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S
Legal MedicineJournal Club
Alejandro Garcés Descovich
Emily Rincón ÁlvarezJorge Enrique Ruíz M
Universidad de La SabanaLegal MedicineXI SemesterApril 24th of 2010
KEYWORDS:
• Forensic age estimation• Criminal proceedings• Dental age• Skeletal maturity
CONTENT INDEX
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
6. Questions time
INTRODUCTION
Estimating the age of living subjects as a problem
Difficult problems facing forensic medicine Criminal Proceedings Doubt (Authorities) Charging of a crime according to age
INTRODUCTION
The need for accurate age estimation techniques has never been greater due to armed conflicts in many countries in our time Immigrants Asylum-seekers
INTRODUCTION
Time consuming task that requires interdisciplinary approach.
Physicians with forensic experience Knowledge of Auxology Radiology Dentistry Legal Medicine
INTRODUCTION
Main objective Differences between
Skeletal Dental age assesments
Comparison of left hand/wrist radiographs and OPG’s
INTRODUCTION
INTRODUCTION
A = Calcification of oclusal points.
B = Fusion of the calsification points
C = End of formation of the enamel.
D = Formation of the crown.
E = The lenght of the root is shorter than the height of the crown.
F = The lenght of the root is the same that the crown.
G = the end of the formation of the root.
H =Closing of the apical orifice.
DERMIRJIAN METHOD
MATERIALS AND METHODS
Retrospective review
Sample 52 immigrants (41 males 11
females) Bari, Italy.
MATERIALS AND METHODS
Originated from areas with major world conflict The Balkans (Slovenia, Serbia, Croatia) Albania Middle East (Palestine, Lebanon, Iran, Iraq, Egypt) (Algeria, Morocco, Nigeria).
MATERIALS AND METHODS
Data: May 1989 to September 2007
Clinical assessment of the individuals Physical examination (Body Mass Index) Signs of sexual maturity (Tanner Staging System)
MATERIALS AND METHODS
Data: Skeletal development
Radiologic exam of Left hand/wrist (Greulich-Pyle method)
Dental examination Inspection oral cavity OPG’s (Panorex)
Pelvic X-ray (23 individuals)
MATERIALS AND METHODS
RESULTS
26 of the 52 individuals Reported ages lower than the assessed ages.
In 43 of all cases, the reported age was 18 years, but only 17 were confirmed by radiographic examinations
OPGs Hand/wrist X-rays
In 26 cases age estimation the individuals were older than had been reported.
RESULTS
RESULTS
Case no. 25: Reported age:
16 years and 8 months Estimated biological age:
22 years and 6 months
Discrepancy in reported age was 5 years and 10 months
RESULTS
Statistically significant difference between: Reported age and assessed biological age
(t = 4.085; p < 0.001)
No statistically significant difference between: Skeletal age and assessed dental age
(t = 0.791; p = 0.431).
DISCUSSION
Analysis of the data revealed:
Significant correlation between: Results from:
Left hand/wrist X-rays OPGs
Almost every individual, indicating:
• Similar growth patterns:• Skeletal• Dental structures
Younger than 16 years
THE OLDER A SUBJECT BECOMES=
THE LESS ACCURATE THE METHODS ARE
DISCUSSION
Markers for: Bones Teeth Sexual development
The only reliable indices for assessing a living individual’s age in forensic settings.
DISCUSSION
Sexual development markers + BMI Is not appropriate for age estimation (Variability)
Diseases (disproportionate growth) Result of malnutrition Congenital disorders
Physical examination (Empirical)
DISCUSSION
X-rays represent the most objective method Assessing dental and bone maturity.
Immigrants in an attempt to avoid criminal prosecution Report their ages as younger than they actually are.
CONCLUSIONS
Standardization of methods used in the age estimation of living individuals is imperative.
All of the techniques employed to asses age in a living individual Estimates of Biological age Doesn’t certains chronological age
CONCLUSIONS
Differences in the rate of ossification in various age-groups Primarily the result of:
Socioeconomic factors
A careful approach to age determination is necessary Few physicians are skilled in forensic age determination. Entrust expert pathologists with the task of performing
age assessment
QUESTIONS???
23rd of April “Day of the Language”
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