CASE REPORT

Dental Age Estimation Helps Create a New Identity Danilo De Angelis, PhD, DDS,* Daniele Gibelli, PhD, MD,* Paolo Fabbri, MD,† and Cristina Cattaneo, PhD, MA, MD, BSc* Abstract: Age estimation involves the reconstruction of age by biological parameters such as skeletal and dental development in minors, or reduction of pulp chamber in adults, to gain indications concerning the chronological age of the person. In most cases, it is needed in forensic scenarios to verify if the supposed age of an individual is correct; in exceptional cases, age estimation is instead required by judicial authorities to create a new identity usually in persons who do not remember who they are. This article aims at reporting the case of J. who was found in 2005 with signs of amnesia because he did not remember his name and age. After several unsuccessful attempts at identifying him, the judicial authority decided to assign a new identity, which was to be constructed according to the real biological data of the individual. The help of a forensic pathologist and a forensic odontologist was then requested, and age estimation was reached by applying methods for adults based on the physiological reduction of pulp chamber. Dental age estimation yielded a final result of approximately 31 years, which was the new age assigned to the person. This article shows a peculiar application of dental age estimation, which can be used not only to ascertain or deny supposed age, but is sometimes needed to create a new identity. Key Words: forensic odontology, dental age estimation, amnesia, identity (Am J Forensic Med Pathol 2015;36: 219–220)

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n the last years, cases of age estimation in the living have become more and more frequent in forensic odontology and anthropology, as also shown by the increase in the number of guidelines and suggestions actually available in literature.1–3 Criteria for age estimation in the living have been given recently by The Study Group on Forensic Age Diagnostic,1,2 with special attention to legal and ethical implications; the group has proposed guidelines for age estimation in the living, with a 3-step procedure including a physical examination and anthropometric analysis, sexual development assessment (clinical/medical examination is first of all important to diagnose disease and syndromes that could influence the estimation of skeletal or dental maturation), dental analysis by an orthopantomogram, and x-ray study of the left hand; if the 21-year threshold is considered, clavicle sternal end x-ray examination4 is suggested. Generally, age estimation is reached by the analysis of radiographic material and, in detail, x-ray examination of the hand and wrist, as well as orthopantomograph; with time, different methods have been developed that allow the operators to provide skeletal and dental age. In this context, the physical

Manuscript received April 25, 2014; accepted April 28, 2015. From the *Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Laboratorio di Antropologia e Odontologia Forense, Università degli Studi di Milano, Milan; and †Forensic Pathologist in Ferrara, Russi, Ravenna, Italy. The authors report no conflict of interest. Reprints: Danilo De Angelis, PhD, DDS, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Laboratorio di Antropologia e Odontologia Forense, Università degli Studi di Milano, Via Mangiagalli 37, 20133, Milan, Italy. E-mail: [email protected]. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0195-7910/15/3603-0219 DOI: 10.1097/PAF.0000000000000178

Am J Forensic Med Pathol • Volume 36, Number 3, September 2015

examination, although preliminary to radiological tests, aims at verifying the suspect of possible alteration of physical development, which may be related to malnutrition, abuse, or pathology. For what concerns adults, the age estimation procedure is affected by relevant limits because of the end of dental and skeletal development; in these cases, orthopantomography analysis still has some importance because it allows the operators to apply techniques based on the reduction of pulp chamber. In addition, if the subject is female, gynecological and hormonal tests may give some indication concerning the fertile age of the individual.5 Other methods, currently applied to dead individuals, are not applicable because they are invasive and therefore are not ethically acceptable.3 The main field of application of age estimation procedures concerns cases of adoption and ascertainment of imputability (14, 16, 18, and 21 years depending on the country), whereas in adults, it aims at verifying the retirement age (50, 55, 60, and 65 years, again depending on the country). In all these cases, age estimation usually is performed to verify the biological age of the individual and to compare it with a supposed birth date, which is reported by adoption documents or identity papers in cases of illegal immigration; this procedure allows the operators to provide an age estimation and to compare the obtained results with the supposed age of the individual to confirm or deny the available information and, in the last case, to correct the personal data of the individual. However, the age estimation procedure may also represent a method for providing a novel age and identity to the individual. This article reports a case where dental age estimation procedure on the living is included in the procedure for assignation of a novel identity in a person affected by amnesia where the original identity could not be recovered.

CASE REPORT In 2005, an unknown person reached the police station of Faenza (Ravenna, Italy); he could not say a word but only wrote English phrases, and he did not remember where he was from and how old he was. All the attempts at identifying him, also through other countries, gave negative results, and the unknown person was admitted in several psychiatric hospitals and clinical structures to ascertain the origin of his amnesia. A precise

FIGURE 1. Orthopantomograph of J. taken in 2005; one can observe the complete maturation of the third molars. www.amjforensicmedicine.com

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De Angelis et al

FIGURE 2. Example of application of the method by Kvaal et al on the lower canines (on the left) and the method of Cameriere et al on the upper ones (on the right).

diagnosis could not be performed, and the clinical personnel were only able to detect the presence of selective amnesia, which prevented him to remember his identity, probably because of a severe psychological trauma. After 3 to 4 days, he began to speak in English; the person, called by clinical personnel with the nickname J., had fragmentary memories concerning his childhood in a town in North Ireland. With time, J. had begun to speak in Italian and proved to understand Dutch; he was also analyzed by an expert in foreign languages who excluded his origin from Ireland and United Kingdom, and hypothesized he could come from Eastern Europe. Toxicological analyses, computed tomography scans, and nuclear magnetic resonance tests were negative. However, for the amnesia, J. was self-sufficient and showed the need for acquiring a new identity to be included in the Italian social structure. In Italy, he also met his girlfriend whom he wanted to marry. In 2009, the Italian judicial authority recognized the case as worth being taken in consideration for a reassignation of identity, according to Italian laws, and requested an age estimation by a forensic pathologist and a forensic odontologist. In January 2010, the individual was examined; his height was 175 cm, and his weight was 67 kg. No scars or surgical signs were observed. Orthopantomograph was performed and highlighted that all the third molars had already finished the development (Fig. 1). The upper first molars and 4 bicuspids were lacking, probably for previous orthodontic therapy. Further endoral x-ray analyses of 4 canines were then requested to apply the methods by Kvaal et al6 and Cameriere et al.7 Both the procedures take into consideration the physiological and progressive decrease in size of the pulp chamber with age because of regular secondary dentine formation; Kvaal et al6 in 1995 developed a method based on the measurement of pulp chamber thickness in different points of x-ray analyses; Cameriere et al7 in 2007 improved a variant of the original method, limited to canines and based on the ratio between the area of the tooth and the area of pulp chamber measured on radiographs by Photoshop software. The 2 methods are not invasive and therefore are useful for age estimation of living individuals. The method of Kvaal et al was applied to the lower canines, whereas the method of Cameriere et al was used on all the 4 canines (Fig. 2). The first one gave an age estimation of 31 to 32 years (error of 11.5 years), whereas the method of Cameriere

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et al gave a result of 30.8 to 31.9 years (error of 5.5 years). A final result of 31 years was finally assigned by the judicial authority who stated a new birth date in January 1, 1979.

CONCLUSIONS Age estimation on the living is usually needed to verify the concordance of biological data of the subject with the supposed age and birth date given by adoption documents and identity papers from the original countries. In these cases, the aim of the procedure is to verify the reliability of the given information and, if discordances are observed, to provide the necessary corrections. This article shows the first case of application of age estimation to a new assignment of identity in a person with signs of amnesia whose original identity could not be recovered. The assignation of a new age was also required by the subject who wanted to be adequately inserted and recognized within the Italian social structures. The techniques of age ascertainment provided by forensic odontology in this case were used to formulate a new age for a novel identity. This is a recent application of dental age estimation that underlines the importance of age assessment of the living, even for the creation of a new identity. REFERENCES 1. Schmeling A, Grundmann C, Fuhrmann A, et al. Criteria for age estimation in living individuals. Int J Legal Med. 2008;122(6):457–460. 2. Schmeling A, Geserick G, Reisinger W, et al. Age estimation. Forensic Sci Int. 2007;165:178–181. 3. Cunha E, Baccino E, Martrille L, et al. The problem of aging human remains and living individuals: a review. Forensic Sci Int. 2009;193:1–13. 4. Schulz R, Mühler M, Reisinger W, et al. Radiographic staging of ossification of the medial clavicular epiphysis. Int J Leg Med. 2008;122(1):55–58. 5. Cattaneo C, De Angelis D, Ruspa M, et al. How old am I? Age estimation in living adults: a case report. J Forensic Odontostomatol. 2008;26(2):39–43. 6. Kvaal SI, Kolltveit KM, Thomsen IO, et al. Age estimation of adults from dental radiographs. Forensic Sci Int. 1995;74(3):175–185. 7. Cameriere R, Ferrante L, Belcastro MG, et al. Age estimation by pulp/tooth ratio in canines by peri-apical x-rays. J Forensic Sci. 2007;52(1):166–170.

© 2015 Wolters Kluwer Health, Inc. All rights reserved.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Dental Age Estimation Helps Create a New Identity.

Age estimation involves the reconstruction of age by biological parameters such as skeletal and dental development in minors, or reduction of pulp cha...
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