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Ives G, Johns SE, Deter C. Sexual dimorphism of pelvic scarring: A new method of adult biological sex estimation. J Forensic Sci 2024. [PMID: 39036898 DOI: 10.1111/1556-4029.15587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/04/2024] [Accepted: 07/03/2024] [Indexed: 07/23/2024]
Abstract
Estimating biological sex is a crucial aspect of forensic anthropology, and is pivotal in forensic investigations. Presently, the most frequently adopted osteological sex estimation methods focus on the anterior pelvis, which is easily susceptible to postmortem damage, revealing a need for additional accurate methods. This study introduces a novel method for estimating adult sex through metric pelvic scar analysis, using a known skeletal sample (169 females; 51 males). Relationships between sex and scar dimensions were subjected to Kendall's tau-B testing, and the strongest associated measurements were further analyzed using binary logistic regression to determine their predictive capacity. The final estimation method was tested on an additional known-sex sample of 43 males and 43 females from the Spitalfields skeletal collection. All associations between biological sex and scar measurements were significant, with the preauricular sulcus and newly defined inferior interosseous cavity presenting the strongest relationships (τb 0.223-0.504). Individual regression models using the approximate volume of each feature predicted sex with over 80% accuracy, but when combined in a single regression model, the accuracy increased to an impressive 97.1%. When then applied to the validation sample, the final estimation model achieved an accuracy of 90.7%. These results highlight the high estimation accuracy achieved by simultaneously utilizing the approximate volume of the sulcus and the inferior cavity. This is not only highly accurate but also utilizes the sturdier posterior pelvis, making it a promising tool for forensic investigations and the wider field of osteology.
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Affiliation(s)
- Georgina Ives
- School of Anthropology and Conservation at the University of Kent, Canterbury, UK
| | - Sarah E Johns
- School of Anthropology and Conservation at the University of Kent, Canterbury, UK
| | - Chris Deter
- School of Anthropology and Conservation at the University of Kent, Canterbury, UK
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DesMarais A, Obertova Z, Franklin D. The influence of age on greater sciatic notch morphology: testing the Walker method in an Australian population. Int J Legal Med 2024; 138:239-247. [PMID: 37055626 PMCID: PMC10772010 DOI: 10.1007/s00414-023-02988-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/17/2023] [Indexed: 04/15/2023]
Abstract
Sex estimation is an integral aspect of a forensic biological profile. The pelvis, being the most dimorphic part of the skeleton, has been studied in considerable detail relative to morphological and metric variation. However, empirical data on the effect of age on pelvic morphology relative to sex-specific morphological variation is limited, especially in regard to the estimation of skeletal sex. This study assesses whether there are age-related differences in the distribution of the Walker (2005) morphological scores for the greater sciatic notch (GSN) in an Australian population. Three-dimensional volumetric reconstructions derived from multi-detector computed tomography (MDCT) scans of 567 pelves of 258 females and 309 males aged 18 to 96 years were scored following Walker (2005). Differences in score distributions and means by sex and age group were tested using Pearson's chi-squared test and ANOVA, respectively. The accuracy of sex estimates derived from logistic regression equations was explored using leave-one-out cross-validation. Significant differences were found in score distribution and means among age groups in females, but not in males. There was a tendency toward higher scores in older females. The overall sex estimation accuracy was 87.5%. When comparing age groups 18-49 and 70 + years, estimation accuracy decreased in females (99% vs. 91%), while the opposite was found for males (79% vs. 87%). These findings suggest that age affects GSN morphology. Higher mean scores in older females imply that, on average, the GSN becomes narrower with increasing age. It is thus recommended due consideration of estimated age when assessing sex based on the GSN in unidentified human remains.
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Affiliation(s)
- Angel DesMarais
- Centre for Forensic Anthropology, School of Social Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, Australia.
| | - Zuzana Obertova
- Centre for Forensic Anthropology, School of Social Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, Australia
| | - Daniel Franklin
- Centre for Forensic Anthropology, School of Social Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, Australia
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Poilliot A, Hammer N, Toranelli M, Doyle T, Gay‐Dujak MH, Müller‐Gerbl M. Influence of size and shape of the auricular surfaces on subchondral bone density distribution in the sacroiliac joint. J Anat 2023; 243:475-485. [PMID: 36893752 PMCID: PMC10439371 DOI: 10.1111/joa.13857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
The sacroiliac auricular surface has a variable morphology and size. The impact of such variations on subchondral mineralization distribution has not been investigated. Sixty-nine datasets were subjected to CT-osteoabsorptiometry for the qualitative visualization of chronic loading conditions of the subchondral bone plate using color-mapped densitograms based on Hounsfield Units in CT. Auricular surface morphologies were classified into three types based on posterior angle size: Type 1: >160°, Type 2: 130-160° and Type 3: <130°. Auricular surface size was categorized based on the mean value (15.4 cm2 ) separating the group into 'small' and 'large' joint surfaces. Subchondral bone density patterns were qualitatively classified into four color patterns: two marginal patterns (M1 and M2) and two non-marginal patterns (N1 and N2) and each iliac and sacral surface was subsequently categorized. 'Marginal' meant that 60-70% of the surface was less mineralized compared with the highly dense regions and vice versa for the 'non-marginal' patterns. M1 had anterior border mineralization and M2 had mineralization scattered around the borders. N1 had mineralization spread over the whole superior region, N2 had mineralization spread over the superior and anterior regions. Auricular surface area averaged 15.4 ± 3.6 cm2 , with a tendency for males to have larger joint surfaces. Type 2 was the most common (75%) and type 3 the least common morphology (9%). M1 was the most common pattern (62% of surfaces) by sex (males 60%, females 64%) with the anterior border as the densest region in all three morphologies. Sacra have a majority of surfaces with patterns from the marginal group (98%). Ilia have mineralization concentrated at the anterior border (patterns M1 and N2 combined: 83%). Load distribution differences related to auricular surface morphology seems to have little effect on long-term stress-related bone adaptation visualized with CT-osteoabsorptiometry. Higher iliac side mineralization was observed in larger joint surfaces and age-related morphomechanical size alterations were seen in males.
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Affiliation(s)
| | - Niels Hammer
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research CenterMedical University of GrazGrazAustria
- Department of Orthopedic and Trauma SurgeryUniversity of LeipzigLeipzigGermany
- Division of BiomechatronicsFraunhofer Institute for Machine Tools and Forming TechnologyDresdenGermany
| | | | - Terence Doyle
- University of Otago School of MedicineDunedinNew Zealand
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Morphological Variations of the Posterior Superior Iliac Spine in Chinese Population: Potential Effects on the Reliability of Palpation. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6290133. [PMID: 35978644 PMCID: PMC9377927 DOI: 10.1155/2022/6290133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/18/2022] [Indexed: 11/24/2022]
Abstract
Objectives The posterior superior iliac spine (PSIS) is an important anatomical landmark often involved in spinal manipulation and surgical bone harvest. Hence, knowledge of variations in the PSIS may be predictive and valuable in clinical settings. Taking the complex morphology into account, the study is aimed at proposing a classification of PSIS in the Chinese population. Methods An anatomical study was undertaken on 288 human ilia. First, the morphological features of variations in the PSIS were noted following visual inspection. Then, 12 variable anatomical parameters were measured in order to determine the differences based on morphology, side, and sex. Results Overall, four types of PSIS were found among 288 bones, including type I “V-shape” (106, 36.8%), type II “U-shape” (121, 42.0%), type III “W-shape” (36, 12.5%), and type IV “ossification-shape” (25, 8.7%). There were no significant sex or bilateral differences in the morphological distribution of the PSIS (p > 0.05). Furthermore, the measurements showed that type I was the narrowest and type III the broadest (p < 0.05). Moreover, female specimens had an overall larger distance and width of surrounding landmarks (p < 0.05), and a significant difference was found in the width of the PSIS between the left and right sides (p < 0.05). Conclusion The PSIS samples displayed multiple morphological variations and could be classified into four types. In addition, sex-based or bilateral differences existed in the size and relative positions. It is thus likely that differences in the morphology and asymmetry of the PSIS provide references for palpation, bone harvest, and other clinical settings.
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Oner Z, Secgin Y, Turan M, Oner S. Gender prediction with the parameters obtained from pelvis computed tomography images and machine learning algorithms. J ANAT SOC INDIA 2022. [DOI: 10.4103/jasi.jasi_280_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Knecht S, Nogueira L, Servant M, Santos F, Alunni V, Bernardi C, Quatrehomme G. Sex estimation from the greater sciatic notch: a comparison of classical statistical models and machine learning algorithms. Int J Legal Med 2021; 135:2603-2613. [PMID: 34554326 DOI: 10.1007/s00414-021-02700-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/09/2021] [Indexed: 11/28/2022]
Abstract
The greater sciatic notch (GSN) is a useful element for sex estimation because it is quite resistant to damage, and thus it can often be assessed even in poorly preserved skeletons. This study aimed to develop statistical models for sex estimation based on visual and metric analyses of the GSN, and additional variables linked to the GSN. A total of 60 left coxal bones (30 males and 30 females) were analysed. Fifteen variables were measured, and one was a morphologic variable. These 16 variables were used for the comparison of six statistical models: linear discriminant analysis (LDA), regularized discriminant analysis (RDA), penalized logistic regression (PLR) and flexible discriminant analysis (FDA), and two machine learning algorithms, support vector machine (SVM) and artificial neural network (ANN). The statistical models were built in two steps: firstly, only with the GSN variables (group 1), and secondly, with the whole variables (group 2), in order to see if the models including all the variables performed better. The overall accuracy of the models was very close, ranging from 0.92 to 0.97 using specific GSN variables. When additional variables starting from the deepest point of GSN are available, it is worth to use them, because the accuracy increases. PLR (after optimization of parameters) stands out from other statistical models. The position of the deepest point of GSN (Fig. 2) probably plays a crucial role for the sexual dimorphism, as stated by the good performance of the visual assessment of this point and the fact that the A2 angle (posterior angle with the deepest point of the GSN as the apex) is included in all models.
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Affiliation(s)
- Siam Knecht
- Faculté de Médecine, Université de Lorraine, 9 avenue de la Forêt de Haye, 54500, Vandœuvre-les-Nancy, France.
- Faculté de Médecine, Institut Universitaire d'Anthropologie Médico-Légale Université Côte d'Azur, 28 Avenue de Valombrose, 06107 cedex 2, Nice, France.
| | - Luísa Nogueira
- Faculté de Médecine, Institut Universitaire d'Anthropologie Médico-Légale Université Côte d'Azur, 28 Avenue de Valombrose, 06107 cedex 2, Nice, France
| | - Maël Servant
- Faculté de Médecine, Institut Universitaire d'Anthropologie Médico-Légale Université Côte d'Azur, 28 Avenue de Valombrose, 06107 cedex 2, Nice, France
| | - Frédéric Santos
- UMR 5199 PACEA, Université de Bordeaux, Allée Geoffroy Saint-Hilaire, Bâtiment B8, CS 50023, Cedex 33615, Pessac, France
| | - Véronique Alunni
- Faculté de Médecine, Institut Universitaire d'Anthropologie Médico-Légale Université Côte d'Azur, 28 Avenue de Valombrose, 06107 cedex 2, Nice, France
- CEPAM, UMR CNRS 7264, 24 avenue des Diables Bleus, 06300, Nice, France
| | - Caroline Bernardi
- Faculté de Médecine, Institut Universitaire d'Anthropologie Médico-Légale Université Côte d'Azur, 28 Avenue de Valombrose, 06107 cedex 2, Nice, France
- CEPAM, UMR CNRS 7264, 24 avenue des Diables Bleus, 06300, Nice, France
| | - Gérald Quatrehomme
- Faculté de Médecine, Institut Universitaire d'Anthropologie Médico-Légale Université Côte d'Azur, 28 Avenue de Valombrose, 06107 cedex 2, Nice, France
- CEPAM, UMR CNRS 7264, 24 avenue des Diables Bleus, 06300, Nice, France
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Garvin HM, Stock MK, Marciniec KA, Mohamed MM, Ternent E, Cirillo LE, Stull KE. Sex estimation of the subadult ilium prior to acetabular fusion. J Forensic Sci 2021; 66:2113-2125. [PMID: 34355806 DOI: 10.1111/1556-4029.14832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/21/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
Previous studies evaluating sexual dimorphism in subadult pelvic features present variable, and at times conflicting, conclusions. As a result, there is yet to be a consensus on whether the subadult pelvis can be used in sex estimation methods. This study aims to assess the forensic utility of ilium shape and greater sciatic notch morphology in sexing subadult pelves prior to acetabular fusion. A sample of 397 modern U.S. individuals with unfused acetabula (i.e., tri-radiate cartilages) aged birth to 14 years was queried from a larger sample of postmortem computed tomography scans. Elliptical Fourier analyses were performed on ilium and greater sciatic notch outlines and resultant PCs were evaluated for significant effects of sex and age. Greater sciatic notch metrics were also collected. Stepwise linear discriminant function analyses with leave-one-out cross-validation were performed on the PCs and metric variables. Analyses were performed on pooled samples, on age-specific cohort samples, and on samples that iteratively removed the youngest one-year cohort. Cross-validated correct classification rates ranged from 57% to 65% and no patterns were observed to support an appearance and/or consistent expression of sexually diagnostic traits. Based on the results, sex estimation using these features is not recommended in pelvic remains prior to acetabular fusion, although the sample sizes of individuals over 5 years of age were limited in this study. Future studies should focus on the sexually diagnostic ability of pelvic traits in subadult samples post-fusion of the acetabulum.
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Affiliation(s)
- Heather M Garvin
- College of Osteopathic Medicine, Des Moines University, Des Moines, IA, USA
| | - Michala K Stock
- Department of Sociology and Anthropology, Metropolitan State University of Denver, Denver, CO, USA
| | | | - Merna M Mohamed
- College of Osteopathic Medicine, Des Moines University, Des Moines, IA, USA
| | - Elizabeth Ternent
- College of Osteopathic Medicine, Des Moines University, Des Moines, IA, USA
| | - Laura E Cirillo
- Department of Anthropology, University of Nevada, Reno, NV, USA
| | - Kyra E Stull
- Department of Anthropology, University of Nevada, Reno, NV, USA.,University of Pretoria, Hatfield, Pretoria, South Africa
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Marino R, Tanganelli V, Pietrobelli A, Belcastro MG. Evaluation of the auricular surface method for subadult sex estimation on Italian modern (19th to 20th century) identified skeletal collections. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2020; 174:792-803. [PMID: 32936960 DOI: 10.1002/ajpa.24146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 08/12/2020] [Accepted: 08/31/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Sex estimation in subadult skeletal remains is still considered highly problematic. The aim of this research is to test the reliability of the method of subadult sex assessment proposed by Luna and co-workers in 2017, based on the analysis of the auricular surface of the ilium. MATERIALS AND METHODS Seven ratios and three morphological traits were recorded for 127 subadult individuals (63 males and 64 females), aged between 0 and 17 years, from several Identified Skeletal Collections of the University of Bologna. Nonparametric Mann Whitney test, Kolmogorov Smirnov test, and the Pearson correlation coefficient were used for continuous variables, whereas the Cramer Coefficient was calculated for qualitative variable. A principal component analysis was also performed on ratio values. The statistic ƞ was taken into account for both types of variables. RESULTS None of the ratios presented significant dimorphic results. Two qualitative variables show statistically significant differences between sexes. The overall morphology proved to be an accurate sex predictor among children aged ≥4 years (78%-86%) and meets the minimum accuracy standard (75%) for subadult sex estimation for individuals between 1 and 17 years of age. The morphology of the retroauricular end of the superior demiface (MRS) can be used with a high level of accuracy for sexing individuals from 1 to 12 years (77%-81%). CONCLUSIONS The metric variables did not replicate the accuracy values originally obtained by Luna and co-workers. Otherwise, the evaluation of the morphological variables proposed by the authors yielded promising results as a reliable sexing technique for individuals who died before puberty.
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Affiliation(s)
- Roberta Marino
- Department of Biological, Geological and Environmental Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Viola Tanganelli
- Department of Biological, Geological and Environmental Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Annalisa Pietrobelli
- Department of Biological, Geological and Environmental Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Maria Giovanna Belcastro
- Department of Biological, Geological and Environmental Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Outline analysis of sex and population variation in greater sciatic notch and obturator foramen morphology with implications for sex estimation. Forensic Sci Int 2020; 314:110346. [DOI: 10.1016/j.forsciint.2020.110346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/14/2020] [Accepted: 05/20/2020] [Indexed: 11/20/2022]
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10
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Nikita E. Documented skeletal collections in Greece: Composition, research, and future prospects. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2020. [DOI: 10.1002/ajpa.24050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Efthymia Nikita
- Science and Technology in Archaeology and Culture Research Centre The Cyprus Institute Nicosia Cyprus
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Monge Calleja ÁM, Aranda CM, Santos AL, Luna LH. Evaluation of the auricular surface method for non‐adult sex estimation on the Lisbon documented collection. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2020; 172:500-510. [DOI: 10.1002/ajpa.24012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/23/2019] [Accepted: 01/07/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Álvaro M. Monge Calleja
- Centro de Investigação em Antropologia e Saúde (CIAS), Department of Life SciencesUniversity of Coimbra Coimbra Portugal
| | - Claudia M. Aranda
- Faculty of OdontologyUniversity of Buenos Aires Buenos Aires Argentina
| | - Ana Luísa Santos
- Centro de Investigação em Antropologia e Saúde (CIAS), Department of Life SciencesUniversity of Coimbra Coimbra Portugal
| | - Leandro H. Luna
- CONICET‐IMHICIHUMultidisciplinary Institute of History and Human Sciences Buenos Aires Argentina
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Andrade VM, Fontenele RC, de Souza AC, Almeida CAD, Vieira AC, Groppo FC, Freitas DQ, Junior ED. Age and sex estimation based on pulp cavity volume using cone beam computed tomography: development and validation of formulas in a Brazilian sample. Dentomaxillofac Radiol 2019; 48:20190053. [PMID: 31322923 DOI: 10.1259/dmfr.20190053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To develop and validate formulas for age and sex estimation based on the pulp cavity volume of teeth using cone beam CT. METHODS The sample was composed of 116 cone beam CT scans from Brazilian individuals of both sexes, ranging in age from 13 to 70 years. A total of 232 teeth (upper central incisors and canines) were evaluated. Two calibrated examiners determined pulp cavity volumes using the ITK-SNAP software. Pearson's correlation test was used to assess the correlation between chronological age and pulp volume. Linear and logistic regression models were developed for age and sex estimation, respectively, and were validated in another sample of 72 teeth. RESULTS Pearson's correlation coefficients between age and pulp volume were negative and significant (p < 0.0001) for both teeth (r = -0.8782 for central incisors and r = -0.8738 for canines). The age estimation formulas showed good determination coefficients (adjusted R² = 0.7614 to 0.8367). For sex estimation, when the age was known, the coefficients were also good (adjusted R² = 0.649 to 0.812). However, when the age was unknown, the coefficients of the sex estimation formulas were low (adjusted R² = 0.047 to 0.393). Validation showed high accuracy of age estimation in individuals older than 35 years, as well as high accuracy of sex estimation when the age was known. CONCLUSIONS Our formulas provided excellent results and can be applied to the Brazilian population. The best results were observed for age estimation in females and for sex estimation when the age was known.
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Affiliation(s)
- Vanessa M Andrade
- Forensic Odontology Service, Afrânio Peixoto Legal Medicine Institute, Rio de Janeiro, Brazil.,Department of Social Odontology, Legal Odontology Division, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
| | - Rocharles C Fontenele
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
| | - Andreia Cb de Souza
- Forensic Odontology Service, Afrânio Peixoto Legal Medicine Institute, Rio de Janeiro, Brazil.,Department of Social and Preventive Dentistry, Dentistry College, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Casimiro Ap de Almeida
- Department of Social and Preventive Dentistry, Dentistry College, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andrea Cd Vieira
- Department of Pathology and Oral Diagnosis, Radiology Service, Dentistry College, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Francisco C Groppo
- Department of Physiological Sciences, Area of Pharmacology, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
| | - Deborah Q Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
| | - Eduardo D Junior
- Department of Social Odontology, Legal Odontology Division, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
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