J Forensic Sci, May 2014, Vol. 59, No.

3
doi: 10.1111/1556-4029.12404
CASE REPORT Available online at: onlinelibrary.wiley.com

ODONTOLOGY; ANTHROPOLOGY; PATHOLOGY/BIOLOGY

Luana D. M. Modesti,1 D.D.S.; Giovanni M. Vieira,2,3,4 D.D.S., M.Sc.; Malthus F. Galv~

ao,5
avio F. B. de Amorim,6,7 D.D.S., M.Sc., Ph.D.
D.D.S., M.D., M.Sc., Ph.D.; and Rivad

Human Identification by Oral Prosthesis

Analysis with Probability Rates Higher than
DNA Analysis

ABSTRACT: Several techniques are used to perform an appropriate and reliable human identification. Forensic dentistry has achieved great
relevance over the past years. The aim of this article is to report the method used for the identification of a male body found in the colliquative
stage of putrefaction. The identification of the victim was succeeded confronting the dental findings found in the corpse with the data present
on dental records provided by his dentist. The major elements for the identity′s recognition were a metal core and a prosthetic crown that were
being fabricated. These elements associated with the dental records were compelling for the elucidation of the case, and a positive body identi-
fication was achieved with high levels of probability. In the present case, cadaveric analysis of stomatognathic system structures achieved a
probability value higher than DNA identification techniques, emphasizing the importance of forensic dentistry.

KEYWORDS: forensic sciences, body identification, dental records, dental prosthesis, Forensic dentistry, dental chart

Forensic dentistry is one of the major specialties in forensic
sciences (1). Several valuable procedures are performed in this
area, such as examination of dental arches for identification of
putrified, mutilated, charred, and skeletonized human remains
(1,2); investigation of mass disasters through the analysis of the
complex stomatognathic system and its alterations (1–3); study
of bite marks on living individuals (interpersonal aggression,
sexual crimes, abuse), dead bodies (homicide) and as an aid in
an attempt to establish the identity of the perpetrator (1,2).
Dental examination is one of the methods routinely used in
forensic anthropology. It is usually applied with other biological
parameters in the process for human identification, for instance,
fingerprint analysis (4,5), iris (4,5) and genetic analysis (1,6). It
should be noted that the conditions in which an individual’s
body is found and their antemortem information determine the
method(s) to be employed (1,6). In this regard, access to detailed
1 examinations to determine the cause of death, the instrument
University of Planalto Central (UNIPLAC), SHIS, QI 07 Conjunto
10 Bloco E, Lago Sul Bras
ılia, Brazil.
2
Department of Orthodontics, Brazilian Dental Association (ABO-DF),
University of Bras
ılia (UnB), Bras
ılia, Brazil.
3
Department of Medical Sciences, University of Bras
ılia (UnB), Bras
ılia,
Brazil.
4
Department of Genomics Sciences and Biotechnology, University of
olica (UCB), Bras
ılia, Brazil.
Cat

5
Campus Darcy Ribeiro, Departamento de Medicina Legal, Faculdade de
Medicina, Universidade de Bras
ılia, Asa Norte, Bras
ılia 70910-900, Brazil.
6
Faculdade de Medicina, Department of Pathology, School of Medicine,
Brasilia, Brazil.
7
Department of Medical Sciences, University of Brasilia (UnB), Brasilia,
Brazil.
Received 4 June 2012; and in revised form 11 Jan. 2013; accepted
20 April 2013.
dental documentation and to complete dental records is a crucial
element in forensic analysis (4). Thus, it is important that the
dental documentation contains as much data as possible (1). The
aim of this article is to report the procedure utilized for a singu-
lar body identification based on the information contained in the
individual’s dental records, along with a prosthesis on which his
dentist was working.
Case Report
On January 16, 2007, the victim’s brother reported to the Fed-
eral District Civil Police, Bras
ılia-Brazil (PCDF), the finding of
a body near his residence, assuming that it was his relative who
had been missing for a week. After completion of initial on-site
forensic analysis, the complete body of a male at the end of the
colliquative stage of putrefaction and beginning of the stage of
skeletonization was verified (Fig. 1). The body was sent to the
Institute of Legal Medicine (IML-DF) for routine necroscopic
and/or means, time of death, and the victim’s identity.
A removable partial dental prosthesis was found in the maxilla
of the body. The analysis of the material revealed to be cobalt-
chrome prosthesis with an asymmetric palatal bar, replacing
teeth 16, 15, 14, 21, 25, and 26. The prosthetic element for tooth
21 was broken. In addition, tooth 13 had a temporary restoration
on the distal surface, and tooth 11, without a crown, had a tem-
porary filling, which showed sealed root canal and intraradicular
preparation (wasted axial wall of the canal and an bevel in the
cervical margin). The remaining teeth were in good general con-
dition. (Fig. 2) The odontologic analysis detected features sug-
gestive of dental treatment in progress. The brother confirmed
that the victim was undergoing dental treatment, taking the

© 2014 American Academy of Forensic Sciences 825

826 JOURNAL OF FORENSIC SCIENCES
FIG. 1––Analysis of the victim’s body.
(a)
(b)
FIG. 2––Front view of the upper jaw and occlusal.
forensic experts to meet his dentist. When contacted, the dentist
confirmed previous treatment of the supposed relative corpse,
thus allowing further investigations in the area. Unfortunately,
the dentist had no antemortem radiographs of the victim.
By means of a term of declarations and document collection,
the patients’s dental records containing the victim’s initial odon-
togram, a pink type IV dental stone model of the upper anterior
teeth with a cast metal core in copper–aluminum and a single
acrylic crown for the upper right central incisor were collected.
Among the forensic dental examinations, try-in of the cast metal
core in the intraradicular root canal of the body showed good
adaptation, and the anatomical coincidence between the plaster
model and the mandible and maxilla was total. Dental chart indi-
cated the treatments to be performed, and some of them were
executed. Note that there was no indication of treatments for the
missing teeth (Figs 3 and 4). Finally, a comparison was made
between the skull and the presented odontogram; the data are
shown in Table 1.
Considering that 1–5.8 06 = 0.999994 and taking into account
the occurrence of all of these features simultaneously, the proba-
bility that the body corresponds to that of our suspect is
99.9994%. Beyond the odontogram analysis, the body identifica-
tion was possible by the perfect match of the metal core and the
prosthetic crown in the tooth 11 of the found jaw. Ten aspects
of this adaptation were listed to perform statistical analysis. The
probabilities’ estimates of each aspects for the perfect match of
the metal cast core and prosthetic crown are shown in Table 2,
and accumulated estimation was calculated as 0.0000000001 or
99.99999999%. It must be mentioned that the value assigned to
EEP% less than 10% is an arbitrary value and is overestimated.
For the aspect “dimensions of the crown” the distal tooth was
used as a guideline to establish the buccal-lingual measurements
(since tooth 21 was missing). Thus, a positive body identifica-
tion was achieved with more than 99.9999999999999999999
99999% probability.
Discussion
The forensic literature reports that it is feasible to identify
charred, skeletonized, or decomposed individuals by analyzing
their dental peculiarities (1,6). The good results obtained in the
field of forensic dentistry are largely due to the fact that teeth
and dental materials are significantly resistant to climatic and
other adverse conditions (6,7). In addition, the information pres-
ent in the dental files of the physicians and dentists (dental
records, radiographs, plaster models, photographs, etc.) is extre-
mely valuable in identifying bodies. (1,2,6).
It is mentioned that, while comparing antemortem with post-
mortem records, some basic criteria should be followed, namely
presence of strong agreement, few relative points of disagree-
ment (<3), as well as proper documentation, completion and fil-
ing of dental records (8). During the first step of this
comparison, individualities’ aspects present in the jaws are con-
sidered, for example the presence and/or absence of teeth, resto-
rations (surfaces and materials), prosthesis, endodontic
treatments, diseases, and abnormalities among other aspects
(1,2). In the examination of dental documentation, data related
to the performed or planned treatment, which were registered in
the dental records by the clinician, are collected and associated
with the findings obtained from complementary examinations
(radiographs, photographs, models, among others) (1,2). The last
step consists of comparing the data collected in the two previous
stages, considering the same reference point (face, teeth, hemi-
arch), and it is based on a qualitative and quantitative analysis
of the dental peculiarities (1,2).
In our case, one of the major elements for the corpse identifi-
cation was the positive comparison at the region of tooth 11. It
 MODESTI ET AL.
(a)
(c)
FIG. 3––Photos of the adaptation of the core and crown in the maxilla, the plaster model and the dental chart.
was prosthetically prepared to receive a metal core and a crown
that had been made and was stored in his dentist’s office. It is
known that each cast metal post and core carries an individual
characteristic, according to the mold performed in the intraradic-
ular cavity previously prepared. The probability of adaptation of
a post and core in preparation different from its mold is remote.
Thus, it is coherent to infer that a well-fabricated intraradicular
cast post and core is a unique and nontransferable identity of the
prepared tooth.
The loss of dental structure combined with endodontic treat-
ment can affect the resistance of a tooth, requiring a single-unit
prosthesis, which demands the use of intraradicular retainer
(IRR) (9,10). IRR is responsible for retention of the final resto-
ration of the treated tooth and protection of the remaining
radicular structure. (9,10) The need for a retainer depends
exclusively on the amount of the remaining coronal dental
structure, which does not always offer the desired resistance.
(11,12) For proper retention of the restoration, the ideal length
of the retainer should measure at least 2/3 of the radicu-
lar length and be greater than or equal to the future crown
(9–11,13). With regard to such criteria, related to fabrication of
the prosthesis, the technical requirements were within the
appropriate standard in this case (9–13). Among the prosthetic
. HUMAN IDENTIFICATION BY ORAL PROSTHESIS 827
(b)
(d)
aspects of greater importance in the identification of this case
are the intra- and extraradicular morphology and dimension of
the post and crown, which includes marginal adjustments
(13,14).
Several antemortem (AM) and postmortem (PM) characteris-
tics were coincident, and an excluding feature was not found
during the analysis of the present case. Taken together, these
findings allow only to conclude that there is a high-level possi-
bility that the remains match the missing person. Unfortunately,
an international reliable system or recognized tool that can pre-
dict the exact probability for human identification based on den-
tal findings does not exist yet. To assess the approximate
probability of identification, we have analyzed the probability of
each match found. It is known that the probability of occurrence
of multiple independent aspects is equal to the product of each
separate probability (p = p1 9 p2 9 p3…pn). Applying this
mathematical principle in human identification, the probability
rate will be as higher according to the number of rare and singu-
lar features. However, based on a mathematical principle, it is
impossible to reach a rate of 100% of probability as the product
of infinite numbers close to zero, as an example, only tends to
get closer to the number zero without reaching it. A critical
trouble is the lack of statistical data for the various dental
828 JOURNAL OF FORENSIC SCIENCES

TABLE 2––Statistical analysis of the metal core and crown fit at tooth 11.
(a)
Aspects EEP%* EEP/100† CPM‡
Metal core length <10 0.1 0.1
Mid-distal dimension of the metal core <10 0.1 0.01
Vestibulo-palatal dimension of the <10 0.1 0.001
metal core
Taper of the metal core <10 0.1 0.0001
Form of the metal core support <10 0.1 0.00001
Dimensions of the metal core support <10 0.1 0.000001
Dimensions of the coronal part of <10 0.1 0.0000001
the metal core
Cervical fit of the crown on the teeth <10 0.1 0.00000001
Dimensions of the crown <10 0.1 0.000000001
Proximal contact of the crown <10 0.1 0.0000000001
*Estimated probability in general population (EPP).
†
Estimated probability in general population/100 (EPP/100).
‡
Cumulative probability for matching (CPM).

(b)

survey conducted in Brazil with 12.811 people in 2002/2003

FIG. 4––Photos of mandible.
characteristics found. Thus, information about the dental status
of the Brazilian population was tracked to reach the most reli-
able parameter for an appropriate comparison. According to a
(15), 24% of people had between 4 and 8 missing teeth, 10%
between 16 and 20 missing teeth, and 9% had total absence den-
tistry. Therefore, based on the reported literature, we have estab-
lished an overestimation value higher than the expected. As an
example, the presence of a silver amalgam restoration in the
lower right first molar is certainly much <50% in the Brazilian
population (15). Consequently, we used a probability below
80% to avoid errors and eliminate the influence of interdepen-
dence of the various characteristics, as the probability of the
presence of a restoration at any given tooth is larger in the group
of people who have another tooth restoration than another, rela-
tive to the general population.
Giving support to our analysis, it is relevant to mention a
regional study performed at the southeast of Brazil, which used
the criteria of DMFT (decayed, missing, filled teeth) to investi-
gate the frequency of caries and loss of the first permanent
molars. The sample was aged between 6 to 18 years, and the
results revealed that 77.82 of the first permanent molars were
restored, 22.18 of decayed teeth, in a total of 239 first perma-
nent molars (16). A more relevant study conducted in 2003

TABLE 1––Comparison of the odontogram and the remains.

Tooth Odontogram Body EEP%* EEP/100† CPI‡

18 Occlusal rest Occlusal caries lesions 80 0.8 0.8
17 Occlusal rest Occlusal caries lesions 80 0.8 0.64
17 Vestibular and cervical rest Initial vestibular caries lesion 80 0.8 0.512
13 Endodontic treatment Endodontic treatment 20 0.2 0.1024
13 Distal–palatal restoration Zinc oxide–eugenol distal–palatal temporary restoration 30 0.3 0.03072
11 Endodontic treatment Endodontic treatment in progress 20 0.2 0.006144
11 Metal core Intraradicular preparation for cast metal core 20 0.2 0.001229
11 Fixed single-unit crown Need for fixed crown 20 0.2 0.000246
22 Restoration of mesial–incisal angle Mesial–incisal caries lesion 30 0.3 7.37 05
38 Occlusal restoration Occlusal zinc oxide–eugenol temporary restoration 80 0.8 5.9 05
36 Mesial–occlusal restoration Mesial–occlusal amalgam restoration 80 0.8 4.72 05
35 Distal–occlusal restoration Missing tooth – graphical note probably refers to the adjacent 80 0.8 3.77 05
tooth 34, with distal–occlusal restoration of photopolymerizable resin
44 Cingulum restoration Cingulum restoration of photopolymerizable resin 30 0.3 1.13 05
45 Distal–occlusal restoration Distal–occlusal caries lesion 80 0.8 9.06 06
46 Occlusal restoration Occlusal caries lesion 80 0.8 7.25 06
48 Occlusal restoration Occlusal caries lesion 80 0.8 5.8 06
*Estimated probability in general population (EPP).
†
Estimated probability in general population/100 (EPP/100).
‡
Cumulative probability for identification (CPI).
 MODESTI ET AL.
showed that the average DMFT/dmft index was found to be
2.78 at 6 years old, which increased to 20.13 in the 35–44
years old (17). The high rate of permanent first molars in this
age group of the population (35–44 years) coincides with the
age of the individual identified reported in this article, which
led us to corroborate our previous estimate value of EEP%
around 80.
Likewise, statistical analysis of all forensic dental features of
the odontogram leads to the basically unequivocal inference that
the body found in fact belongs to the missing individual in ques-
tion. In other words, just the comparison of the odontogram pro-
vided by the dentist with the bones resulted in an identification
probability higher than 99.9994%. Considering only the evalua-
tion criteria related to a perfect fit of the post and core and of
the crown, the identification probability is much higher than
99.99999999%.
Following the same reasoning used for the coincidences
found between the teeth of the plaster model and the teeth of
the skull, we could list more than 10 features with occurrence
lower than 10%, that is, the identification probability by com-
parison of the plaster model is greater than 99.99999999%.
Therefore, considering the dental characters only, the probability
of positive identification is the sum of the three percentage
values found above, that is, higher than 99.9999999999999999
99999999%.
Biostatistical probability of DNA paternity was calculated to
exceed 99.9999% in our case when comparing DNA genetic
profiles of bone remains with living relatives (brothers, sisters,
sons, daughters, nephews, or cousins) Some authors have consid-
ered for a correct and definitive identification probabilities rang-
ing from 99.9% to more than 99.999999% (18). In the present
case, the estimated probability reached a high rate taking into
account only the dental parameters. Thus, it is reasonable to
infer that in some situations, cadaveric analysis of stomatogna-
thic system structures can achieve a probability value more reli-
able than DNA identification techniques, emphasizing their
importance in the forensic medical exam.
According to the records, the cause of the death was falling
from a high place onto a rocky slope. The only lesions found
were fractures in the distal epiphysis of the right tibia, not fatal.
After assessment, the likely hypothesis for the death was closed
head trauma, consistent with the records and preliminary exam-
inations. The thanatognomonic study demonstrated time compati-
bility between the state of the bones and the time of
disappearance, considering the weather at that time.
Conclusion
To sum up, it can be mentioned that, depending on the avail-
ability of antemortem and postmortem information, forensic den-
tistry has the potential to provide high rates of identification
probability. In some cases, the probability value can be greater
than that of DNA analysis. However, more research and data
collection are necessary to establish a reliable system or proce-
dure using the dental identification as the major evidence for
human identification.
The author has requested enhancement of the downloaded file. All in-text references underlined in blue are linked to publications on ResearchGate.
. HUMAN IDENTIFICATION BY ORAL PROSTHESIS 829
Acknowledgment
The authors would like to thank for the valuable contribution
of the Institute of Legal Medicine of the DF, Federal District
Civil Police, Bras
ılia-Brazil.
References
1. Pretty IA, Sweet D. A look at forensic dentistry Part 1: the role of teeth
in the determination of human identity. Br Dent J 2001;190:359–66.
2. Avon SL. Forensic odontology: the roles and responsibilities of the
dentist. J Can Dent Assoc 2004;70(7):453–8.
3. Pretty IA, Webb DA, Sweet D. The design and assessment of mock mass
disasters for dental personnel. J Forensic Sci 2001;46:74–9.
4. Watson A. Biometrics: easy to steal, hard to regain identity. Nature
2007;449:38–40.
5. Nadarajah M, Celalettin T, Azad N, Shahzad M. Fingerprint biometric
for identity management. Int J Ind Eng Manag 2011;2:39–44.
6. Pretty IA. Forensic dentistry: identification of human remains. Dent
Update 2007;34(10):621–2, 624–6, 629–30.
7. Kalpana AP, Rajkumar P, Sangeeta W. Effects of high temperature on
different restorations in forensic identification: dental samples and mandi-
ble. J Forensic Dent Sci 2010;2(1):37–43.
8. Acharya AB, Taylor JA. Are a minimum number of concordant matches
needed to establish identity in forensic odontology? J Forensic Odonto-
stomatol 2003;21(1):6–13.
9. Heydecke G, Peters MC. The restoration of endodontically treated, sin-
gle-rooted teeth with cast or direct posts and cores: a systematic review.
J Prosthet Dent 2002;87(4):380–6.
10. Tang W, Wu Y, Smales RJ. Identifying and reducing risks for potential
fractures in endodontically treated teeth. J Endod 2010;36(4):609–17.
11. Goodacre CJ. Five factors to be considered when restoring endodonti-
cally treated teeth. Pract Proc Aesthet Dent 2004;16(6):457–62.
12. V^arlan C, Dimitriu B, V^arlan V, Bodnar D, Suciu I. Current opinions
concerning the restoration of endodontically treated teeth: basic princi-
ples. J Med Life 2009;2(2):165–72.
13. Baba NZ, Goodacre CJ, Daher T. Restoration of endodontically treated
teeth: the seven keys to success. Gen Dent 2009;57(6):596–603; quiz
604–5, 595, 679.
14. Nissan J, Dmitry Y, Assif D. The use of reinforced composite resin
cement as compensation for reduced post length. J Prosthet Dent
2001;86(3):304–8.
15. Barbato PR, Nagano HCN, Zanchet FN, Boing AF, Peres MA. Tooth
loss and associated socioeconomic, demographic, and dental-care factors
in Brazilian adults: an analysis of the Brazilian Oral Health Survey,
2002-2003. Cad Sa
ude P
ublica 2007;23(8):1803–14.
16. Coser MC, Coser MR, Chiavini P, Boeck EM, Vedovello S, Lucato AS.
Frequency of caries and lost of the first permanent molar. RGO 2004;53
(1):1–84.
17. Brasil, Minist
erio da Sa
ude – Coordenacß~ao Nacional de Sa
ude Bucal.
Condicß~oes de sa
ude bucal da populacß~ao brasileira – Projeto SBBrasil
2003 –Resultados Principais, Capturado em abril de 2004; http://portal.
saude.gov.br/saude/arquivos/pdf/relatorio_brasil_sorridente.pdf.
18. Nakamura H, Yuasa I, Umetsu K, Henke J, Henke L, Nanba E, et al.
Molecular analysis of the human orosomucoid gene ORM1*Q0k€oln
responsible for incompatibility in a German paternity case. Int J Legal
Med 2000;114(1–2):114–7.
Additional information and reprint requests:
Malthus Fonseca Galv~ao, D.D.S., M.D., M.Sc., Ph.D.
Department of Forensic Medicine
Campus Darcy Ribeiro, Departamento de Medicina Legal
Faculdade de Medicina
Universidade de Bras
ılia (UnB)
Asa Norte - Bras
ılia-DF 70910-900
Brazil
E-mail: malthus@malthus.com.br