| Abstract|| |
Introduction: Forensic dentistry is an evolving field in legal medicine. In mass disasters, the co-mingled body parts can be misplaced; however, the intervention by dental experts can efficiently sort out the dispute. Understanding the fact that, rule of phi applies to all that exists in nature, in the present study, we aimed to correlate the Total Maxillary Arch Perimeter with the Total Body Height of an individual in cases scenarios where only the skull along with maxilla is the only leftover remains of the unidentified. Material and Methods: An observational study was designed involving ninety subjects comprising 45 males and 45 females of age 25 to 30 years for the following parameters. Total Body Height (TBH) was measured in centimetres using anthropometric rod. Total Facial Height (TFH) was then measured from nasion to gnathion using digital vernier caliper. Total Maxillary Arch Perimeter (TMAP) was measured from the maxillary arch model cast using digital vernier caliper. Results: The Total Maxillary Arch perimeter has significant positive correlation with Total Body Height as well as Total Facial Height of an individual. The regression equation was positively established for the prediction of Total Body Height from the known Total Maxillary Arch Perimeter as Total Body Height = 80.91762 + 0.718777 (Total Maxillary Arch Perimeter). Conclusion: The Total Maxillary Arch Perimeter can be used as a predictive tool in estimating the Total Body Height of the individual where the skeletal remains of the skull along with maxilla is only present.
Keywords: Anthropometry, arch perimeter, disaster management, forensic odontology, estimation, height, odontometry
|How to cite this article:|
Sriraman R, Dev M. Facio-odontometric analysis in mass disaster victim identification - A novel approach. Indian J Dent Res 2021;32:343-7
|How to cite this URL:|
Sriraman R, Dev M. Facio-odontometric analysis in mass disaster victim identification - A novel approach. Indian J Dent Res [serial online] 2021 [cited 2022 Aug 19];32:343-7. Available from: https://www.ijdr.in/text.asp?2021/32/3/343/338122
| Introduction|| |
Unidentified remains of the human body involves identification by forensic experts through legal determination in relation to the matching of scientific information to the person who is unidentified. Identification of the unknown involves a holistic approach considering all available evidence from scientific knowledge and context. Identification of human from their remains is still a challenge for the forensic experts; however the reconstructive or comparative identification solves the problem. Recognizing the age, gender, height, race are the hallmark in forensic identification of an unknown. Since, there exists a mathematical correlation between Total Body Height and various other body parts (forearm, ulna, upper limb, lower limb, length of finger, thigh height, foot breadth/length, knee height, tibial length, length of sternum, scapula, vertebral column), in situations where the body is highly fragmented, the skeletal remains of the body can be sought to estimate the stature, which may further add up to the identity of the unknown.
Forensic Odontology, therefore, has been defined by the Federation Dentaire Internationale (FDI) as 'that branch of dentistry which, in the interest of justice deals with the proper handling and examination of dental evidence, and with the proper evaluation and presentation of dental findings'. Vast majority of the tsunami victims were identified based on their dental evidence and that was a milestone in the history of forensic odontology. In most disasters, the skull remains intact with maxillary component and dislodged mandible. Identification by dental remains holds a strong evidence since the hard tissues preserved after death withstand a temperature of 1600°C when heated without appreciable loss of microstructure, and the person's teeth change throughout the life along with the combination of decayed, missing, and filled can be obtained from any fixed time.
Need for the study
In mass disasters like airplane crash, bomb blasts and fire accidents, the body parts gets scattered as a result of the disaster and mostly the dental and bony components of the individual remains are subjected to individual identification. In most cases the skull remains are intact with the maxillary components whereas the mandible gets dislodged from the skull. Estimating stature, along with age, sex, and race, is one of the four pillars of the anthropological protocol and may be essential in preliminary screening and reconstructive identification of skeletal remains. According to the Rule of Phi, there exists a definite relationship between the height of the person and various other body parts like head, trunk and lengths of extremities. Stature correlation to skull and jaw dimensions has been frequently reported among various populations. However, few studies have been done correlating various odontometric parameters with the height of an individual. Studies have been done in correlating crown length, crown width, maxillary arch perimeter, arch length to palatal height but to our knowledge, on literature search, this is the first study to test the relationship between the maxillary arch perimeter and body height.
This study was conducted to find the correlation between body height and maxillary arch perimeter in both the sexes for an adjunct accurate and best predictor of stature of an individual. In this study, we attempted to correlate the Total Maxillary Arch Perimeter (TMAP) to the Total Facial Height (TFH) and to the Total Body Height (TBH) of an individual.
| Material and Methods|| |
Study design: Cross sectional study
Sample size calculation
This is a cross sectional study where a pilot testing was conducted on thirty two subjects (17 male, 15 female) outpatients visiting a private dental college in Chennai. With the impression from the pilot study, the current sample size estimation was done using G power software keeping alpha error prob-.05, effect size of 1.3 with equal sizes of sample. The estimated sample size was determined to be 90 distributed equally to the two sample groups- 45 males and 45 females in the present study. The future perspective of the study is to test the equation in a larger population in various ethnic races and age. Approval from the university ethics committee was obtained and the date of approval is 15.03.2016 with Reference Number: Sathyabama University/IHEC/Study No 11.
The following were the inclusion criteria, presence of all permanent teeth in the maxillary arch excluding third molar, willingness to participate with the age criteria being 25-30 year old adults as they were supposed to have the complete permanent dentition and the exclusion criteria were developmental anomalies of facial tissue, history of orthodontic treatment, history of facial surgery, history of trauma, allergy to alginate impression, malocclusion, systemic disease, dental caries and unwillingness to participate.
Before starting the procedure, Institutional Human Ethical Clearance was obtained. Later, the purpose of the study, the procedure that will be executed and the utility of their personal data were explained in detail to all the participants after which an informed written consent was obtained. Sterilization protocols were strictly followed to avoid cross infection.
The Total Body Height, Total Facial Height and Total Maxillary Arch Perimeter were measured as follows:
Total Body Height (TBH) was measured in centimetres using anthropometric rod, standing on a horizontal flat platform stretching the body to the fullest in a straight position. The TBH of each subject was measured as the vertical distance from the vertex to the floor by making the subject stand erect on a horizontal resting plane barefeet.
Total Facial Height (TFH) was then measured from nasion to gnathion using digital vernier caliper.
Total Maxillary Arch Perimeter (TMAP) was measured from the maxillary arch model cast using digital vernier caliper. TMAP was split arch into four parts. First part was measured from the distal contact point of second molar to the distal contact point of the canine on one quadrant. The second segment was measured from the distal contact point of the canine to the mesial contact point of the two central incisors. The third segment was measured from the mesial contact point of the two central incisors to the distal contact point of the canine on the opposite quadrant. The last segment was measured from the distal contact of the canine to distal contact point of the second molar. The sum of all the measured values was considered as TMAP.
All the measurements were done by a single examiner to eliminate inter-observer error. Total Body Height, Total Facial Height and Total Maxillary Arch Perimeter were all measured thrice and the average was recorded in order to minimize the intra-observer error. These data were subjected to statistical analysis using SPSS version 16.
| Results|| |
[Table 1] shows a detailed description of each parameter taken up for the study such as maximum value, minimum value, mean value and standard deviation.
|Table 1: Descriptive statistics of age, total body height, total facial height, total maxillary arch perimeter|
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The data obtained from measuring the TFH, TBH and TMAP were subjected to Pearson correlation analysis and Multivariate Regression analysis. The Pearson Correlational analysis between the TBH and TMAP, TFH is given in [Table 2], there was a strong positive correlation between TFH and TBH with a correlation coefficient value r 0.959, P = 0.001 (P ≤ 0.01). A significant relationship existed between TBH and TMAP with a correlation coefficient value r = 0.908 and P = 0.001 (P ≤ 0.01). The Pearson Correlation Coefficient was calculated between the TMAP and TFH. Positive correlation between TMAP and TFH was observed with a correlation coefficient value r = 0.970 and P value = 0.001 (P ≤ 0.01).
|Table 2: Pearson correlation coefficient analysis between total body height and total maxillary arch perimeter, total facial height|
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Linear regression analysis to estimate TBH of an individual from TMAP is given in [Table 3] along with the equation for estimating the TBH derived from regression coefficient. The analysis states that the stature can be predicted by using both TFH as well as TMAP. Linear regression equation is derived as Total Body Height = 80.91762 + 0.718777 (Total Maxillary Arch Perimeter).
|Table 3: Linear regression analysis to estimate total body height from total maxillary arch perimeter|
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The regression equation has been positively established for the prediction of stature as well as total facial height from the known TMAP [Table 4]. Linear Regression Equation is derived as Total Facial Height = 13.989 + 0.844 (Total Maxillary Arch Perimeter).
|Table 4: Linear regression analysis to estimate total facial height from total maxillary arch perimeter|
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A multi-variate regression analysis [Table 5] was also drawn with known total maxillary arch perimeter and total body height i.e. TBH = 71.84428 + 1.098586 (TFH)-0.29984 (TMAP).
|Table 5: Multi-variate regression analysis between total maxillary arch perimeter (TMAP), total body height (TBH) and total facial height (TFH)|
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| Discussion|| |
Dental evaluation in forensic is highly reliable, since the teeth and its association to the head and facial tissues are unique. Also tooth being a hard tissue, is well protected by the oral soft tissue, it can resist any sort of accidental damage like fire accidents, earthquake etc., Though there are highly sensitive and advanced methods available in forensic detection (example: DNA analysis), metric analysis is simple, cost effective and less time consuming.
Our study on dental and facial anthropometry proves that arch perimeter has significant positive correlation with TBH as well as TFH of an individual. The TFH [r = 0.959, P = 0.01] has highly strong correlation with TBH than the TMAP [r = 0.908, P = 0.001].
The coefficient value of r = 0.970 with P = 0.001 was obtained with SEE ± 15.458 when the TFH was correlated with TMAP, which proves that TMAP can also be used to determine the TFH. The correlation coefficient of TFH with TBH was significantly higher in our study compared to studies concluded by Jibonkumar and Lilinchandra (2006) r = 0.21, Agnihotri et al., (2011) r = 0.32, 0.16 and Wankhede et al., (2012) r = 0.19. Kalia S et al., (2008) correlated TBH to the mesio-distal diameter of anterior teeth and they obtained correlation coefficient value of r = 0.15, SEE = ±3.23 which was lesser than our values. Krishnan K, (2008) reported that head length (r = 0.775) gave a strong correlational value than the facial length r = 0.455 with SEE ± 5.820 in determining the stature, but our study proves that TFH (r = 0.959, P = 0.01) is a better parameter.
From our study we have positively correlated that Total Maxillary Arch perimeter can be used as a predictive tool to estimate the Total Body Height of an individual and the regression equation was derived as Total Body Height = 80.91762 + 0.718777 (Total Maxillary Arch Perimeter). Since we had an additional parameter available in the study, we tried and explored whether there is a correlation between Total Facial Height and Total Body Height of an individual, which was also correlated positively and the regression equation was drawn as Total Facial Height = 13.989 + 0.844 (Total Maxillary Arch Perimeter). This correlation of the Total Facial Height to the Total Body Height can be used as an adjuvant odontometric analysis in cases where the mandible is not available along with the skull and can also be used to reconstruct the face using all the additional parameters that could be found in cases where only the maxillary arch is available.
It is obvious that there are no universally applicable formulae as the relationship between head dimensions and cranial capacity is influenced by the race, sex and age of an individual. There are various methods to estimate stature from the bones, but the easiest and the most reliable method is by regression analysis. These formulae are valid for the age group 25-30 years of the subjects and the data collection was done by a single observer. The parameters chosen remain in proportion to every individual at that specific time as the subjects chosen are healthy individuals with no physical disparities or impairment and are not subjective.
| Conclusion|| |
To our knowledge, on literature search, this is the first study to test the relationship between the maxillary arch perimeter and body height. Our study reveals a strong correlation between the TMAP and the TBH as well as TFH. Hence, the maxillary arch perimeter can be used as a predictive tool in estimating the stature of the individual, which is very helpful in mass disaster identification. The future perspective of the study is to test the equation on various ethnic groups, age and race, such that when the forensic expert encounters multiple comingled skull and bone, the stature can be derived by simple calculation.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Funded by the Indian Council of Medical research-STS (Short Term Studentship program) 2015, Reference ID – 2015-01467.
Conflicts of interest
There are no conflicts of interest.
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Dr. Monica Dev
C/O Dr. Rajkumari S Former Student, Department of Oral and Maxillofacial Pathology, Sathyabama Dental College and Hospital, Chennai - 600 119
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]