Search

Age-at-death estimation is pivotal in the identification of unknown human decedents in forensic medicine. The pulp/tooth area ratio (PAR) method, assessing pulp cavity size as a marker of secondary dentine apposition, is widely utilised for adult age estimation. Despite extensive evaluation of this technique, the influence of image type and enamel area inclusion on method accuracy is insufficiently explored. The present study evaluated the PAR method's applicability using maxillary canines from a South African cadaveric sample, examining reliability, sex bias, and accuracy across different image types and enamel area considerations. An observational, cross-sectional study design was followed. Fifty-two adult maxillary canines were radiographed, sectioned, and analysed using stereomicroscopy. Labiolingual and mesiodistal periapical radiographs, alongside labiolingual stereomicroscopic tooth section images, were analysed using ImageJ to calculate PARs. Age estimation linear regression models were developed for each image type, with and without enamel area inclusion. Models were compared for performance and accuracy using best-subsets regression and cross-validation analyses. Results indicated that the PAR method is a reliable, sex-independent technique, providing relatively accurate age-at-death estimates for South African adults. Image type significantly influenced accuracy, with tooth section images exhibiting the best/lowest error values, followed by labiolingual and mesiodistal radiographs, respectively. Exclusion of enamel area consistently enhanced model performance across all image types. This study contributes valuable data to the underexplored field of dental age estimation techniques for South African adults, highlighting optimal approaches when applying the PAR method to maxillary canines. Additionally, it introduces a refined stereomicroscopic technique, augmenting and enhancing existing practices., (© 2024. The Author(s).)

Background: Medial unicompartmental knee arthroplasty (UKA) has been a successful option for treatment of arthritis in patients with a healthy lateral compartment. However, lateral UKA is less common and results are less consistent. The purpose of this study is to compare progression of radiographically evident osteoarthritis in unoperated compartments during 5 years after lateral and medial UKA., Methods: We undertook serial radiographic evaluation of 20 lateral and 114 medial UKA performed by the senior author during calendar years 2007-2008. Anteroposterior, lateral, and skyline radiographs obtained preoperatively and 1 and 5+ (mean, 5.3; range, 5.1-6.4) years postoperatively were independently graded for osteoarthritis in the unoperated tibiofemoral (TF) and patellofemoral (PF) compartments using established scales of Kellgren (0-4 point global scale for osteoarthritis), Ahlbäck (0-5 point scale based on joint space narrowing), and Altman (0-12 point composite criteria score). Rates of disease progression were compared between lateral and medial UKA groups using bivariate methods and multilevel growth models that adjusted for baseline characteristics., Results: All mean disease grades for the TF and PF compartments increased (worsened) over time. The adjusted rate of Kellgren grade change was statistically (P < .05) faster for lateral UKA in the TF and PF compartments, as was Ahlbäck change in the TF compartment. Kellgren grade for the TF compartment of lateral and medial UKA groups increased 1.1 vs 0.6 points on average over 5 years adjusted for age, sex, and body mass index (P < .001)., Conclusion: Surgeons should consider the propensity for faster disease progression after UKA in evaluating patients with isolated lateral compartment disease., Level of Evidence: Level III, therapeutic study., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The standard age estimation methods of Moorrees, Fanning & Hunt (1963) and that of Demirjian, Goldstein & Tanner (1973) have been shown by several authors to be inaccurate when applied to their juvenile population. This was similarly found to be true in South African children. Pantomographic radiographs of samples of South African children of White, Coloured, Indian and Black origin were used to develop dental age related tables for these ethnic groups. These dental age estimation tables were tested and are presented.

Dental age estimation of juvenile skeletal remains has utilized the methods of Moorrees ,Fanning and Hunt (1963) [MFH] and Demirjian,Goldstein and Tanner (1973) [DGT] for many years with various results. The Demirjian et al method has been tested by several authors on their population groups with varying results.The use of these methods to age the skeletal remains of South African children by the author has not been successful. The aim of this study was to test the accuracy of the dental age estimation methods of MFH and DGT on samples of children of different ethnic groups.The study showed that the MFH method consistently under-estimates the age and the method of Demirjian et al over-estimates theages.

The dental identification of human remains utilizes the matching of dental restorations. The radiographic images of amalgam restorations are paramount in this process. The compound amalgam restoration has a unique radiographic morphology and can be readily identified in both antemortem and postmortem data. To test the radiographic morphology of compound amalgam restorations, 10 out of 40 Typodont teeth, restored by students, were tested for their discriminatory potential by 12 examiners. The results showed that the radiographic morphology of compound amalgam restorations can be accurately matched by dentally trained personnel. This suggests that in cases where accurate radiographic material is used for dental comparison, less than 12 concordant features are necessary for positive dental identification. If the antemortem and postmortem radiographic images of a compound amalgam restoration are exactly the same then this feature is unique and identification can be achieved by a single concordant feature.

The methods used for disaster victim identification is comparative postmortem profiling of dental and fingerprint data. Twelve dental concordant features are normally required for dental identification. The radiographic image of dental amalgam restorations has been shown to be highly significant for identification purposes. The aim of this study was to investigate the radiological morphology of standardized radio-opaque composite fillings in premolar teeth with regard to their discriminatory potential for identification purposes. Thirty lower first premolar teeth ("Typodont" acrylic teeth) that were filled with 3- surface fillings (MOD) radio-opaque composite resin (Z100) by 4th year dental students were used for this study. Bitewing radiographs were taken of all thirty fillings and labeled Set 1. A second set (Set 2) consisted of 10 randomly selected duplicate radiographs of Set 1, plus 2 other radiographic images not from Set 1. Instructions were given to 20 dentally trained examiners to match the 12 radiographic images of Set 2 with the 30 images of Set 1. The results showed that 18 of the 20 examiners correctly matched the 12 radiographic images, one scored 11 out of 12 and one scored 10 out of 12. This study shows that if the ante-mortem and post-mortem radiographs of a single composite filling have exactly the same morphology, this image is unique and 12 concordant features are not necessary for dental identification.

The standard dental bitewing radiograph is used to detect interproximal caries but it also provides a specific view of the dental restorations that can be duplicated for identification purposes. The antemortem and postmortem bitewing radiographs are often not at the same angle and result in distorted images of the restorations. The aim of this study was to investigate the progressive increase in angulations of a bitewing radiograph of the same restoration and to determine at what angle the image is distorted sufficiently as not to be recognized. Bitewing radiographs were taken of the same two restorations at 5 ̊, 10 ̊, 15 ̊ and 20 ̊ superior, inferior, mesial and distal to the original 0 ̊bitewing radiograph. Twenty examiners were required to determine at what angle the distortion prevented matching of the image with the original bitewing radiograph. The results showed that the image distortion at 15 ̊became suspect but at 20 ̊none of the images could be matched to the original bitewing radiograph.

An ageing population requires dental professionals to be aware of the oral effects of medications taken by their patients. This case study will present the challenges faced by the hygienist in the oral health management of a 79-year-old medically compromised patient over a 2-year period. The interrelationship between the ageing process, medical conditions and medications taken, and specific treatment modalities are considered.

Many children die as a result of abuse and neglect each year. Early recognition and effective intervention are crucial factors in the fight against this. Child mortality rates increased in South Africa between 1998 and 2004, with child abuse deaths constituting part of these statistics. Autopsies on children who have died of unnatural causes are often not specific as to the possibility of child abuse. This article presents the extra-oral and intra-oral signs of child abuse from a study of the autopsies of child mortality cases seen at Salt River Medico-Legal Laboratory in Cape Town from 1998 to 2004 with reference to the South African child mortality rates.

Polymorphous low-grade adenocarcinoma (PLGA) and adenoid cystic carcinoma (ACC) have several overlapping histological patterns, including cribriform, tubular and solid patterns. The overlapping clinicopathological features of PLGA and ACC may result in a diagnostic pitfall. ACC has a much worse prognosis than PLGA, making differentiation important for therapeutic and prognostic purposes. Histopathological features remain the most reliable criteria to distinguish between these two tumours. Although PLGA and ACC have many features in common, PLGA is uncommon in the major salivary glands. Histopathological distinction is therefore mainly a problem in tumours of minor salivary gland origin where small biopsies often contribute to diagnostic difficulties. This paper reviews studies which have utilised several immunohistochemical markers in attempts to distinguish between PLGA and ACC, and also studies which have focussed on the two tumours individually. The potential discriminating value of immunohistochemistry between cases of PLGA and ACC still remains controversial.

Part 1 of this two-part article dealt with mass disasters in general, their characteristics and the agencies involved in their management. This part looks at the specific role of the forensic dentist, as well as the general dentist, in a mass disaster as member of an 'away' or 'home' team.

In this article, the first of two on the involvement of dentists in a mass disaster, the focus is primarily on mass disasters in general, some common characteristics and types of disasters, those agencies or individuals involved in the management of a disaster, the different phases of a disaster and the position of the forensic dental identification team (FDIT). Part 2 will deal with the functions, responsibilities and jurisdiction of the FDIT during the various phases of a disaster and more specifically immediately after the disaster.

A case of bilateral swelling of the submandibular salivary glands is presented. The histopathological features were diffuse periductal sclerosis with a lymphoplasmacytic infiltrate which was rich in eosinophils. Some acinar atrophy was seen. Salivary ducts showed mucous and squamous prosoplasia, with focal inspissated mucin. Numerous dilated and congested blood vessels were prominent throughout the stroma. These features overlapped with those of Kimura's disease and angiolymphoid hyperplasia with eosinophils. The features of these conditions and a differential diagnosis are discussed.

The composite resin, compomer and glass ionomer restorative materials used in modern dental practice are fire resistant and remain radiopaque. They shrink significantly and are likely to fall out of the cavities after being burnt, but they remain extremely important for identification purposes and it may be possible to identify the white filling materials used to restore teeth by their radiopacity and morphology. The radiographic density of these filling materials do not change significantly when exposed to heat and although they may be difficult to see with the naked eye, they will remain visible when radiographed. Furthermore, special care has to be taken when handling heated materials as their compressive strengths decrease significantly depending on temperature and time of exposure and damage is possible.

The combination of restorative procedures, developmental or acquired defects, or abnormalities of teeth enables the forensic dentist to make a meaningful comparison of ante- and postmortem data in search of the identity of a person. Dental records are not always sufficiently accurate to supply 12 concordant points from which a positive identification can be made. Under certain circumstances a single feature may be so extraordinary or unique that it alone can be sufficient to make a positive identification. Two cases of identification in which only one unique feature was used are reported.

Ritual or muti murders are a form of human sacrifice practised by some African tribes. The murder is carried out after body parts are removed while the victim is still alive. This case report describes the methods of identification of a young child who was murdered by a traditional healer (isangoma) in Cape Town, and the practice of the traditional healer.

Facial reconstruction is used in an attempt to identify an individual by a three dimensional representation of the facial features using the skull as the foundation after metrical and non-metrical analysis to determine age, race and gender. The skeletonized remains of a female who was reported missing six years previously were recovered from the summit of Table Mountain in Cape Town. Some personal possessions were also recovered, one of which was a shark tooth pendant which the victim's parents recognized. Although there were distinctive dental features, the antemortem dental records had been lost during the initial investigation which therefore precluded identification by this means. However, positive identification was required and facial reconstruction on the skull was undertaken which the parents duly identified. The method used for facial reconstruction is described.

Reconstruction of human faces on skeletal remains is dependent on the facial tissue thickness measurements most of which have been derived from cadaver material using the needle probe technique. Dehydration of soft tissue after death casts doubt on the efficacy of these measurements. No study exists in which the facial tissues of a mixed population group in South Africa have been measured. The utilization of computerized tomography to measure facial tissue thickness as an adjunct to scans for facial sinus disease was employed and allowed the measurement of the thickness of facial soft tissues according to Rhine and Campbell (J. Forensic Sci. 1980: 25; 847-858). The sample consisted of 32 patients, 16 M and 16 F, age range 12 to 71 years. Comparison between the facial tissue thickness of American whites and blacks with South Africans of mixed racial origin showed marked differences in certain anatomical areas. The faces of the blacks were thicker in most areas, those of the whites were thicker in the forehead and periocular area, but thinner in the perioral and gonial areas. It is concluded that the use of the computerized tomography scanning procedure to measure soft tissue depth is more accurate than the needle probe technique. The results obtained from this study are therefore representative of the variation in facial tissue thickness of South Africans of mixed racial origin for facial reconstruction purposes.

A desmoplastic variant of ameloblastoma with osteoplasia in the stroma is reported. This tumour presented in the canine/premolar region of the left maxilla of a 31-year-old woman. It was treated by partial hemimaxillectomy and immediate reconstruction with a non-vascularised iliac graft. The location of this lesion, its histology and radiological features differ from those of the conventional ameloblastoma. The behaviour and prognosis of the desmoplastic ameloblastoma (DA) cannot at this stage be predicted due to the small number of cases that have been reported and a lack of long-term follow-up. To our knowledge this is the first documentation of the CT and MRI features of desmoplastic ameloblastoma with pathologic correlation.

Synovial chondromatosis of the joint is a rare benign condition characterized by the formation of metaplastic cartilage in the synovium of the joint resulting in numerous attached and unattached osteocartilagenous bodies. It may recur after surgical intervention. For this reason removal of the synovium and the bodies is advocated. This is a report of a case which occurred in the temporomandibular joint which had numerous loose bodies and exhibited features of degenerative joint disease as well. The loose bodies were removed, a high condylar shave performed and the synovium left intact. The patient is still free from joint problems five years later.

This is a case report in which the bite patterns of two suspects were compared to a bitemark on the breast of a murder victim. Each suspect had sufficient concordant features to have been found guilty of producing the bitemark. The irony in this case is that the bitemark was not inflicted by the murderer.

The skeletonized remains of an American hitch-hiker were recovered from a forest near Knysna in the Cape. There were no recognizable features except the presence of dental restorations. The use of the "fax" to transmit dental records while being a speedy means of communication does have its limitations. Electrical faults on the telephone line can cause the document to become illegible and subsequent duplication of this document aggravates the problem. An appeal is made to standardize the notation of teeth by using the FDI code and to adopt a 2 digit code for restoration morphology.

Forensic dentistry has become an integral part of forensic medicine over the past 100 years. This has been due to the dedication of people like Amoedo, Gustafson, Sognaes, Keiser-Nielsen and Suzuki, to name but a few. They established the essential role which forensic dentistry plays mainly in the identification of human remains. Dental hard tissues are extremely resistant to fire and are usually the only remains after an extended period of burial. If antemortem dental records are available for an individual then dental identification is as certain as those of fingerprints. In South Africa forensic dentistry had its beginning in 1969 during the Windhoek air disaster. Since then there have been several cases of interest throughout the country, one of which was the crash of the Helderberg off the coast of Mauritius. Other aspects of forensic dentistry are the examination of bite marks and the recognition of facial trauma especially in cases of child abuse; the determination of age, sex and race of skeletal remains; dental ethics and jurisprudence as well as malpractice also form part of the duties of the forensic dentist. The five dental schools in South Africa each have a forensic team which is consulted on a regular basis by forensic pathologists and district surgeons. Forensic dentists are active members of the medicolegal team and should be consulted on a regular basis especially in cases where identification is concerned.

Periapical pathoses which often appear as vague radiolucent areas on routine roentgenographs, are treated by endodontic therapy alone or followed by apicoectomy. Clinicians as well as histopathologists should be aware that a metastatic carcinoma to the jaws can mimic apical lesions. A case of metastatic carcinoma from the larynx, which manifested as a periapical lesion with the clinical signs and symptoms of pulpal pathology, is described.

The exhumation of two victims of a light aircraft accident was performed in February 1991 at Oudtshoorn, Cape. The exhumation was ordered by the magistrate on request of the parents of one of the victims who suspected that their son had been wrongly identified at the postmortem examination. At the pre-burial autopsy all the victims were positively identified, but the identity of two of the victims was subsequently reconsidered and reversed because one of them wore a silver bracelet. Burial then took place. The exhumation was ordered one month after the accident at which stage the bodies were in an advanced state of decomposition. Oral autopsies were performed on each of the victims, the jaws were radiographed and postmortem dental records drawn up. Dental records were obtained from the dentists who treated them and the information from these records was used to draw up ante-mortem dental records. A comparison between the postmortem and ante-mortem records showed that the victims were incorrectly identified and reburial in the correct graves was subsquently carried out. This case again emphasies the importance of dental identification in cases of severe burning, multilation or decomposition in order to avoid mistaken identity and incorrect burial in the future.

The exhumed remains of 181 people, buried during the period 1848-1984 were examined. Because of the carelessness of exhumations, only 125 yielded sufficient information to compare the condition of skulls and jaws with the period in the grave, while 63 yielded information about the teeth. No correlation could be shown between the condition of the skulls and jaws and the period interred, but it was found that the better preserved remains belonged to younger people. Dental findings included the presence of healthy and decayed teeth, gold foil restorations, gold and porcelain inlays, amalgam and silicate fillings, and vulcanite and acrylic dentures. Amalgam restorations were present in people buried from 1875 (114 years ago) and vulcanite dentures from 1882 (107 years ago). The characteristics of the earliest amalgam restorations showed that they could have been placed before 1850. Findings of this study indicate that: (a) one cannot on the appearance of exhumed remains estimate the burial period, (b) dental features were well preserved and can be used for dental identification if antimortem data are available, (c) advanced dentistry could have been practised in South Africa during the last century, and (d) recovery of human skeletal remains from old cemeteries should be undertaken with care to preserve as much information as possible. A plea is made for closer co-operation between developers of old graveyard sites and scientists in order to preserve as much information as possible.

Confusion in the early literature regarding the odontoameloblastoma, resulted in this tumour being reported under a variety of names. Many of the reported cases fail to meet the clinical and histological criteria required for classification as odontoameloblastomata. This article attempts to present a case with clinical, radiological and histological features that meet the required criteria. In this case the ameloblastic component intermingled with the dental hard tissues.

Twelve concordant characteristics are used in fingerprint identification. The South African courts of law are prepared to accept 7 concordant characteristics as being "beyond reasonable doubt" in the case of finger, hand and foot prints. In cases of identification by dental means, 12 concordant features have been advocated. In South Africa, with its mixed population in which a large majority have dental formulae containing normal decayed and missing teeth, these patterns show duplication and triplication. It is feasible to submit 7 concordant dental characteristics as positive identification in a mouth containing dental restorations, but in a mouth which features only missing teeth, pattern duplication demands more than 12 concordant characteristics for positive identification. Seven concordant dental characteristics have not been tested in the South African courts to date.

A comparison of the electron-microscopic features of 11 examples of submucous fibrosis in its moderately advanced and advanced stages with 15 control specimens revealed no obvious abnormality of the collagen fibrils. The notable feature of the collagen in this disease is the densely packed bundles in the lamina propria, reaching close to the epithelial-connective tissue junction, to blood vessel walls, salivary glands and muscle fibers. The width and the periodicity of fibrils vary in both groups of specimens, noticeably so, next to the junction and close to blood vessels, salivary glands and muscles. This is due to the presence of the thinner Type III collagen fibrils in these sites and the natural variation of Type I fibrils. Immunofluorescent microscopy and special staining with sirius red and polarization microscopy demonstrate both types, confirming that Type I collagen forms the bulk of the collagen and that Type III is localized in the sites mentioned above. It is concluded that although there is an excessive increase of collagen, especially Type I, in submucous fibrosis, the fibrils are still morphologically normal.

We found microsomal corticosterone 6 beta-hydroxylase (6 beta-OHase) from cultured A6 kidney epithelial cells to be a cytochrome P-450 enzyme with both similarities to and differences from the rat liver steroid 6 beta-OHase P-450p. Enzyme activity was inhibited by CO, alpha-naphthoflavone, metyrapone, and clotrimazole, well-known inhibitors of P-450 enzymes, and increased by known inducers of P-450 enzymes, including dilantin, phenobarbital sodium, and corticosteroids. Moreover, some additional, relatively specific inducers of P-450p (troleandomycin and pregnenolone-16 alpha-carbonitrile) also induced the A6 6 beta-OHase, whereas inducers of other forms of P-450 (aroclor, spironolactone, and isosafrole) appeared to repress the A6 enzyme. The time course of increase in enzyme activity and increased cellular cytochrome P-450 content were consistent with increased levels of enzyme protein. Induction of 6 beta-OHase by the substrate (corticosterone), the metabolite (6 beta-OH-corticosterone), dexamethasone, and aldosterone was biphasic as a function of inducer concentration, with approximate 50% effective concentration (EC50) values of 10(-8)-10(-9) M and 10(-5)-10(-6) M for the respective components of induction. Cortisol also induced the enzyme at 10(-8)-10(-6) M; however, its metabolite 6 beta-OH-cortisol was ineffective or decreased activity at higher concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Results of percutaneous needle biopsies were evaluated retrospectively in 58 patients in whom a diagnosis of lymphoma was suspected. The biopsy specimen was diagnostic in 94% of the 36 patients with lymphoma, 20 of whom had recurrent disease and 16 of whom had newly diagnosed lymphoma. Sufficient tissue was obtained in 94% of these positive biopsy specimens to allow histologic subtyping of the lymphoma. Immunohistochemical studies performed on seven of the biopsy specimens allowed immunologic subclassification into B-cell and T-cell types of lymphoma. Our results suggest that the percutaneous needle biopsy is a useful and reliable tool in the diagnosis and classification of lymphoma.

Fifty-eight percutaneous needle biopsies of adrenal masses were performed in 53 patients. The technique was initially successful in 44 (83%) of 53 patients. Five patients had second procedures because of initial failure or the possibility of sampling error. Fourteen biopsies were performed in nononcologic patients and 39 in patients with a known malignancy. None of the adrenal masses in nononcologic patients were malignant. Only 18 (46.1%) of the 39 masses in oncologic patients were metastases; the rest represented a variety of nonneoplastic conditions. Seven minor complications occurred in six patients. Two of these patients required transfusions for hypotension or decreases in hematocrit. No correlation was noted between needle size and complications. There were no pneumothoraces. The procedure is an accurate and safe alternative to surgical biopsy.

The Melkersson-Rosenthal syndrome (MRS) is a rare triad of unilateral facial paralysis, facial swelling, and fissured tongue; often only two of the components are manifest. The occurrence of swollen lips together with the characteristic microscopic appearance is called granulomatous cheilitis, which many believe is the oligosymptomatic form of MRS. This article reviews the literature on granulomatous cheilitis associated with MRS. An unusual case of a swollen upper lip together with a fissured tongue, strongly indicating the oligosymptomatic manifestations of MRS, is presented.

Pancreatic neoplasms often present with hepatic lesions as well as a pancreatic mass, as seen on abdominal computed tomography examination. To obtain histologic diagnosis, we advocate computed tomography-directed biopsy of the liver lesion instead of the pancreatic mass because of the increased accuracy and safety of hepatic biopsy as compared with pancreatic biopsy.

Biopsy of deep pelvic lymphadenopathy can assist in staging of pelvic malignancies. A retroperitoneal approach that parallels the iliac wing is described. This technique, performed under computed tomography guidance, is a safe, easy, and accurate means of obtaining tissue for pathologic examination.