Dental Aspects of 3-D Facial Reconstruction

Your name

Your college name

Introduction

The name forensic comes from “forum”, the Roman market place where lawyers did their business.

Every specialty in medicine can have forensic aspects.

Forensic Medicine & Odontology

Forensic medicineForensic medicine is also called as Legal medicine or Medical Jurisprudence, is a branch of medicine which deals with the interaction of medical science with the law.

Forensic odontologyForensic odontology is the study of teeth, dentures and bite marks for the purpose of obtaining criminal evidence, or identifying physical remains or the source of bite wounds

What is Facial Reconstruction?

It is the most commonly used term to designate the procedure of projecting a soft tissue, based on skull architecture.

Synonyms of Facial reconstruction: Facial reproduction Facial restoration Facial approximation

Facial approximation is the better description of the procedure but this term is not in general use.

Types of Facial reconstruction 3 major types of facial reconstruction are:

2-D facial reconstruction 3-D facial reconstruction Computer aided facial reconstruction

3-D facial reconstruction can be done by 3 methods: Anatomical method Tissue depth method Combination method

Facial Reconstruction Step-1Skull protection & preservationSkull protection & preservation

Facial Reconstruction Step-2Placement of tissue depth markersPlacement of tissue depth markers

Facial Reconstruction Step-3Contouring important anatomical landmarksContouring important anatomical landmarks

Facial Reconstruction Step-4Adding more musclesAdding more muscles

Facial Reconstruction Step-5Reconstruction without skinReconstruction without skin

Facial Reconstruction Step-6Completed ReconstructionCompleted Reconstruction

Facial Reconstruction Step-7Finishing touches & Adding accessoriesFinishing touches & Adding accessories

What are the Dental considerations?

#1-Skull protection & handling

Skull should always be handled with care.

Loose or fallen teeth should be replaced with professional help.

Any fractures or bullet wounds need to be taped with masking tape to avoid being filled with clay.

#1-Skull protection & handling

#2-General dental assessment

Once the teeth are secured, evaluate the dentition for potentially useful information like: Clean, open socket indicates post-mortem loss of tooth Socket filled with bone means missing tooth for a period of years

Assessment of teeth & bite provide information about: Appearance of the mouth Socioeconomic status of the individual during life

#2-General dental assessment

#3-Correct positioning of mandible

Jaw relation should be assessed.

Presence of any crowns or dentures.

Any missing teeth. Any lesions within the jaw causing bone expansion.

#3-Correct positioning of mandible

#4-Positioning edentulous mandible

If an edentulous skull with dentures are given, dentures should be placed on the ridge using some clay to simulate the missing gingival tissue.

If there are no dentures, mandible can be positioned using a pencil placed through mandibular notch, behind pterygoid and through opposite mandibular notch.

#4-Positioning edentulous mandible

#5-Gluing mandible to cranium

In life, condyle of the ramus is covered by cartilage and there is an articular disc in TMJ.

This spacing is simulated with the help of clay, cotton, gauge or other materials.

Bone-to-bone gluing should be avoided.

#5-Gluing mandible to cranium

#6-Inter-arch space maintenance

In life, there is spacing between the teeth of the two jaws called as Freeway space.

It should be maintained by placing a toothpick on the occlusal surface of molars and glued.

If teeth-to-teeth contact method is used, the form of facial musculature should be changed accordingly.

#6-Inter-arch space maintenance

#7-Dealing with incomplete skulls

Skulls can be incomplete due to animal activity, injuries, gunshot wounds, explosions or normal deterioration over time.

Such reconstruction can prove very challenging and is no job for the inexperienced forensic artist.

Large areas of cranium can be missing, but don’t interfere with the reconstruction process.

#7-Dealing with incomplete skulls (Contd..)

Common situation of incomplete skull is missing mandible such cases present greater complexity and somewhat diminished likelihood for identification.

Successful mandibular approximation is outlined by: Sassoni & Krogman

Use of lateral and frontal radiographs. It is hypothetical It assures a normal, well proportioned face, but the outcome

of restoration is acceptable

#7-Dealing with incomplete skulls

An Ideal Facial Reconstruction

Conclusion

The mentioned dental considerations in facial reconstruction are simple but play a very important role in making an ideal reconstruction.

Most forensic artists overlook and ignore these steps, leading to inaccurate results.

Thus, a dentist should be consulted for professional help regarding the above stages for achieving the best results.

Special Thanks To

Thanks a lot for not sleeping !