEM DENTAL RADIOGRAPHY • Postmortem dental radiographs prove valuable in the comparison of evidence from a missing person’s dental records. • Best results are achieved when x-ray procedures are systematic and carefully done. • The goal of the forensic dentist is to produce x-rays of excellent quality and quantity. • When an investigation suggests a potential identity, that person’s antemortem radiographs should be evaluated as to type, angulation and content. • The postmortem radiographic effort should duplicate the antemortem record in this regard. TECHNIQUES FOR POSTMORTEM DENTAL RADIOGRAPHY BASIC EQUIPMENT AND SUPPLIES 1. X-ray radiation source 2. Film – use double film pack, if possible, and keep one set with your records. a. periapical/bitewing type film b. occlusal film c. lateral plate films of various sizes, including 5”x7”, 8”x10” 3. Film Developing Unit 4. Positioning aids for stabilizing dental remains to be radiographed
TECHNIQUES FOR POSTMORTEM DENTAL RADIOGRAPHY TECHNIQUE 1. Resected Jaws - position articulated or unarticulated jaws on pedestal to tube height. Secure film to teeth using clay or was and expose for either bitewing or periapical views at 10ma, 65-70Kvp for ¼ second. 2. Combination Periapical/Bitewing View (when jaws are not to be removed) – Make and incision in the tissue medial to the inferior border of the mandible. Slide an occlusal film up the lingual side of the teeth. Secure the film in place as noted above and expose at 10ma, 65-70 Kvp for ¼ - ½ second. This will make a periapical/bitewing film. 3. Skeletonized Remains, Jaw Fragments and Avulsed Teeth - articulate jaws and secure with clay. Slide film in as described in the combination PA/BW technique above. Individual avulsed teeth should be stabilized and laid on the x-ray film. Expose at 10ma, 65 Kvp for ¼ or less seconds. 4. Head In Rigor - use a lateral plate film and align tube in manner for taking a lateral jaw exposure. Expose at 10ma, 65-70 Kvp for 1 second. If using an intensifying screen, cut exposure time in half. 5. Panoramic Radiographs – Cover all surfaces on the machine with plastic wrap. Position head in the machine and secure it in place with clay and floss. Position the head so the Frankfort Plane is roughly parallel with the floor and expose film at 8ma and 80 Kvp. BURNED AND INCINERATED REMAINS • Verification of the identity of burn victims can be one of the more challenging cases for the forensic dentist. Much of the difficulty depends on the condition of the postmortem dental evidence and the quality and quantity of the antemortem information. • These are classified in four categories or degrees:
BURNED AND INCINERATED REMAINS 1. FIRST degree burns: These burns are superficial with n blistering. As primarily a vascular response, this burned area is swollen, red and painful. 2. SECOND degree burns: Some or most of the epidermis is destroyed; blistering does occur and scarring sometimes results. 3. THIRD degree burns: Both the epidermis and dermis are destroyed and the tissue undergoes massive necrosis. Pain is often absent due to destruction of nerve endings. Scarring always occurs. If the thermal injuries are extensive, this type of burn is always fatal. 4. FOURTH degree burns: Charring occurs with the total destruction of skin and underlying tissue. 5. “FIFTH” degree burns: Cremated remains. • Cremation involves the reduction of a normal adult body to two or three pounds of ashes. • These ashes contain recognizable human bone fragments. This reduction process takes approximately one to one and one half hours at constant temperatures of 870 – 980º C. BURNED AND INCINERATED REMAINS The required time for reduction may be shortened substantially in the frail elderly or infants and young children. This is due to the decreased calcification of tissue and the decreased density and mass of the individuals. Usually the forensic odontologist is called to assist in the identification of third, fourth and fifth degree burn victims because the destruction of tissue is extensive. This does not allow for identification by conventional means of visual recognition or fingerprints. Fortunately, the dental structures are remarkably resistant to thermal, traumatic and chemical insult. BURNED AND INCINERATED REMAINS
The severity of the burns depends on two variables: the intensity and the duration of the heat. These two factors may be influenced by many variables which include chemicals,
accelerants, insulators of varying types, location and the accessibility to oxygen. Chemical fires can quickly reach temperatures exceeding several hundred degrees Celsius. Depending on the supply of burning chemicals, these fires may continue to burn for hours. Victims caught in this type of fire may be classified as a fifth degree burn victim if the intensity of heat has been maintained over the required duration of time to cause complete reduction of human tissue. House fires generally have slowly rising temperatures until a flash point is reached. The fire then spreads rapidly to adjacent areas and reaches its highest temperature where the maximum amounts of fuel and oxygen are available. The maximum temperature that most house fires attain is 650º C. Seldom do house fires burn long enough to produce fifth degree burns. All other degrees, however, can be found. With the use of accelerants, this normal fire pattern is modified, prolonged and intensified. One study was done assessing and documenting the destruction of an adult body at a constant temperature of approximately 650º C. The following changes to the body over time were noted: after 10 minutes: the arms are badly charred. after 14 minutes: the legs are badly charred. after 15 minutes: bones are visible in the face and arms. after 20 minutes: the skull and ribs are exposed after 35 minutes: the bones of the upper and lower legs are exposed. The victim containing fourth degree burns over the entire body would appear with the following characteristics. There would be contractures of muscles due to the extreme heat. The characteristic appearances of fourth degree burning include a pugilistic attitude, with arms and legs bent and fists clenched. protruding tongue (due to contraction of facial and neck muscles) and pathologic long bone fractures.
BURNED AND INCINERATED REMAINS There may be substantial skin splitting and the build up of steam from internal fluids may result in rupture of the cranial vault and abdomen. If the extreme temperatures persist, the body is submitted to progressive desiccation and then carbonization. Heat also has an interesting effect on hair. At about 120º C, gray hair turns brassy blond; brown hair at about 93º C for ten to fifteen minutes turns a reddish hue and black hair remains unaltered with high temperatures. DENTAL EVIDENCE IN BURNED VICTIMS In most badly burned victims (third and fourth degree burns), we see a carbonization of the crowns of the anterior teeth. They are virtually unprotected while the posterior teeth, insulated by layers of skin, muscle and fatty tissue, remain unscathed and are usable for identification purposes. The effects of fire on the presence and condition of teeth can give the investigator an idea of attained temperatures. Other dental materials can also be indicators. The melting point of porcelain is 1232ºC. Amalgam and gold melt at 956ºC. Acrylic melts at a temperature of 600ºC. Prolonged fire may eliminate the soft tissue insulation of the posterior teeth. Evidence found at a scene may be fragmented anatomical crowns that have loosened from underlying dentin and root structure. The insulating factors of the bone and the relative temperature gradients between infra-bony and supra bony structures cause the fractures to occur. Rapid dehydration of the surface of the anatomical crown coupled with the expansion of the organic pulpal tissue water, increase the likelihood of the suprabony portion of the tooth loosening from the residual and infra-bony insulated root structure. Separated anatomical crowns can be identified.
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