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By S. Kamak. Bellarmine University. 2018.
Meticulous evaluation of the original materials facilitates the creation of an accurate record of the status of the patient’s mouth at the time of the last dental visit purchase 4 mg risperdal with amex symptoms 24. It is important to review all written records and radiographs and to give special attention to the most recent procedural notes discount risperdal 4mg without a prescription treatment efficacy, patient ledgers, and radiographs. Dental treatment is regularly performed afer the latest radiographic and clinical examination. Te antemortem forensic record should be recorded in a format that accurately portrays the latest known status of that patient’s dental status (Table 9. Although this is commonly done manually for indi- vidual identifcations, in multiple fatality incidents it is likely that a computer program will be used for the search and comparison of the antemortem and postmortem records. Tis allows the comparison of a record (antemortem or postmortem) against all opposing (postmortem or antemortem) records in the database, with the resulting possible matches displayed and linked for further visual comparison. Te search results are displayed in fve separate tables as most dental hits, least dental mismatches, most restoration hits, most 172 Forensic dentistry identifer matches, and fuzzy dental logic. Afer selecting a record for compar- ison, the examiner is then able to view the specifcs of each record and view the case identifers, the odontogram, and an associated graphic/radiograph of the cases in a side-by-side fashion. Whether the initial comparisons are made manually or with the aid of a computer, a visual comparison of the records should be made by the forensic odontologist. Forensic dentists may assist medical examiners and coroners by compar- ing the dentition of decedents with antemortem photographs showing the teeth. Souviron, who has long used what he calls smiley-face photographs to compare to unidentifed bodies. Te grin line method (a smile may not show teeth) using Adobe® Photoshop® has been developed, evaluated, and utilized. Te method and its uses have been presented in the Odontology Section of the American Academy of Forensic Sciences. Tis is true of all anatomic features, including fngerprints and the teeth (see Chapters 6 and 14). Forensic examiners have considered the mathematical probability of an individual dentition having a unique combination of missing or present teeth, restored and unrestored teeth, or restored or unrestored surfaces of those teeth. Te number of diferent combinations possible in this type of mathematical sampling is very large. In the abstract for this paper Keiser-Nielsen cautioned that a dental expert “cannot base his identifcation of an unknown body on the relative frequency of occur- rence of any singular dental feature, its particular discrimination potential. Forensic dental identifcation 173 Instead, he must make a quantitative and qualitative evaluation of the combi- nation of features involved. Keiser-Nielsen’s interest was initiated by the acceptance of fngerprint analysis in courts all over the world based on their accuracy and reliability. Although standards varied in diferent jurisdictions at that time, in most, when twelve concordant fngerprint characteristics could be demonstrated in an antemortem and postmortem comparison, it was maintained that the material must have originated from the same person. Keiser-Nielsen sought to develop a parallel application for the feld of forensic dental identifcation. Specifcally, he sought to quantify the probability that any two individuals would have the same combination of teeth missing and present and teeth restored and unrestored. Te same calculation could be done for other features, for instance, the number of teeth with restorations. Applied to the human dentition, Keiser-Nielsen proposed that even greater discrimination could be established using combinations of features. If only teeth missing/present and teeth restored/unrestored were considered with no regard to which surfaces were restored, the formula involved cal- culating the possible combinations for missing teeth, then multiplying that number by the number determined by calculating the number of possible combinations of restored teeth in the remaining teeth. Using Keiser-Nielsen’s exampleof an individual missing four teeth and having four of the twenty-eight remaining teeth restored, the formulae are: 32 × 31× 30 × 29 For the four missing teeth, K32,4 = = 35,960 , representing 1 × × × the number of diferent possible combinations for four missing teeth. For the four restored teeth in the remaining twenty-eight, K28,4 = 28 × 27 × 26 × 25 = 20,475, representing the number of diferent com- 1 × × × binations of four restored teeth among twenty-eight teeth. Ten by multiplying the two, 35 960 × 20 475 = 736 281 000, Keiser- Neilsen calculated that the number of possible combinations of a person with four missing teeth and four restored teeth is 736,281,000. In other words, the likelihood of any two people having the same four teeth missing and the same four teeth flled (surfaces not considered) is 1 in over 736 million, more than twice the number of people alive in the United States (July 2008). In other words, if there are thirty-two teeth present, and x represents the number of teeth that have been extracted or flled, then the table gives the Table 9.
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