All of the skeletal remains, debris, sewage and other materials found in the sewer were retrieved and taken to the local morgue for further study. The forensic team separated the skeletal remains from the sewage and then carefully examined the sewage and other materials with a metal detector for any further evidence. All other sewers on this system also were examined for anything that might be helpful in solving this case.

On further investigation, a bone section—a superior extremity or head of a left tibia—was discovered in another retention sewer about one-half mile away from the original sewer site. (A retention sewer allows solid materials to settle at the bottom of the basin while the liquid waste flows off into a storm sewer.) Finding the skeleton in a retention sewer presented an additional problem; because the skeleton had been saturated in waste materials for more than one year, many toxicological and chemical analyses might not be valid.

The skeletal remains were given a coroner case number. A positive identification was imperative, even though the skeleton was found so close to the missing girl’s home.

	INVESTIGATION

TOP ABSTRACT INVESTIGATION ODONTOLOGICAL ANALYSIS COMPARISON OF DENTAL FINDINGS DISCUSSION CONCLUSION

 
The forensic team cleaned, oriented, measured, examined and photographed all skeletal structures in the morgue. We used metal detectors as well as sifting and straining to carefully examine all sewage, debris and extraneous materials associated with the skeleton. We also visually studied the material for any evidence that might be helpful in solving this case.

Forensic pathology report. The forensic pathologist reported that he believed the skeletal remains were those of a young female. The remains were in an advanced state of decomposition, with nearly total skeletonization. No evidence of penetrating, perforating or blunt force injury was found. We should note that the hyoid and soft-tissue structures of the neck were missing. No evidence of defects to the ribs or extremities secondary to sharp force injury was found and no bullet wounds were noted. The circumstances surrounding the finding of the body and lack of significant findings precluded a refined statement as to the cause of death. The cause of death, as recorded on the death certificate, was pending further investigation; the manner of death was homicide.

Toxicology report. The toxicology report of specimens submitted for analysis did not reveal any significant data because of the extended time that the body had been immersed in the polluted sewer. Results of DNA testing were inconclusive.

The lack of fusion of a number of the epiphyses and the dental development of the skeleton suggested an adolescent aged 14 to 15 years.

The anthropologist reported that a general review of the skeletal remains revealed no evidence of bullet or knife wounds, fractures, or blunt or vehicular trauma. Although most of the flesh and soft tissue had decomposed, traces of blonde hair and tissue remained on the skull, suggesting that the body had been placed in the sewer head first. This theory is based on the assumption that a retention sewer should contain a little water in its base; therefore, the head would be continuously immersed in moisture and be the last tissue to skeletonize.

Bone fusion. The forensic team examined all bones for developmental fusion, which is one measure of an individual’s chronological and physiological age. We found that cranial sutures were unfused, as were the sutures of the clavicles. Both scapulae revealed that the tips of the acromion processes were unfused. The distal ends of the humerus were fused, but the proximal ends were not fused. The radius and ulnas exhibited proximal fusion, but the distal ends were unfused. The coccyx was not fused, and portions appeared to be missing. The distal ends of both fibulae were unfused, and the proximal ends had recently fused. The tibias exhibited fusion of the distal ends but not of the proximal ends.

The configuration of the pubic symphyses and the bilateral presence of exaggerated "billowing" of the pelvis suggested a configuration that would be expected in a girl younger than 17 years of age. The iliac crests were not fused and the majority of the surfaces of the pelvis suggested a person of about 15 years of age. A number of the smaller epiphyses and most of the smaller bones of the wrists, ankles, hands and feet were missing, as was the hyoid bone. The presence of a fractured hyoid bone might have suggested strangulation as a cause of death.

The pelvic basin, relatively wide sciatic notches of the innominates of the pelvis, gracile skull, delicate bone structure and other features clearly were those of a female. Although adolescents generally have less well-defined developmental sexual traits than do adults, this individual had well-developed features characteristic of a female. Evaluation of sex is extremely important in the determination of age, since girls mature more rapidly than boys, with epiphyseal fusion occurring as much as one full year or more earlier in girls than in boys.

The lack of fusion of a number of the epiphyses, as well as the dental development of the skeleton, suggested an adolescent aged 14 to 15 years.

	ODONTOLOGICAL ANALYSIS

TOP ABSTRACT INVESTIGATION ODONTOLOGICAL ANALYSIS COMPARISON OF DENTAL FINDINGS DISCUSSION CONCLUSION

 
Postmortem findings. We examined a complete skull and mandible. Postmortem periapical radiographs were obtained in less-than-optimal conditions and photographs also were taken. Impressions were made of the jaws, and stone cast models were fabricated (Figure 1). The skull was taken to the orthodontist’s office of the presumed victim, where it was placed in the same cephalostat from which the preorthodontic treatment cephalometric radiograph was obtained. We then obtained a postmortem cephalometric radiograph (Figure 2).

View larger version (129K): [in this window] [in a new window]   Figure 1. Postmortem study models. A. Anterior view. B. Occlusal view.

View larger version (94K): [in this window] [in a new window]   Figure 2. Postmortem cephalometric radiograph.

In the absence of other restorations, we carefully examined each tooth for any highly unusual or distinct anatomical features. We noted that the molars and premolars exhibited a unique buccal cusp, with a distinct central cusp traversed by grooves that extended from the central fossa approximately two-thirds of the way up the inner aspect of the buccal cusps.

The maxillary anterior dentition (teeth nos. 7, 8, 9 and 10) exhibited an unusual "shovel" or "dished-out" lingual surface. The mandibular left and right first molars exhibited a "5-Y" cuspal pattern, with three buccal cusps and the distobuccal cusp in a distinct distal position. The mandibular right canine (tooth no. 27) exhibited a notch on the distal inclined plane of the incisal cusp. The mandibular right first premolars had a unique flat surface that exhibited a wear facet on the mesial and distal inclined planes of the buccal cusp.

Antemortem findings. We obtained antemortem records from the suspected victim’s general dentist. These records revealed that sealants were placed on teeth nos. 19 and 30 on Dec. 3, 1995, and the dental record noted that the patient had a history of good oral hygiene.

Records obtained from her orthodontist consisted of a panoramic radiograph, a cephalometric radiograph and orthodontic study models (Figure 3) dated Nov. 20, 1993. These procedures had been performed for diagnostic purposes for stage 1, interceptive orthodontic therapy when the patient was 9 years and 10 months of age. At that time, she was in the early mixed-dentition stage, with the permanent incisors and first molar fully erupted, and the primary canines and molars lost and their permanent successors erupting.

View larger version (129K): [in this window] [in a new window]   Figure 3. Antemortem study models. A. Anterior view (Nov. 20, 1993). B. Occlusal view (Nov. 20, 1993).

We carefully examined the study models for any distinctive anatomical features. We noted that the maxillary molars exhibited a unique buccal cusp that had a distinctive central cusp with grooves on either side of the mesiobuccal cusp. The lingual surface of the maxillary central and lateral incisors had a shoveled or dished-out contour. The mandibular left and right first molars (teeth nos. 19 and 30) had a 5-Y cuspal pattern in which the distobuccal cusp was positioned in the distal contact area.

A second cephalometric radiograph (Figure 4) had been obtained on Jan. 10, 1996, for diagnostic purposes at the start of orthodontic therapy. The patient was about 12 years old at the time. Her developmental or physiological age was late mixed-dentition stage.

View larger version (111K): [in this window] [in a new window]   Figure 4. Antemortem cephalometric radiograph (Jan. 10, 1996).

	COMPARISON OF DENTAL FINDINGS

TOP ABSTRACT INVESTIGATION ODONTOLOGICAL ANALYSIS COMPARISON OF DENTAL FINDINGS DISCUSSION CONCLUSION

 
Many variations and nuances in the dental structure and features are consistent in Jane Doe and the patient thought to be Jane Doe (Table). These features include the following:

– the mesiodistal measurements of the teeth;

– the shoveled or dished-out contour of the lingual surfaces of the maxillary anterior dentition (teeth nos. 7, 8, 9 and 10);

– the unique anatomy of the buccal cusps of the molars and premolars;

– the supplemental minor buccal cusp on the maxillary left premolar (tooth no. 13);

– the notch noted on the distal inclined plane of the mandibular right canine (tooth no. 27);

– the flat surfaces of the mesial and distal inclined planes of the mandibular right first pre-molar (tooth no. 28);

– the position of the distobuccal cusp of the mandibular left and right first molars (teeth nos. 19 and 30).

We compared the antemortem and postmortem periapical, panoramic and cephalometric radiographs by superimposing them on one another; this revealed distinct consistencies in the tooth size, tooth shape and degree of root formation, as well as in the patterns of bone trabeculation.

A medical radiologist at Phoenixville Hospital, Diagnostic Imaging Department, Phoenixville, Pa., evaluated the antemortem and postmortem cephalometric radiographs that were obtained using the same cephalostat. He compared the skeletal features of the skull and mandible. The comparisons revealed numerous consistencies in the size and shape of the maxillary and frontal sinuses, the nasal spine and the mandibular bony trabeculations.

The orthodontic treatment received by the patient thought to be Jane Doe could have caused spacing of the maxillary anterior teeth, resulting in the diastema that was noted mesial to the maxillary right canine. The eventual settling of mandibular teeth can result in slight crowding. These conditions of maxillary diastema and mandibular crowding were noted on the study models of Jane Doe.

	DISCUSSION

TOP ABSTRACT INVESTIGATION ODONTOLOGICAL ANALYSIS COMPARISON OF DENTAL FINDINGS DISCUSSION CONCLUSION

 
This was a challenging case in regard to dental identification because the skeletal remains were those of a 14- to 15-year-old girl with a full set of permanent teeth in Class I occlusion. The missing person was a 14-year-old girl who had completed orthodontic therapy, had good tooth alignment and occlusion, and had received only two sealant restorations. However, her panoramic and cephalometric radiographs, as well as the orthodontic study models, were obtained at age 9 years and 10 months, when she was in the mixed dentition stage. No radiographs of her adult dentition had been made. In addition, her final orthodontic impression was a working model of only the maxillary arch, with bands, brackets and orthodontic wire still in place. Moreover, the model did not have a full complement of teeth.

To make an identification with a reasonable degree of dental certainty, we had to note all variations in and distinctive features of the anatomical dental structures. Consistencies in tooth size, tooth shape, degree of root formation and bone trabeculation needed to be evaluated. Ante-mortem and postmortem cephalometric radiographs, as well as the assistance of a medical radiologist to evaluate the size and shape of the maxillary and frontal sinuses, the nasal spine and mandibular bony trabeculations, were helpful in identifying the victim. Moreover, the anthropological examination confirmed that the age and sex of the skeletal remains were consistent with those of the missing girl.

	CONCLUSION

TOP ABSTRACT INVESTIGATION ODONTOLOGICAL ANALYSIS COMPARISON OF DENTAL FINDINGS DISCUSSION CONCLUSION

 
After comparing the antemortem and postmortem study models, as well as the periapical and cephalometric radiographs, we concluded with a reasonable degree of dental certainty that Jane Doe and the orthodontic patient are the same person. As of August 2002, the case remained open as an unsolved homicide. Law enforcement agencies are still pursuing all leads.

View larger version (106K): [in this window] [in a new window]   Dr. Goodman is a retired orthodontist and chief deputy coroner, Chester County, Pa. Address reprint requests to Dr. Goodman at 401 Camp-wood Road, Phoenixville, Pa. 19460-2494, e-mail "NRGoodman{at}juno.com".

View larger version (151K): [in this window] [in a new window]   9Dr. Himmelberger is a forensic odontologist in private practice in Devon, Pa. She also is the antemortem team leader of PADIT (Pennsylvania Dental Association Dental Identification Team).