Clinical application of dental prosthesis marking in forensic dentistry: A twin case report

Manu Rathee; S Divakar; Prachi Jain; Sandeep Singh; Sujata Chahal

doi:10.4103/jdrr.jdrr_129_22

CASE REPORT

Year : 2022 | Volume : 9 | Issue : 4 | Page : 315-319

Clinical application of dental prosthesis marking in forensic dentistry: A twin case report

Manu Rathee, S Divakar, Prachi Jain, Sandeep Singh, Sujata Chahal
Department of Prosthodontics, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India

Date of Submission	19-Aug-2022
Date of Decision	08-Sep-2022
Date of Acceptance	16-Sep-2022
Date of Web Publication	12-Feb-2023

Correspondence Address:
S Divakar
Department of Prosthodontics, Post Graduate Institute of Dental Sciences, Rohtak, Haryana
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jdrr.jdrr_129_22

Abstract

Forensic dentistry plays an important role in cases where other analyses such as visual, photographs, and fingerprints seem to be ineffective. Any medicolegal inquiry must have proper identification since the improper identity might interfere with delivering justice. In edentulous patients, forensic identification based on examination of prosthodontic appliances is becoming more important, since the labeling of dentures and other prosthetic appliances may provide vital evidence for the patient's identification. This case report discusses the two methods of embedding patient details in the removable and fixed prosthesis using quick response (QR) code and ceramic staining.

Keywords: Ceramic staining, denture marking, fixed dental prosthesis, QR code, removable prosthesis

How to cite this article:
Rathee M, Divakar S, Jain P, Singh S, Chahal S. Clinical application of dental prosthesis marking in forensic dentistry: A twin case report. J Dent Res Rev 2022;9:315-9

How to cite this URL:
Rathee M, Divakar S, Jain P, Singh S, Chahal S. Clinical application of dental prosthesis marking in forensic dentistry: A twin case report. J Dent Res Rev [serial online] 2022 [cited 2023 Mar 22];9:315-9. Available from: https://www.jdrr.org/text.asp?2022/9/4/315/369582

Introduction

Keiser-Neilson defined forensic odontology in 1970 as a branch of forensic medicine that deals with handling, examination, and evaluation of dental evidence in criminal justice cases. The main scientific identifiers are DNA analysis, fingerprint analysis, and ante- and postmortem dental comparison. Because teeth are the resilient human body parts which can be preserved even after death caused by fire or water. Forensic dentistry is used in situations where methods for identification such as visual recognition and fingerprint analysis seem to be ineffective, such as in advanced stages of decomposition or burnt cases.^[1]

The prevalence rate of edentulism among elderly people in India is 16.3%, according to the research conducted by Peltzer et al.^[2] Since there is a complete loss of teeth in these individuals, it is very difficult to identify them from any natural and mass disaster. According to the recommendations of the American Board of Forensic Odontology, the majority of dental identifications are made using prosthetics, missing teeth, cavities, and/or restorations. Denture/prosthetic markings in completely/partially edentulous patients are considered a means of identifying geriatric persons in institutions or in postmortem during wars, crimes, or disasters.^[3]

There are various methods available in the literature to engrave/scribe/inclusion of patient's identification details in the prosthesis. This case report describes the two different methods of denture marking in removable and fixed dental prostheses.

Case Reports

Case 1

A 56-year-old male reported complaints of difficulty in having food due to missing upper and lower teeth. History reveals that the patient had undergone an extraction of all his teeth due to mobility 20 years back. Thereafter, the patient had undergone rehabilitation with conventional complete denture 10 years back and lost it in a marriage function 2 months before. On medical history, the patient was diabetic and hypertensive under medication for 5 years. On general examination, patient was well built with normal gait and oriented to time, place and person. On intraoral examination, the patient had completely edentulous maxillary and mandibular arches with high well-rounded ridge with adequate height and width (Order 3) according to Atwood's classification of residual ridge. On palpation, the patient had a slightly irregular and keratinized alveolar ridge [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d.

Figure 1: Case 1 examination: (a) Prerehabilitative frontal view, (b) Prerehabilitative smile view, (c) Intraoral maxillary view, (d) Intraoral mandibular view

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Treatment planning

The patient had given two treatment options of conventional complete denture prosthesis and implant-supported fixed prosthesis. After consulting with the patient regarding treatment options and considering their financial strains, a conventional complete denture with embedded patient details (QR code in the center of the palate in maxillary denture and Aadhaar number and phone number in the flange area of mandibular denture) was planned. The patient's written consent for the procedure, photography, and scientific publishing of the procedure performed was taken before the commencement of the treatment.

Treatment progress

The primary impression was made using irreversible hydrocolloid impression material (Algitex Alginate Impression Material, Dental Products of India), and the cast was retrieved [Figure 2]a. Over the primary cast, a custom tray was fabricated using spacer wax and self-cure acrylic resin (DPI-RR Cold Cure; Dental Products of India). The border molding procedure was done using green stick compound, and functional impression was made using light-body elastomeric impression material (AvueGum Light Body, Dental Avenue) [Figure 2]b and [Figure 2]c. The impression was poured using type III gypsum product (Ultrastone Dental Stone, Kalabhai Karson Pvt. Ltd.) [Figure 2]d and [Figure 2]e. The temporary denture base with occlusal rims was fabricated over the master cast, and conventional jaw relation was recorded [Figure 2]f. After articulation, artificial teeth were arranged, and try-in was done [Figure 2]g. The processing of denture was like the same as conventional methods, and subsequently, finishing and polishing of denture were completed [Figure 2]h and [Figure 2]i.

Figure 2: Complete denture fabrication (a) Primary impression, (b) Border molding using green stick compound, (c) Secondary impression, (d) Plaster beading, (e) Master cast, (f) Jaw relation, (g) Teeth arrangement, (h) Flasking of dentures, (i) Finished final prosthesis

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Denture marking

The two-dimensional (2D) quick response (QR) code was generated using mobile software (QR Scanner and QR Code Generator and Radio and Notes v. 02.03.0805) with patient details such as name, age, Aadhaar, and phone number. The 2D QR label of 1.5 cm × 1.5 cm in size was made in square shape and printed on A4 paper. In order to prevent the contact of monomer of acrylic resin on contact with printed QR code ink, the paper was laminated using a laminator. The Aadhaar and phone number of the patient was separately printed in a rectangular shape and laminated for mandibular denture. A trough was made at the center of palate in maxillary denture and in the lingual flange areas of mandibular denture. The laminated QR code, Aadhaar, and phone number were placed without folding it and secured using clear self-cure resin [Figure 3]a, [Figure 3]b, [Figure 3]c, [Figure 3]d, [Figure 3]e. After polymerization, with the help of the same mobile software, the QR code was scanned and decoded, which shows complete patient details as text in the mobile phone [Figure 4]a and [Figure 4]b.

Figure 3: Denture marking (a) Final prosthesis in situ, (b) Final maxillary denture with embedded QR code, (c) Intraoral occlusal view of maxillary denture, (d) Final mandibular denture with embedded Aadhaar and phone number, (e) Intraoral occlusal view of mandibular denture, (f) Postrehabilitative view

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Figure 4: (a) Scanning of embedded QR code using mobile software, (b) Decoded QR code with patient details

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Insertion and postrehabilitative instructions

The denture was finished and polished again and inserted into the patient's mouth [Figure 3]f. The patient was educated how to use the prosthesis and given instructions on how to place and remove it. The patient was recalled for follow-up after a day, a week, and a month.

Case 2

A 26-year-old male reported complaints of unesthetic appearance due to missing upper and lower anterior teeth. History reveals that the patient had met with an accident before 4 months, during which the lower mandibular bone, teeth, and upper anterior teeth got fractured, and he extracted the teeth 2 months before. The patient was well built, healthy, and not under any medication. On intraoral examination, the patient had partially edentulous maxillary and mandibular anterior teeth with missing of 11, 12, 13, 41, and 42. On further examination, the patient had an alveolar defect on the mandibular lower anterior region with healed fractured segment [Figure 5]a, [Figure 5]b, [Figure 5]c.

Figure 5: Case 2 examination and tooth preparation. (a) Intraoral occlusal view, (b) Intraoral maxillary view, (c) Intraoral mandibular view, (d-f) Conventional tooth preparation done on 14, 21, 31, and 43

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Treatment planning

Since the patient desired fixed treatment, the conventional porcelain-fused metal (PFM)-fixed dental prosthesis was planned for maxillary and mandibular missing anterior teeth with engraved patient name on the maxillary prosthesis. The implant-supported prosthesis was ruled out as the patient had recent accident, unhealed alveolar bone, severe crowding, and irregular occlusion.

Treatment progress

The conventional tooth preparation was carried out on 14, 21, 31, and 43 with equigingival shoulder finish line all around the tooth [Figure 5]d, [Figure 5]e, [Figure 5]f. After gingival retraction using retraction cord, the final impression was made using putty and light-body elastomeric impression materials (AvueGum Putty and Light Body, Dental Avenue). The master cast was retrieved, and the wax pattern was prepared using inlay wax [Figure 6]a and [Figure 6]b. After sprue attachment, the conventional dewaxing and casting procedure was done in an induction casting machine, followed by finishing of metal coping. After metal try-in, porcelain layering was done. The defective areas were layered with pink ceramics. After firing, the name of the patient was engraved using paint brush on the lingual surface of maxillary prosthesis using brown staining, after which the conventional porcelain layering, firing, glazing, finishing, and polishing were done [Figure 6]c.

Figure 6: (a) Final impression, (b) Master cast, (c) Master cast with final prosthesis with embedded patient name, (d) Final prosthesis in situ, (e) Maxillary occlusal view showing the embedded patient name, (f) Mandibular occlusal view

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Insertion and postrehabilitative instructions

The prosthesis was evaluated for marginal fit and occlusion, initially on cast and then in the patient's mouth. After evaluation, the prosthesis was cemented using glass ionomer luting cement (Gc Gold Label 1 Luting and Lining), and excessive cement were removed using floss and straight probe. The patient was recalled for follow-up after a day, a week, and a month [Figure 6]d, [Figure 6]e, [Figure 6]f.

Discussion

A prosthodontist can become a part of forensic team and render the services in a better way. The various methods and techniques available in the literature for dental identification were comparative dental identification (ante- and postmortem comparison), intelligent dental identification, photographic superimposition, disaster victim identification process, palatal rugae identification, lip print identification, denture markings, and identification of dental implants.^[4]

Denture marking is accepted as a means of identifying dentures and persons in disasters and calamities, lost appliance identification in medical facilities, nursing homes, and institutions, as well as in people with psychiatric issues such as traumatic or senile memory loss. There were various methods available in the literature for denture marking such as surface marking, ID band, engraved fixed and removable restorations, lenticular system, RFID tags, bar/QR coding, and electronic microchips.^[5],[6]

The advantages and disadvantages of denture marking was explained in [Table 1].^{[6],[7],[8],[9]} The common location for denture marking is cameo or polished surface in removable prosthesis and lingual surface of fixed bridges. The most appropriate sites are posterior palatal surface of maxillary dentures and lingual flanges of mandibular dentures. Other sites are buccal to tuberosities and occlusal surfaces of posterior teeth in fixed restorations.^[10]

Table 1: The advantages and disadvantages of denture marking

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This case report discusses the simple technique of denture marking in two cases:

Removable complete dentures: By inclusion of patient details as laser-printed QR code on the palatal region of maxillary denture and the phone/Aadhaar number in the lingual flange of mandibular denture
Fixed partial denture: By painting the patient's name using brown stains on the lingual surface of PFM crowns after firing.

Conclusion

A person's identity can be determined by certain characteristics such as facial features, bruises, tattoos, malformations, and dental examinations. Due to the unique nature of each restoration, people who have prostheses and restorations may be carrying their information in oral cavity with them. The identification of these individuals depends on the type of material used, the dentist's skills, and the changes noticed after restoration. Denture marking or labeling is not a new concept in either forensic dentistry or prosthetic dentistry. As prosthodontists, it is our ethical and professional responsibility to make dentures embedded with a personal number or any other patients' details that will assist them to identify their dentures and themselves during investigations.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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