1.  Legal Medicine Journal Club Alejandro Garcés Descovich Emily Rincón Álvarez Jorge Enrique Ruíz M Universidad de La Sabana Legal Medicine XI Semester April 24th of 2010

2. KEYWORDS: Forensic age estimation Criminal proceedings Dental age Skeletal maturity

3. CONTENT INDEX 1. Introduction 2. Materials and Methods 3. Results 4. Discussion 5. Conclusions 6. Questions time

4. 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

5. 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

6. INTRODUCTION  Time consuming task that requires interdisciplinary approach.  Physicians with forensic experience  Knowledge of Auxology  Radiology  Dentistry  Legal Medicine

7. INTRODUCTION  Main objective  Differences between  Skeletal  Dental age assesments  Comparison of left hand/wrist radiographs and OPG’s

8. INTRODUCTION

9. 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

10. MATERIALS AND METHODS  Retrospective review  Sample  52 immigrants (41 males 11 females)  Bari, Italy.

11. 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).

12. 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)

13. 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)

14. MATERIALS AND METHODS

15. 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.

16. RESULTS

17.  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

18. 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).

19. 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

20. DISCUSSION  Markers for:  Bones  Teeth  Sexual development  The only reliable indices for assessing a living individual’s age in forensic settings.

21. DISCUSSION  Sexual development markers + BMI  Is not appropriate for age estimation (Variability)  Diseases (disproportionate growth)  Result of malnutrition  Congenital disorders  Physical examination (Empirical)

22. 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.

23. 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

24. 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

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