Journal of International Dental and Medical Research ISSN 1309-100X Analysis of Tooth Measurement

http://www.ektodermaldisplazi.com/journal.htm Sita Rose Nandiasa, and et al

Analysis of Tooth Measurement Method Accuracy in Digital Periapical Radiograph

for Personal Identification
Sita Rose Nandiasa1, Bramma Kiswanjaya2*, Mindya Yuniastuti1
1. Departement of Oral Biology-Forensic Dentistry, Faculty of Dentistry, Universitas Indonesia, Indonesia.
2. Departement of Dento-Maxillofacial Radiology, Faculty of Dentistry, Universitas Indonesia, Indonesia.

Abstract

In the field of forensic dentistry, methods for personal identification through tooth measurement
have been developed. This study aimed at proposing a new method for personal identification using
digital periapical radiograph.
Seven measurements were performed in 206 digital periapical radiographs (103 patients with
age more than 14 years old have double radiographs in the same region of interest) from seven
reference distanceswhich were appointed before the measurement in permanent mandibular
second premolar and first molar. The measurement process was done in two ways, digital
radiography software andmanual measurement.
The reliability of seven reference points was assessed with intra-observer and inter-observer
values (TEM < 1 mm). The accuracy of tooth measurement method was assessed withBland-
Altman test that demonstrated no statistical difference(p> 0.050) regarding paired radiograph
comparison. Limits of agreement (LOA) values from Bland-Altman test showed range of difference
(mm) from paired radiograph whichwas still acceptable as same person. The method been
examined further through blind test for similarview radiographs resulted 100% match between one
pair radiograph with true identity came from thesame person.
The method proposed in this study is able to identify person accurately.
Clinical article (J Int Dent Med Res 2017; 10: (1), pp. 9-13)
Keywords: Digital periapical radiograph; personal identification; tooth measurement method.
Received date: 28 September 2016 Accept date: 29 October 2016

Introduction and 93% in Balagopal study.11,15Periapical

radiography technique with good visual and
Health legislation of Republic Indonesia geometric aspectsis usually been used in
(No. 36/2009) gives mandate to government and identification process rather than any other
community to identify unidentified person due to techniques.7,11,16 It is also common technique in
mass disaster incident.1,2 Determining person clinical practice which makes periapical
identity is termed by personal identification.3The radiograph as a valuable antemortem
most important thing in identification process is data.1,7,11,16–18
preservation of biological sample.4 Tooth have Digital radiography technique becomes
been proven to be resistant biological sample.5–10 well received in Indonesia, even though its use is
Antemortem and postmortem dental still centralized in class A hospital.19 Digital
comparison commonly use radiograph as an technique offers enhancement in picture quality
objective tools since every single anatomical through dental software package, better
structure will be projected on it.11–14 The accuracy visualization, radiograph in screen monitor, and
of radiograph utilization in forensic identification retaking radiograph instantly.20–24 Digital
process reaches 81.6% in MacLean et al study radiographs can be printed in certain paper for
assessment and communication purpose. It has
*Corresponding author: high sensitivity and good overall display
Bramma Kiswanjaya, DDS, PhD compared with screen monitor view.25
Departement of Dento-Maxillofacial Radiology, In line with the development of digital
Faculty of Dentistry, Universitas Indonesia,
Central Jakarta, Indonesia. radiography technique, identification method
E-mail: [email protected] using digital system is believed to be more
accurate, faster, efficient, and accepted

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 Journal of International Dental and Medical Research ISSN 1309-100X Analysis of Tooth Measurement
http://www.ektodermaldisplazi.com/journal.htm Sita Rose Nandiasa, and et al

legally.26–28Some conditions are not feasible to be appointed in cemento-enamel junction (CEJ) and
examined with conventional radiography apical part of permanent mandibular second
technique like fragile decease or stiffness premolar and first molar. Measurement results
induced by heat.12,29 were tabulated in Excel spreadsheet.
Digital periapical radiography technique is For tooth measurement, the distance
able to identify person as stated in Maurya et al between twoselected reference points was
study.26 Similar to Maurya et al, Borker and Naik measured with total of seven distances (three
study tooth measurement method to identify from mandibular permanent second premolar
person by using reference points in teeth with and four from mandibular permanent first molar)
accurate result.30 Santoro et al on their study has (Figure 1). As already mentioned above, the
introduced cemento-enamel junction (CEJ) as a sample was digital periapical radiograph from
stable anatomical part on teeth so that it can be 103 patients with each patient has two
used as reference point in tooth measurement radiographs which were first-taken and second-
method to identify person with sensitivity 97%, taken radiograph. The 103 samples consisted of
specificity 85%, and accuracy 95%.31 49 samples left mandibular and 54 samples right
In order to effectively establish individual mandibular.
identity through personal identification, it is
necessary to increase new studies and evolve
new methods.

Materials and methods

The sample was 206 digital periapical

radiographs (103 patients that have double
radiographs), with known age more than 14
years old. These radiographs belong to the
Specialized Pavilion at Faculty of Dentistry,
Universitas Indonesia. Sex was not separated in
this study based on assumption that the result
from tooth measurement comparison will match
individually. Figure 1. Reference distancesaccording to tooth
In this study, reference points were measurement method.
appointed and tooth measurements were CMA) Distance between mesial CEJ and mesial apical.
performed. For method validation, calibration was CDA) Distance between distal CEJ and distal apical.
set with two examiners. The examiners examined CMD) Distance between mesial CEJ and distal CEJ.
AMD) Distance between mesial apical and distal. apical.
206 digital periapical radiographs in different
place and time. Intra- and inter-observer test
were applied using Dahllberg formula (Technical Comparison of seven reference distances
Error Measurement or TEM) for method measurements from digital periapical radiograph
calibration. However, only one examiner was done between first-taken (analogue as
examined 206 printed radiographs. antemortem radiograph) and second-taken
For standardization of measurement, (analogue as postmortem radiograph)
digital radiographs were calibrated in 41 mm size radiographs for each 103 samples, so was
with no image enhancement and printed printed radiographs. The measurement
radiographs (JPEG format) were calibrated in 31 difference (mm) between paired radiograph
x 41 mm size before printed in glossy paper comparisons then analyzed further to determine
using HP inkjet with standard optimization. to whom it belongs.
For tooth measurement obtainment, For the statistical analysis, reliability of
digital ruler (Digora for windows 1.51) was used reference points was assessed with Dahlberg
for digital radiographs and caliper digital formula. The accuracy of tooth measurement
(Mitutoyo) was used for printed radiographs. method on digital periapical radiographs was
Measurements were obtained by measuring the assessed with Bland-Altman test without doing
descriptive analysis or normality test first
distance between reference points previously

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 Journal of International Dental and Medical Research ISSN 1309-100X Analysis of Tooth Measurement
http://www.ektodermaldisplazi.com/journal.htm Sita Rose Nandiasa, and et al

because the sample is more than 30 (for Bland-

Altman only). Measurement comparison between
digital periapical radiographs and its printed was
then assessed with student t-test.
The application of this method aimed at
developing radiographic measurement from tooth
for personal identification.

Results

Dahlberg formula was used to test the

reliability of reference points with Technical Error
Measurement (TEM) intra- and inter-observer
result below than 1 mm for all reference points.
Bland-Altman test result in table 1 shown Table 1. Tooth measurement comparison result
p-value for tooth measurement comparison for whole samples of digital periapical
between paired digital periapical radiograph radiograph.
samples. All of the reference distances were
considerably above significance level (p > 0.050)
with its limits of agreement (LOA) value.
Bland-Altman test result in table 2 and
table 3 shown p-values for tooth measurement
comparison in different mandibular side, both
were considerably above significance level (p >
0.050) for all reference distances with its LOA
value.
Bland-Altman test result for tooth
measurement comparison in printed radiographs
for left mandibular samples shown p-value below
significance level which was CMD 2ndP (p =
0.019), meanwhile result for right mandibular
samples shown p-value was considerably above
significance level (p > 0.050) for all reference Table 2. Tooth measurement comparison result
distances. for left mandibular samples of digital periapical
In addition, student t-test result for radiograph.
measurement comparison between digital
periapical radiographs and its printed has shown
significance p-value (p = 0.000) for all reference
distances.
Blind test result in table 4 shown positive
matches between one first-taken radiograph with
three second-taken radiographs that have similar
view with first-taken radiograph in Mr. X2
(57.14% and 71.43%).

Blind test result in table 5 shown

positive matches between one first-taken
radiograph with four second-taken
radiographs that have similar view with first-
taken radiograph in Mr. X4 (100%). Table 3. Tooth measurement comparison result
for right mandibular samples of digital periapical
radiograph.

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 Journal of International Dental and Medical Research ISSN 1309-100X Analysis of Tooth Measurement
http://www.ektodermaldisplazi.com/journal.htm Sita Rose Nandiasa, and et al

values in whole samples and one significance p-

values in left mandibular samples. Non-
significance p-values were needed in this
methods means that there were no great
deviations between paired measurements.
Measurement result from digital periapical
Table 4. Percentages of match obtained from radiograph seems to be better than printed
mandibular and left mandibular LOA of seven radiograph.
reference distances. P-value result for measurement
comparison between digital periapical
radiographs and its printed shown great
deviations. Measurement from digital periapical
radiograph should not be compared with its
printed directly, as we finally knew that there was
some digital data loss when digital radiograph
was being printed to glossy paper.
The author tested the accuracy of this
Table 5. Percentages of match obtained from
new developed method by re-measuring and
mandibular and right mandibular LOA of seven
comparing one first-taken radiograph to several
reference distances.
second-taken radiographs that have similar view.
As mentioned above, the differences (mm) those
Discussion
were still in the range of limits of agreement
(LOA) might indicated the same person. Paired
Positive identification could be made by radiograph from one person may have
comparing specific appearances from multiple measurement match almost in seven reference
teeth or even from one single tooth.5,32,33
distances as we could see in blind tests above.
Development of prophylactic dental care, Previous studies used only mandibular
consequential, and preventive treatment resulted permanent first molar and measured it with their
in the decrease of caries incident and tooth own methods. Positive identification was claimed
restorations.5,14,17,34 These factors made the only based on statistical analysis. New methods
identification process became harder if it just
of personal identification are still anticipated,
relied on specific appearances. Tooth especially in the needs of definite measurement.
measurement turned out to be an important The present study aimed at bringing new insights
aspect in comparison,35 as being mentioned in in terms of personal identification methodology.
previous studies.26,30,31
In this study, another tooth was added as Conclusions
sample.Reference points were determined by the
author with total of seven reference distances It is thus concluded that the method
were gained from two teeth. Thus reliability of presented in this study is accurate for personal
these reference points needs to know in advance identification by using limits of agreement (LOA)
at the beginning. All of the reference points could from seven reference distances from mandibular
be use in tooth measurement method based on second premolar and permanent first molar.
Technical Error Measurement (TEM) result, since Comparison of paired radiograph should be done
acceptable measurement tolerance (MT) for between the same radiograph techniques.
tooth and bone measurements was 1 mm. However, further studies are required to achieve
Samples on this study were slightly not better results and to develop limits of agreement
equal on each mandibular side. However, this from other tooth.
study tried to analyze the whole, left and right
mandibular sample. Bland-Altman test result Acknowledgements
showed nosignificance statistical difference (p-
value) for all reference distances in digital This study was supported by Universitas
periapical radiographs.Meanwhile, result from Indonesia.
printed radiographs shown two significance p-

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Journal of International Dental and Medical Research ISSN 1309-100X Analysis of Tooth Measurement
http://www.ektodermaldisplazi.com/journal.htm Sita Rose Nandiasa, and et al

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