Age estimation ( Dental) & PM Instruments.pptx

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1. DENTAL

2. TEETH Eruption and Calcification Aspartic Acid Racemization Tooth Development Stages / Degree of Tooth Mineralization / Radiographic Gustafson’s Method Boyde’s Method – Histologic Stack Method – Size and Weight

3. Eruption and Calcification Tooth Structure Tooth Development and Eruption Deciduous Teeth Eruption Calcification Permanent Teeth Eruption Calcification

4. Tooth Structure

5. Tooth Development and Eruption Formation of alveolar cavities Development of tooth germ Formation of enamel and dentin Neonatal line Eruption of deciduous tooth Completion of root formation Calcification of teeth Eruption of permanent tooth

6. Differences between Deciduous and Permanent Teeth S.No Criteria Deciduous Teeth Permanent Teeth Crown 1. Size Smaller, Lighter, Narrower Heavier, Stronger, Broader 2. Direction of Ant. Teeth Vertical Inclined to forward 3. Colour China white Ivory White 4. Rate of attrition Quick Slow 5. Enamel Thinner, Bulges out close to cervical line Thicker, Tapers close to cervical line 6. Neck More constricted, Marked Less constricted

7. S.No Criteria Deciduous Teeth Permanent Teeth Crowns of Anterior Teeth 7 Labial Surface Smoother Depressions / Perikymata 8 Incisal Edges No mameolons Mameolons present Crowns of Posterior Teeth 9 Molars Buccal and ligual surface are flatter Less flat Roots 10 Molars Smaller and more divergent Larger and less divergent

8. Mamelons Deciduous Permanent

9. Deciduous Teeth Eruption S.No Tooth Eruption Root Resorption Begins 1. Central Incisor – Lower 6 Months 4 th Year 2. Central Incisor – Upper 8 Months 5 th Year 3. Lateral Incisor – Upper 10 Months 5 th Year 4. Lateral Incisor – Lower 12 Months 5 th Year 5. 1 st Molar 14 Months 6 th Year 6. Canine 18 Months 8 th Year 7. 2 nd Molar 24-30 Months 7 th Year

10. Deciduous Teeth Calcification S. No Tooth Calcification Begins Calcification of root complete 1. Central Incisor – Lower 14 Wk IU 1.5 to 2 Yrs 2. Central Incisor – Upper 14 Wk IU 1.5 to 2 Yrs 3. Lateral Incisor – Upper 16 Wk IU 1.5 to 2 Yrs 4. Lateral Incisor – Lower 16 Wk IU 1.5 to 2 Yrs 5. 1 st Molar 15.5 Wk IU 2 to 2.5 Yrs 6. Canine 17 Wk IU 2.5 to 3 Yrs 7. 2 nd Molar 18-19 Wk IU 3 Yrs

11. Permanent Teeth Eruption S.No Tooth Eruption 1. 1 st Molar 6 Yrs 2. 1 st (Central) Incisor 7 Yrs 3. 2 nd (Lateral) Incisor 8 Yrs 4. 1 st Premolar 9 Yrs 5. 2 nd Premolar 10 Yrs 6. Canine 11 Yrs 7. 2 nd Molar 12 Yrs 8. 3 rd Molar 18 – 25 Yrs

12. Permanent Teeth Calcification S.No Tooth Calcification Begins Calcification of root complete 1. 1 st Molar At Birth 9 Yrs 2. 1 st (Central) Incisor 4 Months 10 Yrs 3. 2 nd (Lateral) Incisor 1 Yr 11 Yrs 4. 1 st Premolar 1.5 Yrs 12 Yrs 5. 2 nd Premolar 2 Yrs 13 Yrs 6. Canine 4 Yrs 13 Yrs 7. 2 nd Molar 2.5 - 3 Yrs 15 Yrs 8. 3 rd Molar 8 – 10 Yrs 18 – 25 Yrs

13. Age wise Dentition Chart Age Temporary Teeth Permanent Teeth Total Teeth 6 M 2 2 8 M 4 4 10 M 6 6 12 M 8 8 14 M 12 12 18 M 16 16 21/2 – 5 Y 20 20

14. Age Temporary Teeth Permanent Teeth Total Teeth 6 Y 20 4 ( M1 ) 24 7 Y 16 8(+ I1 ) 24 8 Y 12 12(+ I2 ) 24 9 Y 8 16(+ PM1 ) 24 10 Y 4 20(+ PM2 ) 24 11 Y 24(+C) 24 12 Y 28 (+ M2 ) 28 18-24 Y 32(+ M3 ) 32

15. AGE ESTIMATION FROM TEETH

16. Gustafson’s Method Objective method for determining age in dead Six Criteria 1. Attrition 2. Secondary dentin 3. Paraodontosis 4. Cementum apposition 5. Root Resorption 6. Transparency of Root

17. Technique Most suitable teeth are incisors Observation of Periodontosis before removal Cleaned and disinfected with 3 % H2O2 Ground down perpendicular to axis Scoring of all 6 criteria, plot against graph Rate of Error - +/- 4 to 7 years

18. Stack Method Stack evolved s method to know age from weight of the erupting teeth of fetus & infant. Dry weight of the mineralized tooth cusps can gives an approximate age of the child. From 5 months in utero to postnatal age of 7 months. Formula applied using height and weight of teeth to calculate the age of the child. Age (Weeks) Sum of teeth weight (mg) 28 (prenatal) 60 40 (prenatal) 460 2 (postnatal) 530 30 (postnatal) 1840

19. Boyde’s Method Histological method Basis – Ameloblasts produce enamel in the crowns which appears like incremental striae ( Striae of Retzius ) The darkest & thickest incremental line is neonatal line The neonatal line is the darkest band which represents the disrupted enamel formation due to the stress of being born Counting of enamel rings outside neonatal line can reveal age of child. Applicable mainly to infants. Accuracy with error of 20 days.

20. INCREMENTAL LINES Successive apposition of layers of enamel during formation of crown. Appear as brownish bands in ground section. Surround the tip in longitudinal section Appear like concentric rings in transverse section like annual rings of tree.

21. NEONATAL LINE

22. PERIKYMATA Transverse ridges or grooves on external surface of enamel corresponding to incremental lines is called Perikymata

23. ASPARATIC ACID RACEMIZATION Amino acids are optically active having 2 forms ‘L’ & ‘D’ enantiomers which are mirror images of each other. Living forms have ‘L’ form of enantiomers which is partly converted to ‘D’ form over time. This racemization stops with death. Among all the amino acids, asparatic acid has one of the fastest racemization rates & most commonly used for age estimation. It is currently one of the most accurate & reliable methods for the estimation of age.

24. Aspartic Acid Racemization Age estimation by quantifying relative amounts of L- and D-forms (High Performance Liquid Chromatogrpahy + Mass Spectroscopy)

25. Numbering and Coding Systems of the Teeth (Nomenclature)

26. Universal System. Palmer Notation System. The Federation Dentaire International (FDI) 2 digit system CHARTING OF TEETH

27. UNIVERSAL NOTATION SYSTEM UPPER RIGHT UPPER LEFT LOWER RIGHT LOWER LEFT

28. PAMLER NOTATION SYSTEM

29. The Federation Dentaire International: (FDI) system assigns two numbers to each tooth in any quadrant. The first number indicates the quadrant in which the tooth is positioned and the second number identifies the specific tooth. The first numbers 1 through 4 for Permanent Dentition, 5 through 8 for the Primary Dentition.

30. Permanent Dentition Maxillary Left Teeth Maxillary Right Teeth 2 1 3 4 Mandibular Left Teeth Mandibular Right Teeth

31. Quadrant codes 1 upper right permanent teeth 2 upper left permanent teeth 3 lower left permanent teeth 4 lower right permanent teeth

32. 5 upper right deciduous teeth 6 upper left deciduous teeth 7 lower left deciduous teeth 8 lower right deciduous teeth

33. Tooth codes 1 central incisors 2 lateral incisors 3 canines 4 1st premolars (permanent teeth) / 1st molar (deciduous teeth)

34. 5 2nd premolars (permanent teeth) / 2nd molar (deciduous teeth) 6 1st molars (permanent teeth) 7 2nd molars (permanent teeth) 8 3rd molars (permanent teeth)

35. Permanent Dentition Maxillary Left Teeth Maxillary Right Teeth 2 8 2 7 2 6 2 5 2 4 2 3 2 2 2 1 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 3 8 3 7 3 6 3 5 3 4 3 3 3 2 3 1 4 1 4 2 4 3 4 4 4 5 4 6 4 7 4 8 Mandibular Left Teeth Mandibular Right Teeth

36. Primary Dentition Maxillary Left Teeth Maxillary Right Teeth 6 5 7 8 Madibular Left Teeth Mandibular Right Teeth

37. Primary Dentition Maxillary Left Teeth Maxillary Right Teeth 6 5 6 4 6 3 6 2 6 1 5 1 5 2 5 3 5 4 5 5 7 5 7 4 7 3 7 2 7 1 8 1 8 2 8 3 8 4 8 5 Mandibular Left Teeth Mandibular Right Teeth

38. Law for age estimation Juvenile Justice Act 2015, Section 94 Birth Certificate (or equivalent certificate) by school Birth certificate by corporation or municipality or panchayat Medical examination on orders of committee or board.

39. Scenario Mr. Ajay S/o Gopal Singh, resident of H.No - 6/2/12, Serene Palza , Fatimanagar , Pune , who is working in a factory has been arrested by Police of Wanaworie for alleged complaint of assault on girl against him today morning. He gives his age is of 17 years, however police feels his age is more than 18 years. His height is 145 cm, weight 50 kg and all teeth erupted except third molars. He is sent to you by Sub inspector of Wanaworie Police station with a letter along with Hav . N Gaikwad , No 7891 for medical examination and estimation of age of Mr. Ajay. You are requested to examine the above individual and enlist the relevant radiological findings with X-Rays.

40. To, The Sub Inspector, Wanaworie Reference : FMT / AFMC /1/2018 Name : Mr . Ajay , S/o Gopal Singh Age : (a) As alleged by subject : 17 Years (b) As alleged by person or police accompanying : >18 Years Sex : Male ; Occupation : Factory Worker ; Marital Status : Unmarried Address : H.No - 6/2/12, Serene Palza , Fatimanagar , Pune Brought by Police Constable : Name : Hav . N Gaikwad , No,: 7891 ; P.S : Wanaworie , Letter No : 1234/1/18 dated 3 Oct 2018 Identified by : Hav . N Gaikwad / (Parent / Guardian) Date and Time of Examination : 4 Oct 2018 at 1430 Hrs Place of examination : Armed Forces Medical College, Pune Alleged History : Alleged history of assault on a girl today morning at at around 0830 hours near Fatima Nagar.

41. Consent : I, Ajay S/D/W/o : Gopal Singh R/o H.No - 6/2/12, Serene Palza , Fatimanagar , Pune give my free consent for a complete medical examination and other relevant investigations for the purpose of making an age report. The nature and consequences of such examination have been explained to me in my own language and I have understood them.   Signature / Thumb impression of Witness : $$$$ (If minor below 12 yrs, consent of Parents / Guardian) Examined in presence of (If Female) : NA _________________________ (Signature of female attendant) Identification Marks : (Preferably note only on exposed areas, opposite sides) 1. Black Mole on Right Hand, over base of thumb, 2 mm diameter, Elevated and Non-hairy 2. Black Mole on Left Ankle , inner side, 2 mm diameter, Non-elevated, Non-hairy Birth Date : ( As per alleged ) Education : 10 th STD

42. Physical Examination : 1. Height : 145 cm 2. Weight : 50 kg 3. Chest girth at the level of nipple : 72 cm 4. Abdominal girth at the level of navel : 65 cm 5. General build and appearance : Avg. bulit and well nourished 6. Hairs : Pubic : Present , Axillary : Present , Scalp : Present, Black , Facial : Present , (Beard : Absent , Moustache : Absent ) Body : Present, Sparse 7. Development of breasts : NA 8. Development of genitals : Well developed, Normal 9. Onset of Puberty : Voice : Hoarse Adam’s apple : Prominent Menarche (in females) – Yes / No, If yes, how much time before ; NA Date of Menarche : ___________ Regularity of menses : _________

43. 10. Dental Examination : Orodental Hygiene : Good Dental Formula : (Mark ‘S’ – Indicates space behind 2 nd Molar Mark ‘X’ – Indicates tooth not erupted or space not present) 1. Any other findings : Skin : Normal, No wrinkles Eye : Black, Normal Other : No medical Co-morbidities 2. Advised X-Ray : X-Rays of Shoulder, Elbow, Wrist, Pelvis X 17 16 15 14 13 12 11 21 22 23 24 25 26 27 X X 47 46 45 44 43 42 41 31 32 33 34 35 36 37 X

44. X-Ray of Shoulder X-Ray Plate No R1245 /18 dated 3 Oct 2018 Findings Head Fused with Shaft  > 18 to 19 Years Acromion united  17 – 18 yrs

45. X-Ray Shoulder Joint Age Finding 1 Yr Head of Humerus (A) , Tip of coracoid (A) 3 Yrs Greater Tubercle (A) 5 Yrs Lesser Tubercle (A) 5 to 6 Yrs All the above fuses to form composite epiphysis 10 - 11 Yrs Coracoid Base (A) 14 - 15 Yrs Acromion process (A), Coracoid base unites with scapula 17 – 18 yrs Acromion process fuses with Scapula, 18 - 19 Yrs Composite epiphysis fuses with shaft of Humerus

46. X-Ray of Elbow X-Ray Plate No R1246 /18 dated 3 Oct 2018 Findings Medical epicondyle fused shaft  > 16 – 17 Years Upper end of Radius and Ulna united with shaft  > 16 – 17 Years

47. X-Ray of Elbow Joint Age Findings 1 Yr Capitulam (A) 5 Yrs Head of Radius – Upper end (A) 6 – 7 Yrs Medial Epicondyle (A) 9 Yrs Ulna – Upper end / Olecranon (A) 10 Yrs Trochlea (A) 10 – 11 Yrs Lateral Epicondyle (A) 14 – 15 Yrs Conjoint Epiphysis formation - Union of 3 Centers Capitulam + Trochlea + Lateral Epicondyle 16 – 17 Yrs Conjoint Epiphysis fuses with Shaft of Humerus 16 - 17 Yrs Medical Epicondyle fuses with shaft of Humerus 16 – 17 yrs Upper end Radius and Ulna fuses with Shaft

48. X-Ray of Wrist X-Ray Plate No R1247 /18 dated 3 Oct 2018 Findings Pisiform appeared  > 12 Years Base of 1 st Metacarpal Fused  > 15 Years Lower end Radius and Ulna not fused  < 19 Years

49. X-Ray of Wrist Joint & Hand Age Findings 2 Month Capitate (A) 3 Month Hamate (A) 1.5 – 2.5 Yrs Heads of 2 nd to 5 th Metacarpal (A) 2 Yrs Lower end of Radius (A) 2 -3 Yrs Base of 1 st Metacarpal (A) 3 Yrs Triquetral (A) 4 Yrs Lunate (A)

50. Age Findings 4 – 5 Yrs Scaphoid (A) , Trapezoid (A), Trapezium (A) 5 – 6 yrs Lower end of Ulna (A) 9 – 12 Yrs Pisiform (A) 15 Yrs Base of 1 st Metacarpal fuses unites with Shaft 16 Yrs Head s of 2 nd to 5 th Meatcarpal unites with Shaft 18 - 19 Yrs Lower end of Radius and Ulna unites with Shaft

51. X-Ray of Hip X-Ray Plate No R1248 /18 dated 3 Oct 2018 Findings Iliac Crest not fused  < 20 Years Head of femur fused  > 17 – 18 years

52. X-Ray of Pelvis Findings Age Ischio -Pubic rami unites by - 7 – 8 Yrs Acetabular cup appears as Tri-radiate cartilage - 13 years Tri-radiate gets united appears as cup - 15 years Iliac Crest Oss. Center & Pubis Center appear at - 14 Yrs Both unite at - 20 Yrs Tip of Ischium appears & fuses respectively by - 16 Yrs & 20 Yrs Sacrum begins to unite by 20 yrs, and becomes a single bone by 25 yrs

53. Ossification takes place slightly earlier (by about a year) in females than in males. Parts Appearance Fusion Head 0.6 to 1 Yr 17 to 18 Yrs Greater Trochanter 4 Yrs 17 to 18 Yrs Lesser Trochanter 12 to 14 Yrs 17 to 18 Yrs Lower end 9 th month (at birth) 18 to 19 Yrs

54. Provisional Age Certificate OPINION On clinical examination of the individual, age is about more than 18 and less than 19 years. However, the final opinion regarding the age should be collected from this office after submission of the Radiological report and the birth certificate. Signature : @@@@ Name (Dr. ABCD ) Designation : RMO MCI Reg No : 8880 Stamp :   Place : AFMC , Pune   Date : 4 Oct 2018

55. Age Certificate To, The Sub Inspector, Wanaworie Reference : Age estimation of Mr Ajay , letter No . FMT / AFMC /1/2018 dated 03 Oct 2018. Sir, I Dr. ABCD , after going through the findings of Mr. Ajay S/D/W/o : Gopal Singh R/o H.No - 6/2/12, Serene Palza , Fatimanagar , Pune .

56. Physical examination report No. 1234/2018 , dated 03 Oct 2018 , X-Ray plate No. R1248 /18 dated 03 Oct 2018 , Radiological Examination report No. 4321/X/18 , dated 03 Oct 2018 , and the Date of Birth Certificate No. 1232 6544 9439 , dated 1 Jan 1990 produced before me, I am of the opinion that the individual’s age is about more than 18 less than 19 years . Signature : @@@@ Name (Dr. ABCD ) Designation : RMO MCI Reg No : 8880 Stamp : Place : AFMC , Pune   Date : 4 Oct 2018

57. POST-MORTEM INSTRUMENTS

58. Artery Forceps

59. These are the scissor-like instruments having serrated margins over the blunt blades and a catch at handles which facilitates to lock the instrument so that blades don’t open. Two types Straight & Curved Uses To clamp the cardiac and pyloric end of the stomach to prevent spillage of gastric contents To strip the dura mater to check for any fractures at the base of the skull

60. Amputation Knife It is a single piece instrument wherein handle is modified to be continued as a single-edged blade. Uses To cut through joints for dismemberment.

61. Bone Cutter It is a non-detachable instrument. Uses To cut the first rib while opening the thoracic cavity To disarticulate or cut through the sterno-clavicular joint before removing the sternum.

62. Brain Knife It is the largest of all knives, made of stainless steel. Uses To make sections of the brain To make cut sections of the solid organs such as lung, liver, kidney and brain All the organs are cut along their long axis

63. Calipers Description - Made of stainless steel, has a metallic scale and two movable semicircular parts with one end that can slide on the scale and the other end is knobbed. Use - For measuring dimensions of skull while assessing cephalic index

64. Cartilage Knife It is a single piece instrument wherein handle is modified to be continued as single-edged blade. Uses Cut through the costo-chondral junction to remove the sternum To cut through the inter-costal muscles so as to check for any rib fracture

65. Saw Hand saw   Description - Made of stainless steel, single blade saw, length of the blade is about 20 cms with one side serrated Uses To open the skull – Cut outer table To cut lamina and pedicle of the vertebral column

66. Saw Councilman’s Saw

67. Hack Saw Rachiotomy Saw

68. Electric Saw

69. Hand saw   Description - made of stainless steel, single blade saw, length of the blade is about 20 cms with one side serrated Use - sawing and cutting the skull cap and spinal laminae

70. Enterotome It is a non-detachable instrument having a pointed blade and a blunt blade. The blunt end (called as guiding end) prevents formation of artifacts (tears). Uses For opening of the stomach and other hollow viscera or organs Can be used in cutting open the ventricles of the heart

71. Forceps

72. Forceps Three types Non-tooth (Smooth) forceps Toothed forceps Rubber tip forceps Uses Toothed and blunt – To hold and incise various structures such as skin, dura , great vessals , oesophagus Rubber tip – To hold bullet retrived during autopsy

73. Hammer and Chisel

74. For opening skull, the inner table To remove pituitary gland To chip mastoid cell and to look for haemorrhages in case of drowning

75. Probe Made of stainless steel, has a blunt end and the other end is having an eye Uses To explore coronary arteries, bile ducts, pancreatic ducts, ureter , and urethra etc.

76. Rib Shear / Rib Cutter

77. Made of stainless steel, long handle for mechanical advantage, the blades are curved  Uses To cut the ossfied ribs ( costo-chondral junction) and sterno-clavicular joint

78. Scalpel Made up of stainless steel Two types 1. Detachable – Blade can be replaced 2. Non-detachable – Single unit handle continues as blade

79. Uses To make incision To reflect scalp To cut tentorium cerebelli Dissection of heart – Serial sectioning of coronary artery Foetal Autopsy Dissection for looking ossification centres

80. Scissors Straight large Scissors To open abdominal cavity To cut dura mater and pericardium, aorta, trachea To cut diaphragmatic attachments

81. Medium Sized Scissors To open skull during foetal autopsy in a flower like pattern Preferred scissor for foetal autopsy Used instead of large straight scissors

82. Small Scissors (Mayo Scissors) To cut bile duct, renal arteries, coronary artery To cut open carotid artery in cases of hanging or strangulation to look for tears

83. Spinal Wrench Description - Made of stainless steel, measuring about 17 cms , one half is handle and the other half is having a sharp blade on one side with a small projection at the tip. Use- For opening Spinal Laminae

84. Tongue Knife

85. Tongue Knife Blade longer (2 times) than handle Width of blade is less compared to brain knife Uses To retrieve tongue, cut inner surface of mandible attachments For removal organs in en mass removal technique To open ventricles of heart To cut cervical fascia and neck muscles To cut through spinal cord to look for any injury

86. Weighing Machine Description - made of stainless steel, it is a balance with two metallic pans, one pan is used for keeping weights and the other pan is used for keeping organs. Use- for determining weight of viscera