European Journal of Forensic Sciences
Review Article
www.ejfs.co.uk
DOI: 10.5455/ejfs.163440
Periodontics perspective in
identification and age estimation
Thorakkal Shamim
Department of Dentistry,
Government Taluk Head
Quarters Hospital,
Malappuram, Kerala,
India
Address for correspondence:
Thorakkal Shamim,
Department of Dentistry,
Government Taluk Head
Quarters Hospital,
Malappuram, Kerala, India.
E-mail: shamu3duad@gmail.
com
Received: July 02, 2014
Accepted: July 16, 2014
Published: August 06, 2014
ABSTRACT
Forensic odontology is a specialized field of dentistry that analyses dental evidence in the interest of justice.
Periodontics is a clinical dental speciality dealing with diseases of the periodontium. This speciality is utilized
for identification of individuals through morphology and pathology of periodontium and is also utilized for age
estimation studies which include periodontosis, root transparency and root length. This paper aims to discuss
the periodontics perspective in identification and age estimation.
KEY WORDS: Forensic sciences, forensic odontology, age estimation, identification, periodontics, perspective,
periodontium
INTRODUCTION
Forensic odontology is a specialized field of dentistry which
analyses dental evidence in the interest of justice. Dental
evidence has been used for the identification of victims and
suspects in mass disasters, abuse and crimes [1]. Dental
evidence is presented in the following sequence in the court
of law i.e., proper handling, thorough examination, evaluation
and presentation [1].
A working classification for forensic odontology was formulated
based on the relationship of various dental specialities with
forensic odontology [2]. A detailed review about the utility
of these dental specialities with forensic odontology was
ascertained to understand the forensic implications of each
individual dental speciality and to do research in the parent
dental speciality [3]. The new working classification proposed
for forensic odontology based on its relationship with other
dental specialties was evaluated in scientometric research [4].
The role of forensic odontology in the identification of
the homicide cases has been extensively reported [5]. The
resilience of the dental structures to postmortem assault
and teeth as a source of DNA will contribute to making
identification successful [6]. The late President of Pakistan,
General Zia-ul-Haq who died in a plane crash and the late
Indian Prime Minister, Mr. Rajiv Gandhi who was assassinated
in a terrorist attack in 1991 were identified from their
dentition [7].
18
The introduction of universal coding will be of immense
help in forensic dental identification. A simplified Indian
coding was proposed for forensic dental identification based
on the interrelationship of dental specialties with forensic
odontology [8]. A simple and cost-effective technique, easily
performed in dental clinic practice using discarded Lead foil of
the intraoral periapical radiograph as an inclusion agent in the
dentures of the individuals for the identification process was
proposed recently [9].
Periodontics is a clinical dental speciality dealing with diseases of
periodontium [3]. This speciality is utilized for identification of
individuals through morphology and pathology of periodontium
and is also utilized for age estimation studies which include
(periodontal ligament attachment level) periodontosis, root
transparency and root length [2]. This paper aims to discuss the
periodontics perspective in identification and age estimation
in terms of the following aspects.
METHODS
A review of the literature was done using PubMed to evaluate the
periodontics perspective in identification and age estimation.
The following keywords were searched in PubMed: Identification,
gingival morphology and pathology, the contour of the gingiva,
gingival recession, gingival enlargement, interproximal
craters, the color of the gingiva, plaque and calculus deposits,
periodontal ligament morphology and pathology, thickness
of periodontal ligament, widening of periodontal ligament,
lateral periodontal cysts, periodontal abscess, status of alveolar
Eur J Forensic Sci
● Oct-Dec 2014 ● Vol 1 ● Issue 1
Shamim: Periodontics perspective in identification and age
bone, height, contour and density of crestal bone, thickness of
interradicular bone, pattern of lamina dura, trabecular bone
pattern, bone islands, bone loss, periodontal cosmetic surgeries,
crown lengthening procedure, root hemisection, regenerative
surgery, periodontal microsurgery, age estimation, periodontosis.
Root transparency and root length.
DISCUSSION
Identification
Focal and Diffuse Enlargements of the Gingiva
Gingival enlargements are quite common and can be classified
as focal and diffuse enlargements. The etiology of the gingival
enlargement may be inflammatory (abscess), idiopathic
(hereditary gingival fibromatosis), drug induced (calcium
channel blocker, phenytoin, cyclosporine), granulomatous
disease (tuberculosis), neoplasms (leukemia) and any other
systemic and local pathology [17-21].
Interproximal Craters
Periodontics is the speciality of dentistry dealing with diseases
of the gums and other structures around the teeth [3]. This
speciality is utilized for identification of individuals through
gingival morphology and pathology, periodontal ligament
morphology and pathology, status of alveolar bone and
periodontal cosmetic surgeries [Table 1].
Interproximal craters are usually presented in necrotising
ulcerative gingivitis with interdental necrosis, punched
out ulcerated papillae, gingival bleeding and pain [22]. Similar
ulcerative changes of gingiva is also reported in Fanconi’s
anaemia and HIV infection [23,24].
Gingival Morphology and Pathology
The Color of the Gingiva
The clinical parameters of the gingiva such as contour, recession,
enlargements, interproximal craters, color (inflammatory
changes, physiological [racial] or pathological pigmentations),
dental plaque and calculus deposits were taken into consideration
for establishing identity of the individuals [Table 1].
The usual color of the gingiva is coral pink and gingiva will exhibit
physiologic pigmentation. The most common site of physiologic
pigmentation is the labial part of the gingiva, and the attached
gingiva is the most common pigmented anatomic division [25].
The highest rate of gingival pigmentation has been observed at
the incisors [26]. The pathologic pigmentations in gingiva may be
smoker’s melanosis, melanotic macule, oral melanoacanthoma,
pigmentation by foreign bodies or induced by drugs, Peutz–Jeghers
syndrome, Addison’s disease and oral melanoma [27].
The Contour of the Gingiva
The contour or shape of the gingiva varies considerably among
individuals and depends on the shape of the teeth and their
alignment in the arch, the location and size of the area of
proximal contact and the dimensions of the facial and lingual
gingival embrasures [10]. The harmony of gingival contour is
jeopardized by improperly constructed dental restorations and
prosthetic abutments [11]. The anatomical form, marginal
adaptation, marginal discoloration and surface roughness of the
dental restorations and prosthetic abutments in relation with
the contour of the gingiva should be assessed. Stillman’s cleft
(apostrophe shaped identations extending from the gingival
margin apically) and McCall’s festoons (life saver shaped
enlargements of marginal gingiva in canine premolar region)
associated with occlusal trauma will enhance the identification
process [12,13].
Gingival Recession
Gingival recession is an undesirable condition presenting as
localized and generalized form resulting in root exposure [14].
The etiology of gingival recession was traced to bad oral
hygiene practices, high level of dental plaque and calculus and
tobacco consumption habit with more cases reported in older
population [14]. Gingival recession was reported in young
Israeli adults with history of past orthodontic treatment and
oral piercing [15]. The presence and extent of gingival recession
will increase with age and it is frequently seen on buccal surfaces
than on other aspects of the teeth [14]. Gingival recession is
also associated with clinical crown length, arch relationship and
frenum involvement [16].
Eur J Forensic Sci
● Oct-Dec 2014 ● Vol 1
● Issue 1
Plaque and Calculus Deposits
The oral hygienes status can be assessed by recording plaque
and calculus deposits and there is a definite correlation between
bad oral hygiene status with higher plaque and calculus
deposits [28]. Plaque and calculus deposits will be higher in
certain pathologic conditions [29,30].
Periodontal Ligament Morphology and Pathology
The clinical parameters of the periodontal ligament such as
thickness of periodontal ligament, widening of periodontal
ligament and pathologies of the periodontal ligament such as
lateral periodontal cysts and periodontal abscess were taken
into consideration for establishing identity of the individuals
[Table 1].
Thickness of Periodontal Ligament
The thickness of the periodontal ligament will be directly related
to age and mesiocclusal drifting of teeth [31]. A more recent
study on rats about the importance of periodontal ligament
thickness, it was interfered that periodontal ligament thickness
is directly proportional to root dimensions [32].
Widening of Periodontal Ligament
The widening of the periodontal ligament space is seen related to
19
Shamim: Periodontics perspective in identification and age
Table 1: Interrelationship of periodontics with forensic
odontology
Thickness of Interradicular Bone
Identification
Gingival morphology and pathology:
a. Contour, recession, focal/diffuse enlargements, interproximal craters
b. Colour-inflammatory changes, physiological (racial) or
pathological pigmentations
c. Plaque and calculus deposits
Periodontal ligament morphology and pathology:
a. Thickness
b. Widening
c. Lateral periodontal cysts and periodontal abscess
Status of alveolar bone:
a. Height, contour, density of crestal bone
b. Thickness of interradicular bone
c. Pattern of lamina dura
d. Bone loss (horizontal/vertical)
e. Trabecular bone pattern and bone islands
Periodontal cosmetic surgeries:
a. Crown lengthening procedure
b. Root hemisection along with regenerative surgery
c. Periodontal microsurgery
Age estimation
Periodontosis (gum recession)
Root transparency and root length
The buccal interradicular cortical bone thickness between
canine and first premolar or between first premolar and second
premolar is the greatest and between central incisor and lateral
incisor is the least and buccal and palatal interradicular cortical
bone thickness and alveolar process width will tend to increase
from crest to base of alveolar process [43].
bisphosphonate-associated osteonecrosis of the jaws, progressive
systemic sclerosis and primary hyperparathyroidism [33-35].
Lateral Periodontal Cysts and Periodontal Abscess
The lateral periodontal cyst is a rare developmental odontogenic
cyst seen in mandibular premolar region of adults [36]. Lateral
periodontal cysts are non-keratinized cysts located adjacent or
lateral to the root of a vital tooth [37].
Periodontal abscess is localized, purulent infection within
the tissues adjacent to the periodontal pocket that may lead
to the destruction of periodontal ligament and alveolar bone
[38]. More recently, an unusual case of recurrent periodontal
abscess in a 31-year-old male electrician due to his habit of
using his teeth as a tool for stripping electrical wires was
reported [39].
Status of Alveolar Bone
The clinical parameters of the alveolar bone such as height,
contour and density of crestal bone, thickness of interradicular
bone, pattern of lamina dura, bone loss (horizontal or vertical),
trabecular bone pattern and bone islands were taken into
consideration for establishing identity of the individuals
[Table 1].
Height, Contour and Density of Crestal Bone
Bone mineral density is an important risk indicator for
periodontitis in postmenopausal women [40]. Tobacco
consumption induces alveolar crest height loss independently of
mandibular bone mass and bone density [41]. Osteoporosis or
low systemic bone mineral density is considered as a risk factor
for periodontal disease progression [42].
20
Pattern of Lamina Dura, Trabecular Bone Pattern and
Bone Islands
Partial or complete loss of lamina dura, delicate or absent
trabecular patterns, and an overall granular or chalky white
appearance associated with an increase in radiographic density
are seen in patients with renal osteodystrophy [44]. Trabecular
pattern can be assessed in mandible using periapical and
panoramic radiographs [45,46].
Bone Loss (Horizontal or Vertical)
Horizontal alveolar bone loss is seen more often than the vertical
bone defects in periodontal patients [47].
Periodontal Cosmetic Surgeries
The periodontal cosmetic surgeries such as crown lengthening
procedure, root hemisection along with regenerative surgery
and periodontal microsurgery were taken into consideration for
establishing identity of the individuals [Table 1].
Crown Lengthening Procedure
Open-flap and minimally-invasive flapless esthetic crown
lengthening procedures are usually recommended for the
treatment of excessive gingival display [48]. The effect of
esthetic crown lengthening procedures play a major role in the
perception of whether a person is attractive and whether or
not they are perceived as friendly, trustworthy, intelligent, and
self-confident [49].
Root Hemisection along with Regenerative Surgery
Hemisection is a viable method of preserving periodontally or
endodontically compromised teeth or roots (mainly mandibular
first molars) [50]. Among regenerative surgical procedures in
periodontics, guided tissue regeneration is still the favourable
technique with significant clinical and histologic documentation
of periodontal regeneration [51].
Periodontal Microsurgery
Periodontal microsurgery is now grouped under minimally
invasive periodontal therapy that preserves dentition and
supporting structures and allows less extensive manipulation
of surrounding tissues than conventional procedures and
accomplishing the same treatment results [52].
Eur J Forensic Sci
● Oct-Dec 2014 ● Vol 1 ● Issue 1
Shamim: Periodontics perspective in identification and age
Age Estimation
One of the interesting applications of forensic odontology is age
estimation by means of teeth [53]. Periodontics is also utilized
for age estimation studies which include periodontosis (gum
recession), root transparency and root length [Table 1] [2].
Periodontosis
16.
17.
18.
19.
Periodontosis is one of the six dental changes that is used along
with attrition, secondary dentin deposition, root translucency,
cementum apposition and root resorption to estimate age by
Gustafson’s method [1].
Root Transparency and Root Length
The dental features such as root translucency and root length
can be used along with the extent of periodontosis to estimate
age in adults [54]. Lamendin et al. developed a general
technique to estimate age of adults at death using two dental
features (periodontosis and translucency of the tooth root) and
Prince and Ubelaker modified this method, creating a formula
for each sex and for different ancestries and obtained more
precise age estimations [55].
20.
21.
22.
23.
24.
25.
26.
27.
CONCLUSION
28.
To conclude, this article hopes to sensitize all dental fraternities
and periodontics specialists around the globe to know the
interrelationship of periodontics with forensic odontology.
29.
30.
REFERENCES
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Shamim T. Forensic odontology. J Coll Physicians Surg Pak 2010;20:1-2.
Shamim T. A new working classification proposed for forensic
odontology. J Coll Physicians Surg Pak 2011;21:59.
Shamim T. Forensic odontology. J Coll Physicians Surg Pak
2012;22:240-5.
Shamim T. Publication trends in the journal of forensic dental sciences
2009-2012. J Sci Res 2013;2:152-6.
Shamim T, Ipe Varghese V, Shameena PM, Mahesh MR. Forensic
odontology to the rescue: A case report. Med Legzal Update
2006;6:115-8.
Shamim T. Deoxyribonucleic acid profiling in forensic dental
identification. Indian J Hum Genet 2013;19:513.
Shamim T, Sudha S, Shameena PM, Ipe Varghese V. An insight to
forensic odontology. Kerala Dent J 2006;29:45-7.
Shamim T. A simplified Indian coding proposed for forensic dental
identification. J Coll Physicians Surg Pak 2014;24:609-10.
Shamim T. Lead foil in the intraoral periapical radiograph as an
inclusion agent: A simple method in denture identification. J Coll
Physicians Surg Pak 2012;22:130-1.
Fiorellini JP, Kim DM, Uzel NG. Anatomy of the periodontium. In:
Newman MG, Takei H, Klokkevold PR, Carranza FA, editors. Carranza’s
Clinical Periodontology. China: Saunders, Elsevier; 2012. p. 12-27.
Simon Z, Rosenblatt A. Challenges in achieving gingival harmony.
J Calif Dent Assoc 2010;38:583-90.
Thom G. Stillman’s cleft caused by traumatic occlusion. The
interesting case. Stomatol DDR 1979;29:374-7.
Bhola M, Cabanilla L, Kolhatkar S. Dental occlusion and periodontal
disease: What is the real relationship? J Calif Dent Assoc
2008;36:924-30.
Kassab MM, Cohen RE. The etiology and prevalence of gingival
recession. J Am Dent Assoc 2003;134:220-5.
Slutzkey S, Levin L. Gingival recession in young adults: Occurrence,
Eur J Forensic Sci
● Oct-Dec 2014 ● Vol 1
● Issue 1
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
severity, and relationship to past orthodontic treatment and oral
piercing. Am J Orthod Dentofacial Orthop 2008;134:652-6.
Mathur A, Jain M, Jain K, Samar M, Goutham B, Swamy PD, et al.
Gingival recession in school kids aged 10-15 years in Udaipur, India.
J Indian Soc Periodontol 2009;13:16-20.
Aghili H, Goldani Moghadam M. Hereditary gingival fibromatosis:
A review and a report of a rare case. Case Rep Dent 2013;2013:930972.
Livada R, Shiloah J. Calcium channel blocker-induced gingival
enlargement. J Hum Hypertens 2014;28:10-4.
Subramani T, Rathnavelu V, Alitheen NB. The possible potential
therapeutic targets for drug induced gingival overgrowth. Mediators
Inflamm 2013;2013:639468.
Gill JS, Sandhu S, Gill S. Primary tuberculosis masquerading as
gingival enlargement. Br Dent J 2010;208:343-5.
Arul AS, Verma S, Ahmed S, Arul AS. A clinical and fine needle
aspiration cytology study of gingiva in acute leukemia. Dent Res J
(Isfahan) 2012;9:80-5.
Atout RN, Todescan S. Managing patients with necrotizing ulcerative
gingivitis. J Can Dent Assoc 2013;79:d46.
Srirangarajan S, Shetty S, Prasanna D. Necrotic ulcerative changes in
Fanconi’s anaemia: A case report. Oral Health Prev Dent 2011;9:91-7.
Mataftsi M, Skoura L, Sakellari D. HIV infection and periodontal
diseases: An overview of the post-HAART era. Oral Dis 2011;17:13-25.
Gorsky M, Buchner A, Fundoianu-Dayan D, Aviv I. Physiologic
pigmentation of the gingiva in Israeli Jews of different ethnic origin.
Oral Surg Oral Med Oral Pathol 1984;58:506-9.
Tamizi M, Taheri M. Treatment of severe physiologic gingival
pigmentation with free gingival autograft. Quintessence Int
1996;27:555-8.
Gondak RO, da Silva-Jorge R, Jorge J, Lopes MA, Vargas PA. Oral
pigmented lesions: Clinicopathologic features and review of the
literature. Med Oral Patol Oral Cir Bucal 2012;17:e919-24.
Chandrashekar BR, Suma S, Kiran K, Manjunath BC. The use of school
teachers to promote oral hygiene in some secondary school students
at Hyderabad, Andhra Pradesh, India: A short term prospective pilot
study. J Family Community Med 2012;19:184-9.
Bayraktar G, Kurtulus I, Duraduryan A, Cintan S, Kazancioglu R,
Yildiz A, et al. Dental and periodontal findings in hemodialysis
patients. Oral Dis 2007;13:393-7.
Machuca G, Segura-Egea JJ, Jiménez-Beato G, Lacalle JR, Bullón P.
Clinical indicators of periodontal disease in patients with coronary
heart disease: A 10 years longitudinal study. Med Oral Patol Oral Cir
Bucal 2012;17:e569-74.
Louridis O, Demetriou N, Bazopoulou-Kyrkanidou E. Periodontal
ligament thickness as related to age and mesiocclusal drifting of
teeth: A histometric study. J Periodontol 1974;45:862-5.
Cuoghi OA, Tondelli PM, Aiello CA, Mendonça MR, Costa SC.
Importance of periodontal ligament thickness. Braz Oral Res
2013;27:76-9.
Phal PM, Myall RW, Assael LA, Weissman JL. Imaging findings of
bisphosphonate-associated osteonecrosis of the jaws. AJNR Am J
Neuroradiol 2007;28:1139-45.
Mehra A, Kumar S. Periodontal manifestations in systemic sclerosis:
A review. Dent Today 2008;27:50, 52, 54.
Padbury AD Jr, Tözüm TF, Taba M Jr, Ealba EL, West BT, Burney RE,
et al. The impact of primary hyperparathyroidism on the oral cavity.
J Clin Endocrinol Metab 2006;91:3439-45.
Ku m u d a A r v i n d Ra o H T, S h e t t y S R , B a b u S. U n u s u a l
clinicoradiographic presentation of a lateral periodontal cyst. J Dent
(Tehran) 2012;9:265-9.
Formoso Senande MF, Figueiredo R, Berini Aytés L, Gay Escoda C.
Lateral periodontal cysts: A retrospective study of 11 cases. Med
Oral Patol Oral Cir Bucal 2008;13:E313-7.
Marquez IC. How do I manage a patient with periodontal abscess?
J Can Dent Assoc 2013;79:d8.
Bhat GS, Singh V, Bhat KM. Recurrent periodontal abscess associated
with “teeth as a tool”. J Indian Soc Periodontol 2012;16:113-4.
Singh A, Sharma RK, Siwach RC, Tewari S, Narula SC. Association
of bone mineral density with periodontal status in postmenopausal
women. J Investig Clin Dent 2013.
Mesa F, Souki N, Galindo-Moreno P, Velasco-Torres M, O’Valle F,
Bravo M. Tobacco consumption induces alveolar crest height loss
independently of mandibular bone mass and bone density. Clin Oral
Implants Res 2014;25:1034-40.
21
Shamim: Periodontics perspective in identification and age
42.
43.
44.
45.
46.
47.
48.
49.
22
Esfahanian V, Shamami MS, Shamami MS. Relationship between
osteoporosis and periodontal disease: Review of the literature. J Dent
(Tehran) 2012;9:256-64.
Sawada K, Nakahara K, Matsunaga S, Abe S, Ide Y. Evaluation
of cortical bone thickness and root proximity at maxillary
interradicular sites for mini-implant placement. Clin Oral Implants
Res 2013;24 Suppl A100:1-7.
Antonelli JR, Hottel TL. Oral manifestations of renal osteodystrophy:
Case report and review of the literature. Spec Care Dentist
2003;23:28-34.
Pham D, Jonasson G, Kiliaridis S. Assessment of trabecular pattern
on periapical and panoramic radiographs: A pilot study. Acta Odontol
Scand 2010;68:91-7.
Aranha Watanabe PC, Moreira Lopes De Faria L, Mardegan Issa JP,
Caldeira Monteiro SA, Tiossi R. Morphodigital evaluation of the
trabecular bone pattern in the mandible using digitized panoramic
and periapical radiographs. Minerva Stomatol 2009;58:73-80.
Jayakumar A, Rohini S, Naveen A, Haritha A, Reddy K. Horizontal
alveolar bone loss: A periodontal orphan. J Indian Soc Periodontol
2010;14:181-5.
Ribeiro FV, Hirata DY, Reis AF, Santos VR, Miranda TS, Faveri M,
et al. Open-flap versus flapless esthetic crown lengthening:
12-month clinical outcomes of a randomized controlled clinical trial.
J Periodontol 2014;85:536-44.
Malkinson S, Waldrop TC, Gunsolley JC, Lanning SK, Sabatini R. The
effect of esthetic crown lengthening on perceptions of a patient’s
attractiveness, friendliness, trustworthiness, intelligence, and selfconfidence. J Periodontol 2013;84:1126-33.
50.
Ronay V, Sahrmann P, Ender A, Bindl A, Schmidlin PR. Cerec
reconstruction of a hemisected mandibular molar: Method and case
report. Int J Comput Dent 2012;15:55-66.
51. Wolff LF. Guided tissue regeneration in periodontal therapy.
Northwest Dent 2000;79:23-8, 40.
52. Dannan A. Minimally invasive periodontal therapy. J Indian Soc
Periodontol 2011;15:338-43.
53. Shamim T, Ipe Varghese V, Shameena PM, Sudha S. Age
estimation: A dental approach. J Punjab Acad Forensic Med Toxicol
2006;6:14-6.
54. Ubelaker DH, Parra RC. Application of three dental methods of adult
age estimation from intact single rooted teeth to a Peruvian sample.
J Forensic Sci 2008;53:608-11.
55. González-Colmenares G, Botella-López MC, Moreno-Rueda G,
Fernández-Cardenete JR. Age estimation by a dental method:
A comparison of Lamendin’s and Prince & Ubelaker’s technique.
J Forensic Sci 2007;52:1156-60.
© GESDAV; licensee GESDAV. This is an open access article licensed under
the terms of the Creative Commons Attribution Non-Commercial License
(http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted,
non-commercial use, distribution and reproduction in any medium, provided
the work is properly cited.
Source of Support: Nil, Conflict of Interest: None declared.
Eur J Forensic Sci
● Oct-Dec 2014 ● Vol 1 ● Issue 1