|Year : 2023 | Volume
| Issue : 2 | Page : 150-160
Denture marking for personal identification in forensic odontology: A narrative review
Manveen Kaur Jawanda1, Sonia Gupta2, Harman Sandhu3, Rosa Llisel Ocampo Escobedo4, Harkaran Singh Bhullar5, May Hamza6
1 Department of Oral Pathology and Microbiology and Forensic Odontology, Luxmi Bai Institute of Dental Sciences and Hospital, Patiala, India
2 Department of Oral Pathology and Microbiology and Forensic Odontology, Rayat and Bahra Dental College and Hospital, Punjab, India
3 Building Smiles Dental Clinic, Mohali, Punjab, India
4 Adjunct Faculty in College of Health Care Professions, Houston, TX, USA
5 Himachal Institute of Dental Sciences, Paonta Sahib, Himachal Pradesh, India
6 Department of Prosthetic Dental Sciences, College of Dentistry, Jouf University, Sakaka, Kingdom of Saudi Arabia
|Date of Submission||21-Oct-2022|
|Date of Decision||27-Feb-2023|
|Date of Acceptance||06-Mar-2023|
|Date of Web Publication||28-Apr-2023|
#95/3, Adarsh Nagar, Dera Bassi, District Mohali 140507, Punjab
Source of Support: None, Conflict of Interest: None
Aim: In certain situations, other forensic aids fail to provide proper personal identification such as changes after death, tissue injury trauma, burns, and insufficiency of fingerprint evidence. Dental identification plays a crucial role in this aspect. However, in edentulous patients, who do not possess teeth and the alveolar bone resorbs very fast, denture marking is a reliable aid for easy identification. This review was carried out to investigate how many methods of denture marking are listed in the literature for personal identification to date and which method is the most reliable?Materials and Methods: Following PRISMA principles, a search of the published literature was conducted electronically in PubMed/Medline, ResearchGate, Google Scholar, and Scopus databases, without the publication year limitation using keywords such as (“Denture marking,” OR “Denture labelling”) AND (“Prosthesis”), AND (“Personal identification”), AND (“Forensic science” OR “Forensic odontology”). A manual search of all related journals and reference lists of the relevant articles was also performed. Results: The database search yielded a total of 140 articles; out of which 45 relevant articles were selected describing 10 surface denture marking methods and 20 inclusion denture marking methods. Each method is enclosed with a few of its advantages and disadvantages. Conclusion: From this research, it can be concluded that at present, 30 denture marking methods for personal identification have been reported in the literature, but it cannot be stated definitely which method is the most reliable, as the strengths and weaknesses of each method supersede each other. Robust research and a number of population-based studies are required in this context.
Keywords: Denture Marking, Forensic, Identification, Personal
|How to cite this article:|
Jawanda MK, Gupta S, Sandhu H, Ocampo Escobedo RL, Bhullar HS, Hamza M. Denture marking for personal identification in forensic odontology: A narrative review. J Int Oral Health 2023;15:150-60
|How to cite this URL:|
Jawanda MK, Gupta S, Sandhu H, Ocampo Escobedo RL, Bhullar HS, Hamza M. Denture marking for personal identification in forensic odontology: A narrative review. J Int Oral Health [serial online] 2023 [cited 2023 Jun 4];15:150-60. Available from: https://www.jioh.org/text.asp?2023/15/2/150/375366
| Background|| |
One of the important contributions of forensic science is the identification of the dead/deceased person. In certain situations, other forensic aids fail to provide proper identification such as few changes after death, tissue injury due to any trauma, insufficiency of fingerprint evidence, or when the deceased is burned, skeletonized, or decomposed. Dental structures are the most pliable and hardest tissue of the body. Thus, pathological conditions noted in dental records, treatments, and prosthetic devices may survive under such conditions when fingerprints and deoxyribonucleic acid may not. Therefore, dental tissue plays an important role in personal identification. History reveals that denture marking has led to a valuable contribution in personal identification in the field of forensic sciences since the ancient period of time,,,,, [Table 1]. It had been used to identify famous people such as ‘Adolf Hitler’, ‘Eva Braun’, ‘the late Indian Prime Minister Rajiv Gandhi’, and ‘the late Pakistani President Zia-ul Haq’. It had also been used to identify the dead in numerous mass disasters such as the New York City World Trade Center bombing, the Waco Branch Davidian blockade, and innumerable plane crashes and natural disasters.,,,,
|Table 1: Historical background of role of dental prosthesis in personal identification,,,,,,|
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Guidelines established by the American Board of Forensic Dentistry state that the most dental identifications are made based on physical characteristics and some clinical findings such as teeth that have been repaired, have deteriorated, are missing, or have prosthetics. However, in the edentulous patients, who do not possess teeth and the alveolar bone resorbs very fast, in such cases, there is a lack of such features for the comparison of antemortem and post-mortem interpretations. In that situation, denture marking is a reliable aid for easy identification. Denture marking is a method of incorporating an identification mark into the denture, thus named as “labelled denture.” It helps in preserving the dentures in certain specifications such as in geriatric and mental institutions and hospitalization, where dentures are maintained by the caretakers.
The American Dental Association has established specific standards for markings on dentures, which are represented in [Figure 1]. There are particular locations for placing a denture marker. These are the Bucco-posterior surface of the maxillary denture and the Lingual Flange of the mandibular denture. These areas are chosen because of their unique characteristics.
|Figure 1: Requirements of an ideal denture marking method (according to the American Dental Association)|
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They provide easy accessibility to the reader.
They indulge the incorporation of sufficient thickness of resin without causing any technical difficulties.
They have no impact on the denture’s appearance.
Some other sites are also selected for this purpose, such as between the buccal or palate and the maxillary tuberosity. The lingual surface of the anterior and posterior sides is preferred in fixed appliances.
Literature has revealed that denture marking has been used as a valuable tool in personal identification. This review was carried out to investigate how many methods of denture marking are listed in the literature for personal identification to date and which method is the most reliable?
| Materials and Methods|| |
The preferred reporting items for systematic reviews and meta-analyses (PRISMA) were followed when conducting the current study. Considering the nature of the study, there was no necessity of taking any ethical approval.
Focused PICO question
For reliable search screening, we defined a PICO question; ‘‘How many methods of denture marking are listed in the literature used for personal identification to date, and which method is the most reliable?”
P—Population: Complete/partial dentures with denture marking/labelling.
I—Intervention: Various denture marking methods for personal identification.
C—Comparison: Between different denture marking methods
O—Outcome: Advantages and disadvantages of denture marking methods
The search strategy used for the present review
Following PRISMA principles, a search of the published literature was conducted electronically in PubMed/Medline, ResearchGate, Google Scholar, and Scopus databases, without publication year limitation using keywords like (“Denture marking,” OR “Denture labelling”) AND (“Prosthesis”), AND (“Personal identification”), AND (“Forensic science” OR “Forensic odontology”) [Figure 2]. Additionally, a manual search of all pertinent journals” reference lists was carried out.
Three stages of study screening were used in the current review. First, duplicate titles were ruled out after independent evaluation by two authors (MKJ and SG). The chosen abstracts of all the publications were then independently examined by four authors (HS, RLOE, HSB, and MH). In the last phase, each of the authors independently read the texts of the chosen papers (MKJ, SG, HS, RLOE, HSB, and MH). For cases that looked to fulfill the inclusion criteria or where the information was insufficient to draw a firm conclusion, the full report was gathered, discussed and decided among all writers.
Papers describing several denture marking techniques in the literature. Papers included were published from 1950 to 2022.
Case studies and experimental studies conducted using various methods of denture marking in personal identification.
Publications in English literature only.
Articles with incomplete, repetitive, and duplicate data.
Animal studies were excluded.
Abstracts, editorials, letters, correspondences, web pages, and book chapters.
Risk of bias assessment
The risk of bias in the included studies was appraised following the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Regarding the parameters utilized for data extraction in our research, there were some missing data in many of the investigations. To address this bias, we made an effort to get in touch with the authors of those instances, but we were unsuccessful in getting the information we needed.
The data were extracted following study selection, screening, and a careful inspection. Two tables were created by cross-checking the data and tabulating it [Table 2] and [Table 3]. Six weeks were allotted to collect the data in the event that any were missing. We then marked the missing data as “Not available (NA)” in the text and tables if it was still missing. The name of the denture marking method, the author and year, the technique employed, and the benefits and drawbacks of each method were some of the data items that were extracted.
|Table 2: Surface denture marking methods according to the present literature research (1950‐2022)|
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|Table 3: Inclusion denture marking methods according to the present literature research (1950‐2022)|
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| Results|| |
The database search yielded 140 articles in total; out of which 45 relevant articles were selected [Figure 2]. The publications selected were between 1950 and 2022. The literature research documented a total of 30 methods of denture marking; out of which 10 were surface denture marking methods [Table 2] and 20 were inclusion denture marking methods [Table 3]. Each method is enclosed with a few of its advantages and disadvantages.,,,,,,,,,,,,,,,,,,,,,,,,,,,
| Discussion|| |
Dental structures are the hardest and the most pliable tissues of the human body. Pathologic conditions observed in dental records, therapies done and prosthetic aids used may remain unchanged even withstanding a high-temperature range while other features, such as fingerprints and deoxyribonucleic acid may not. Denture marking is an important tool in the identification of victims in edentulous patients with the absence of teeth. It also aids in prosthesis identification, maintenance of records, and retrieval when necessary.
One of the investigations found that out of 380 air accident fatalities, 97 had dentures, but only seven had markings. During the Bradford football ground fire disaster, it was reported that 38% of the victims wore dentures, of which only one was marked. Some researchers also stated that if all the victim’s dentures had been identifiable, then the contribution of dentistry would have risen up to 85% as compared to 58% that had been documented in the previous records. These results addressed the forensic experts, dentists, and general practitioners to indulge in denture marking as one of the important aids for personal identification.
The present literature research revealed that denture marking has been implemented for personal identification for ancient period and various methods of denture marking are available to date. Dentures can be labelled either on the surface or in the interior aspects using different materials and methods.
The oldest surface denture marking methods used were engraving and embossing methods. Later, many other methods of denture marking were introduced in this category. Most of these involved the use of burs, markers and scalpels. Harvey first demonstrated the use of the invisible ink method that was made visible with ultraviolet light. Later, various types of pens and pencils were used to mark the dentures such as fiber tip pens, spirit-based pens, electronic pens, graphite pencils and so on., But these markings may not last for a long time. Jaffrey introduced the use of onion skin paper that could be placed at the base of the denture. Lasers have been used in various aspects of dental and medical science in diagnosis as well as therapeutic interventions. Ling et al. investigated the application of copper vapor laser (CVL) for the identification of patients using an etching method.
In recent years, bar codes are being used as surface denture marking methods in a wide range for personal and forensic identification. They have the advantage of withstanding a wide variety of temperatures.
The first inclusion denture marking method reported in the literature was introduced by Lose, wherein an onion skin paper was placed on the polished surface of the denture during trial closure and the patient’s name was embedded into it. Later, Fiske et al. used a channel method. Young introduced an engraving method of inclusion denture marking for the identification of the deceased. Toolson et al. used Min. I. Dent denture identification strip method for the patient’s identification. But the temperature range used in this method needed to be regulated requiring accurate procedures to be followed.
The use of acrylic resins increased with the evolution of more denture marking methods. Oliver documented a technique of inclusion denture marking using heat cure acrylic resin. Ryan et al. used polymethyl methacrylate resin bar. Postfabrication technique described by Berry et al. involved the use of acrylic monomer. The use of clear acrylic resins leads to easy reading of the polished label.
With time, micro-labelling methods became popular. Various methods used here are the labelling machine PT 20 P Touch technique introduced by Coss and Wolfaardt, graphic imaging using polarized digital slide film, a strip of absorbent paper documented by Ibrahim and the computer printing method investigated by Ling. Sanyal and Badwaik used a computer labelling method in the personal identification of a 53-year-old male patient. The technique used could be applied as both the prefabrication and postfabrication methods of denture labelling.
One of the important requirements of any denture marker is being thermal resistant in case of extensive fires, burns, and high temperatures. Milward et al. investigated the patient’s identification using a thermal-resistant data matrix code wafer. Reeson used stainless steel tape for the inclusion denture marking method; the stainless steel being thermally resistant provided accurate details. Matsmura and Shimoe used an embossed tape that had the capability to withstand a high range of temperatures.
In the case of severe blaze, metallic markers are the most durable. The Swedish ID-Band is now considered an international standard as described by Stavrianos.
The Swedish ID-Band is a stainless steel bracelet with the letter S and 10 digits of numbers. The patient’s birthdate, month and year are represented by the first six digits. The birth date is represented by the next three digits and the final digit indicates the gender. Numerous studies have shown that ID-band is less temperature resistant than other types of jewelry. Three different steel band types (Jasch, Remanit, and ID) exposed to temperature ranges of 1100, 1200 and 1300°C were studied by Olsson et al. At 1100°C, only the ID band and the Jasch band could be read; at 1200 and 1300°C, none of them could be read. In 1995, Thomas et al. evaluated three bands: Titanium (Ti), Ho and ID. In comparison to Ti, ID and Ho had greater strength and higher elongation. In their study from 2012, Acharya et al. discovered that the SS band placed second to other commonly used bands.
On the basis of the comparison of antemortem and post-mortem dental records, radiofrequency identification tag (RFID) technology has recently been used as a denture marking method for personal identification. It is a form of wireless electronic communication that was initially used to identify Royal Air Force aircraft in 1940. Recent research by the Austrian disaster victim identification team during the tsunami crisis in 2004 examined the use of this technology for body tagging and resource management at a hospital during a mass casualty situation.
Richmond and Pretty in an experimental study demonstrated the use of RFID tags in denture labelling. Nuzzolese et al. performed an experimental study to investigate the feasibility of the RFID method in forensic identification. To ensure the effectiveness and range of data transmission, the three RFID-tagged dentures underwent testing. The transponder returns a coded signal to the reader, which the reader decodes into readable data. Pallaggati et al. in an experimental study depicted the efficacy of RFID in personal identification and found the technique to be beneficial with minimal disadvantages. The biggest advantage of this technology is the storage of large amounts of data without affecting the strength of the denture but the popularity of this method is not so much documented because of its high cost and unavailability at every set-up. But it is suggested that the use of smart labels will prove to be a cost-effective procedure.
The ceramic crown engraving method introduced by Kamath and Kamath used dental porcelain and the patient’s initials are covered with a stain. But it is not being implemented as a reliable method of denture labelling owing to a lack of providing full details due to a shortage of space.
Reeson introduced the lead foil radiographic method of denture labelling. Venkat Nag et al. and Bansal et al. applied this method in denture labelling for the identification of edentulous patients. Fernandez et al. in their experimental study observed the use of the lead foil method as a reliable method of forensic identification. The technique proved to be simple and easy to perform.
In the past few years, the patient’s photograph itself had been used as a method of denture marking for forensic identification. Anehouser et al. found that complete denture wearers involved a marking method that could result in rapid identification, as demonstrated by a photograph.
Few data verified that the memory card method can be implemented as an easily used technique in the identification of deceased in mass disasters. Luthra et al. investigated this method as the denture marking technique. The details of patients could be preserved for a long time via this method. Kamble et al. used both patient’s photograph and micro-SD memory for the identification of 64-year-old edentulous patient. The patient’s photograph was placed on the micro-SD memory card, in which the patient’s information was already saved. The memory card and photographs were covered with a cellophane sheet and inserted in the palatal aspect of the maxillary denture. The photograph and the memory card were evaluated after 6 months and it was observed that there was no harm to the photograph and the memory card. The patient’s information in the memory card was completely readable, making its use effective. There are several advantages of this innovative, dual-purpose denture marking system. It is cost-effective, not technique sensitive and does not interfere with the esthetics, oral function or strength of the denture. The photograph can be used in day-to-day identification and the memory card incorporated in the denture can be used for the identification of victims in mass disasters as the patient’s information will remain stable in the memory card.
Gujjalapudi et al. used a combination of the lead foil method and the photographic method of denture marking in the identification of a patient’s missing teeth. And their study concluded these methods to be feasible for use as an innovative tool in patient identification preventing anxiety and confusion and saving time.
With the advancement of new technologies, 2-D barcoding has been introduced as an innovative method of denture marking for personal identification. In 2012, Rajendran et al. developed a comparatively straightforward 2-D bar-code approach using a code generator and patient information including name and social security number. A barcode scanner can read data that are optically encoded and machine-readable as a barcode. Compared to labels that only have names and ID numbers, barcodes provide a lot more information about the patient. The barcode sign stands for general information about the patient, including name, age, sex, address, occupation, phone number, and nationality. The patient data can be quickly and readily retrieved by scanning the barcode. On an Android device or any smartphone, the barcode scanner application is simple to download from the internet and install. And this bar-coding method can be used as both surface denture marking and inclusion denture marking methods.
In recent years, the use of a 2-D barcode termed as “QR code” has been proven to be a reliable and effective method of denture marking to be used in personal identification. Jain et al. used the QR code method in the personal identification of a 55-year-old female patient with a complaint of missing teeth. They provided evidence that this method worked well for denture identification systems. The traditional method is technique-sensitive and may distort the barcode or impair the QR Code’s legibility. Transparent acrylic sheets are produced using only air-free, 100% pure monomers. They are conveniently offered.
In 2016, Poovannan et al. carried out an in vitro study to assess the accuracy of QR code labels placed at different depths in heat-cured acrylic blocks following acid treatment, heat treatment (burns), and fracture in forensics. They came to the conclusion that this method was accurate under different depths of acrylic sheet, acid (sulfuric acid 99%, hydrochloric acid 40%), and heat (up to 370°C). Dentures may be labelled using QR codes with ease.,
In recent years, individual identification has been done using Aadhar card scanning. Aadhar card number and its QR code are unique for each individual and both can be scanned to identify the patient’s identity. Many researchers used Aadhar card numbers and QR code scanning in a completely edentulous patient for denture marking.,,,, They documented that patients’ Aadhar cards can be an easy aid to track unidentified cases and this technique can be easily implemented throughout the country in mass disasters or patient recognition.
Looking at the current literature and studies reported it can be stated that denture marking can be used as an important tool for personal identification. Marking dentures can potentially improve the quality of care delivered to patients.,
Several numbers of methods are listed in this context but each technique supersedes one another in its strengths and weaknesses. The surface methods are simple, easy, and cheap, without the need for any special skills but they are unable to preserve the identity for a long time. The inclusion methods are permanent and provide more predictable results, but could weaken the strength and surface texture of the denture. These are more costly and need special trainers.
Limitations of the current research
One of the major limitations of the current research was that most of the studies included were experimental studies and a very few were individual based. Population-based studies have not been documented in the literature to date according to our research.
| Conclusions|| |
Denture marking can be used as a reliable tool not only for personal identification in forensics but also for prosthesis identification, record maintenance, and retrieval whenever needed. At present, 30 denture marking methods for personal identification have been reported in the literature, but it cannot be stated definitely which method is the most reliable, as the strengths and weaknesses of each method supersede each other. Robust research and a number of population-based studies are required in this context.
We acknowledge all the authors for their contribution and all other individuals who have assisted in completing this research in a direct or indirect way.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
MKJ: Conceptualization, Data curation, Investigation, Methodology, Project administration, Resources, Validation, Writing—original draft, Writing—review & editing, Supervision, Visualization.
SG: Conceptualization, Data curation, Investigation, Methodology, Project administration, Resources, Validation, Writing—original draft, Writing—review & editing.
HS, RLOE, HSB, MH: Data curation, Investigation, Methodology.
Ethical policy and institutional review board statement
Not required for the current research.
Patient declaration of consent
Not required for the current research.
Data availability statement
All data is available in the tables, no other data can be shared.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]