Development of a radiographic dental implant guide for forensic identification using current dental implants

Abstract

Introduction: Forensic dentistry plays a key role in identifying human remains that cannot be identified visually or by other means. Studies have shown that in cases of single or multiple deaths, scientific identification of human remains utilising forensic dentistry is often the most successful source of identification. Dental identification of human remains consists of a very complex procedure that makes it necessary during the investigation process to use and compare unique dental identifiers. A reliable and accurate method of identifying human remains is a positive radiological identification between ante-mortem and post-mortem images of dental radiographic images. Even if ante-mortem radiographic images may not be present during the identification process, post-mortem images may include details of dental restorations such as dental implants which cannot be seen during visual examination. The different types of dental implants vary in morphology and in conjunction with the unique appearance of dental anatomy and the placement of custom restorations such as dental implants, it has been found to accurately assist in the identification of human remains. Objectives: To establish a radiographic dental implant guide for ten commonly used dental implant types in the Western Cape, South Africa; and to identify and describe the morphological characteristics of these dental implant types as observed on pantomographs. Methods: The ten commonly used dental implant types were imaged radiographically to create a reference instrument which served as a tool for identifying and comparing different types of dental implants. The morphologies of the different dental implants, specifically the apex, thread and neck, were observed on ante-mortem pantomographs and compared to the appearance of the dental implants on the reference instrument to make a positive match. The straight tube image of all ten dental implant types in the reference instrument was used as the point of reference to positively identify the morphological characteristics of each dental implant type on the pantomographs. The morphological characteristics of the ten commonly used dental implant types used in the Western Cape were described and based on this a radiographic dental implant guide was developed. Results: A total of 384 dental implants were observed on the pantomographs. Of these, 380 dental implants could be positively identified on the pantomographs while 4 dental implants could not. A total of 350 dental implants (91%) were identified as dental implant types listed in the reference instrument while 30 dental implants were identified as a dental implant type not listed in the reference instrument. A total of 208 dental implants (54.2%) could be positively identified using the morphological characteristics namely the apex, thread and neck on the straight tube images of the dental implant type in the reference instrument. The radiographic dental implant guide was developed based on positive identification of the morphological characteristics of the dental implant types. Conclusion: This research study has illustrated that the morphology of dental implants can be used to differentiate between different dental implant types on pantomographs. Each dental implant type had unique morphological characteristics as well as similarities which enabled distinction between the different dental implant types, which facilitated dental implant identification and the development of a radiographic dental implant guide. The radiographic dental implant guide developed as part of this research study, may be useful in the field of forensic dentistry and forensic radiology.