Estimation of Age by Evaluating the Occlusal Tooth Wear in Molars: A Study on Dakshina Kannada Population

Purpose

Assessment of teeth to estimate age in the living as well as the dead is well documented in the literature. Though applied in conjunction with other parameters in Gustafson’s technique, attrition of teeth solely is an underexplored indicator for age estimation mainly in India. Most of the studies using attrition of teeth have been conducted in bioarchaeology, and in populations where studies are being conducted in forensic contexts, the results are debatable. Thus, the present study aimed to evaluate the accuracy of age estimation using the Average Stage of Attrition (ASA) method by Li and Ji in adults of the Dakshina Kannada region.

Materials and Methods

This cross-sectional study assessed the degree of attrition in both maxillary and mandibular first and second molars of 136 adults of Dakshina Kannada origin (age range: 20–70 years) according to the 10 stages given by Li and Ji to derive population-specific linear regression equations.

Results

Univariate analysis of prediction of age with attrition showed a significant association of attrition score with age, stratified by sex, arch as well as in total (p-value <0.001) with a standard error of estimate of 9.231 years. The estimated age was within ±5 years of the actual age in 44.2% of the females and 50.0% of the males. A comparative review of 23 studies done to estimate age from attrition score clinically is documented in the manuscript.

Conclusion

The findings of this study suggest that evaluation of tooth wear by the Average Stage of Attrition (ASA) method can be used as a non-invasive means to aid in the determination of age in adults of Dakshina Kannada origin. Although the error increases with age, this method provides a measurable means of seriation into older and younger categories.

Heterogeneous Hunter-Gatherer and Steppe-Related Ancestries in Late Neolithic and Bell Beaker Genomes from Present-Day France

The transition from the Late Neolithic to the Bronze Age has witnessed important population and societal changes in western Europe.¹ These include massive genomic contributions of pastoralist herders originating from the Pontic-Caspian steppes^2,3 into local populations, resulting from complex interactions between collapsing hunter-gatherers and expanding farmers of Anatolian ancestry.^4-8 This transition is documented through extensive ancient genomic data from present-day Britain,^9,10 Ireland,^11,12 Iberia,¹³ Mediterranean islands,^14,15 and Germany.⁸ It remains, however, largely overlooked in France, where most focus has been on the Middle Neolithic (n = 63),^8,9,16 with the exception of one Late Neolithic genome sequenced at 0.05× coverage.¹⁶ This leaves the key transitional period covering ∼3,400-2,700 cal. years (calibrated years) BCE genetically unsampled and thus the exact time frame of hunter-gatherer persistence and arrival of steppe migrations unknown. To remediate this, we sequenced 24 ancient human genomes from France spanning ∼3,400-1,600 cal. years BCE. This reveals Late Neolithic populations that are genetically diverse and include individuals with dark skin, hair, and eyes. We detect heterogeneous hunter-gatherer ancestries within Late Neolithic communities, reaching up to ∼63.3% in some individuals, and variable genetic contributions of steppe herders in Bell Beaker populations. We provide an estimate as late as ∼3,800 years BCE for the admixture between Neolithic and Mesolithic populations and as early as ∼2,650 years BCE for the arrival of steppe-related ancestry. The genomic heterogeneity characterized underlines the complex history of human interactions even at the local scale.

Age estimation based on 3D pulp chamber segmentation of first molars from cone-beam-computed tomography by integrated deep learning and level set

OBJECTIVES

To develop an automatic segmentation method to segment the pulp chamber of first molars from 3D cone-beam-computed tomography (CBCT) images, and to estimate ages by calculated pulp volumes.

MATERIALS AND METHODS

Patients with CBCT scans were retrospectively identified. The age estimation was formulated as CBCT image segmentation using a coarse-to-fine strategy by integrated deep learning (DL) and level set (LS), followed by establishing a linear regression model. On the training data, DL model was trained for coarse segmentation. The validation set was to determine the optimal DL model, and a LS method established on it was to refine the coarse segmentation. On the testing data, the integrated DL and LS method was applied for pulp chamber segmentation, followed by volume calculation and age estimation. Statistical analysis was performed by Wilcoxon rank sum test to demonstrate gender difference in pulp chamber volume, and volume difference between maxillary and mandibular molars. Wilcoxon signed-rank test was adopted to compare true and estimated ages.

RESULTS

A total of 180 CBCT studies were randomly divided into 37/10/133 patients for training, validation, and testing data, respectively. In the training and validation sets, the results showed high spatial overlaps between manual and automatic segmentation (dice = 87.8%). For the testing set, the estimated human ages were not significantly different with true human age (p = 0.57), with a correlation coefficient r = 0.74.

CONCLUSIONS

An integrated DL and LS method was able to segment pulp chamber of first molars from 3D CBCT images, and the derived pulp chamber volumes could effectively estimate the human ages.

Long-term occlusal changes and patient satisfaction in patients treated with and without extractions: 37 years after treatment

INTRODUCTION

The objective of this research was to evaluate the treatment outcomes, long-term occlusal changes, and patient satisfaction after 37 years of nonextraction and extraction treatments.

METHODS

Fifty-seven patients with Class I and Class II malocclusion were divided into 2 groups. Group 1 included 16 patients treated with nonextraction therapy, with mean initial (T1), final (T2), and long-term posttreatment (T3) ages of 13.2, 15.0, and 50.3 years, respectively. Mean treatment time (T2 - T1) and long-term follow-up time (T3 - T2) were 1.8 and 35.2 years, respectively. Group 2 included 41 patients treated with extraction of 4 first premolars, with mean ages at T1, T2, and T3 of 13.3, 15.6, and 53.6 years, respectively. Mean treatment (T2 - T1) and long-term follow-up (T3 - T2) times were 2.3 and 37.9 years, respectively. The Peer Assessment Rating (PAR) index and Objective Grading System (OGS) indexes were evaluated at T1, T2, and T3 stages. The subjects also answered an online questionnaire regarding esthetic and occlusal self-perception at T3. Intergroup comparison was performed with t tests.

RESULTS

The PAR index improved with treatment and similarly worsened at T3 for both groups. OGS scores were close to the passing score at T2 for both groups. The nonextraction group presented worse OGS scores at T3 than the extraction group. Nonextraction patients perceived more changes in alignment over time, but overall satisfaction was similar.

CONCLUSIONS

The PAR index improved with treatment, and the PAR and OGS scores showed a significant increase, indicating great occlusal changes in the long-term stage. The nonextraction group showed more occlusal changes and perceived more changes in their alignment over time, but overall patient satisfaction was similar in both groups.

Enamel thickness variation in the deciduous dentition of extant large-bodied hominoids

OBJECTIVES

Enamel thickness features prominently in hominoid evolutionary studies. To date, however, studies of enamel thickness in humans, great apes, and their fossil relatives have focused on the permanent molar row. Comparatively little research effort has been devoted to tissue proportions within deciduous teeth. Here we attempt to fill this gap by documenting enamel thickness variation in the deciduous dentition of extant large-bodied hominoids.

MATERIALS AND METHODS

We used microcomputed tomography to image dental tissues in 80 maxillary and 78 mandibular deciduous premolars of Homo sapiens, Pan troglodytes, Gorilla, and Pongo. Two-dimensional virtual sections were created from the image volumes to quantify average (AET) and relative (RET) enamel thickness, as well as its distribution across the crown.

RESULTS

Our results reveal no significant differences in enamel thickness among the great apes. Unlike the pattern present in permanent molars, Pongo does not stand out as having relatively thicker-enameled deciduous premolars than P. troglodytes and Gorilla. Humans, on the other hand, possess significantly thicker deciduous premolar enamel in comparison to great apes. Following expectations from masticatory biomechanics, we also find that the "functional" side (protocone, protoconid) of deciduous premolars generally possesses thicker enamel than the "nonfunctional" side.

DISCUSSION

Our study lends empirical support to anecdotal observations that patterns of AET and RET observed for permanent molars of large-bodied apes do not apply to deciduous premolars. By documenting enamel thickness variation in hominoid deciduous teeth, this study provides the comparative context to interpret rates and patterns of wear of deciduous teeth and their utility in life history reconstructions.

Aging of the normal occlusion

OBJECTIVES

The aim of this study was to evaluate the qualitative occlusal changes in individuals with normal occlusion during a period of 47 years.

MATERIALS AND METHODS

The sample comprised dental models of 20 subjects with normal occlusion (8 males; 12 females) taken at 13.2 years (T1) and 60.9 years of age (T2). The occlusal features were evaluated with the objective grading system (OGS) and with the six keys to normal occlusion (SKNO). The subjects also answered a questionnaire on the aesthetic and occlusal self-perception at T2. Comparisons from T1 to T2 were performed with paired t- and McNemar tests (P less than 0.05).

RESULTS

OGS analysis showed a significant improvement in the marginal ridge levelling and tooth buccolingual inclination. There was a significant deterioration of the antero-posterior occlusal relationship from T1 to T2. Subjects without tooth loss showed a dental alignment worsening between time points. The marginal ridges, buccolingual inclination, and interproximal contacts improved. The SKNO analysis showed a significant deterioration of the maxillary second molars buccolingual inclination and an improvement of the maxillary second molar angulation. All patients were satisfied with their smiles, and 60 per cent of the subjects had no complaints. Dental crowding caused dissatisfaction in 35 per cent of the sample.

LIMITATIONS

A limitation of this study was the high prevalence of tooth loss in the sample from T1 to T2. Only 30 per cent of the subjects had no tooth loss in T2.

CONCLUSIONS

The aging process slightly deteriorates some occlusal features of individuals with normal occlusion. However, most individuals were satisfied with their aesthetics and occlusal comfort at the sixth decade of life.

Permanent tooth emergence: Timing and sequence in a sample of Black Southern African children

OBJECTIVES

This study investigates mean age, sequence, and temporal trends of permanent tooth emergence in Black Southern African children and compares the findings with other population samples.

MATERIALS AND METHODS

This community-based cross-sectional study involved 639 Black Southern African children between 5 and 20 years of age. Probit analysis was used to derive the mean age at emergence of the permanent teeth. Sex and cross-population comparisons were undertaken to determine similarities and differences in emergence timing and sequence.

RESULTS

Females emerged all teeth earlier except for M3s (p < .05). Black Southern Africans have earlier mean ages of emergence compared to population samples from the USA, Europe, Australia, and Asia. Sexual dimorphism was detected in the mandibular I1/M1 emergence sequence (females, M₁ I₁ ; males, I₁ M₁ ). The sequence in males is similar in both jaws to males from other sub-Saharan African, USA, and European samples. Females show a similar sequence pattern in the maxilla with other sub-Saharan African, and also Australian and US females of European ancestry. There is a high frequency of polymorphism in the P1P2C1 emergence sequence, with significantly more P2P1C1 maxillary sequences seen among males. Polymorphic variation was common for the I₁ M₁ sequence in both males and females.

DISCUSSION

Mean age of tooth emergence among Black Southern African children is similar to children from most other sub-Saharan African populations. No temporal change was seen in the mean age of emergence. Earlier permanent tooth emergence in Black Southern Africans is part of a general sub-Saharan pattern that is distinct from European and Asian populations.

Age estimation based on pulp/tooth volume ratio measured on cone-beam CT images

OBJECTIVES

After tooth eruption, the size of the pulp cavity decreases with age owing to deposition of secondary dentine. The aim of this study was to investigate the relation between the chronological age and the ratio of pulp volume (PV) to tooth volume (TV) measurements using CBCT images of single rooted teeth.

METHODS

Maxillary anterior, canine and mandibular canine/premolar CBCT scans of patients older than 15 years of age were collected from the archives between 2013 and 2015 years. Patients with CBCT scans of teeth were seen in detail and patients with known chronological age were included. Teeth with caries, filling or crown restorations, periapical pathologies or pulps that could not be identified were excluded. Consequently, 204 patients with 655 teeth were evaluated. The PV and the TV of each tooth was measured and then the PV/TV ratio was calculated. Simple linear regression analysis was performed in order to predict age estimation by using PV/TV.

RESULTS

The PV/TV of all teeth ranged between 0.01 and 0.08. A negative correlation was found between the PV/TV ratio and age (p < 0.05). The regression analysis showed the highest Pearson correlation (0.532) for the maxillary central incisor tooth. Considering measurements of the PV/TV of all assessed teeth, there was no significant difference in the intercept between both gender (p > 0.05).

CONCLUSIONS

This study revealed that PV/TV ratio was not gender dependent and the strongest correlation was found between the age and PV/TV ratio measured on maxillary central incisors than other teeth.

The applicability of dental wear in age estimation for a modern American population

OBJECTIVES

Though applied in bioarchaeology, dental wear is an underexplored age indicator in the biological anthropology of contemporary populations, although research has been conducted on dental attrition in forensic contexts (Kim et al., , Journal of Forensic Sciences, 45, 303; Prince et al., , Journal of Forensic Sciences, 53, 588; Yun et al., , Journal of Forensic Sciences, 52, 678). The purpose of this study is to apply and adapt existing techniques for age estimation based on dental wear to a modern American population, with the aim of producing accurate age range estimates for individuals from an industrialized context.

MATERIALS AND METHODS

Methodologies following Yun and Prince were applied to a random sample from the University of New Mexico (n = 583) and Universidade de Coimbra (n = 50) cast and skeletal collections. Analysis of variance (ANOVA) and linear regression analyses were conducted to examine the relationship between tooth wear scores and age.

RESULTS

Application of both Yun et al. () and Prince et al. () methodologies resulted in inaccurate age estimates. Recalibrated sectioning points correctly classified individuals as over or under 50 years for 88% of the sample. Linear regression demonstrated 60% of age estimates fell within ±10 years of the actual age, and accuracy improved for individuals under 45 years, with 74% of predictions within ±10 years.

DISCUSSION

This study demonstrates age estimation from dental wear is possible for modern populations, with comparable age intervals to other established methods. It provides a quantifiable method of seriation into "older" and "younger" adult categories, and provides more reliable age interval estimates than cranial sutures in instances where only the skull is available.

Forensic Age Estimation of Chinese Malaysian Adults by Evaluating Occlusal Tooth Wear Using Modified Kim's Index

Background and Objective

Evaluation of dental attrition is an easy and relatively accurate approach to estimating the age of an adult either ante- or postmortem for some specific population. Dental attrition represents a progressive physiological age change that can be measured using variety of indices to aid as an adjunct in forensic age estimation. Some of the previously proposed indices have their own practical limitations. This paper focuses on using modified Kim's criteria to score dental attrition to estimate the age of Chinese Malaysian adults and validate it.

Methodology

Tooth wear was evaluated on 190 dental models of Chinese Malaysian adults (age range: 20–60 years) using modified Kim's index to custom-derive a population specific linear equation. The same equation was validated further on new 60 dental casts.

Results and Conclusion

Regression analysis revealed good correlation between age and teeth wear and lower standard error of estimate. Test of regression on a test sample (n = 30 pairs, age range: 20–60 years) showed insignificant difference between predicted versus the actual age with statistically acceptable mean absolute difference. These data suggest that modified Kim's index can be used effectively in forensic age estimation.

A new method for the estimation of age at death by using electrical impedance: A preliminary study

Estimation of age at death is an important part of physical and forensic anthropology. The aim of this study was to investigate whether bioelectrical impedance analysis (BIA) of long bones can be used in the field of forensic medicine as a method to estimate age at death. BIA is easy to use and allows repeat measurements to be taken over time, and the equipment is inexpensive and portable. Impedance values (Z values) in 378 long bones (humeri, radii, femora, tibiae) of 40 male (233 bones) and 26 female (145 bones) autopsy cadavers were measured using two wire electrodes (connected to an alternating current device and a measuring device) inserted into the metaphyses of long bones. Computed tomography of the greater trochanter of the femur was also analyzed to evaluate bone mineral density (BMD). The results showed that Z values could be used to estimate age in males, and with an age cut-off point of 50 years in females. When estimating age at death from femur and tibia in males by using BIA, it is not necessary to consider the length of subjects. And it was thought that Z values reflected BMD. Among the long bones, the tibia is the most suitable and easy to use for Z value measurement. Z value measurement is a useful method for quantitative evaluation of age at death that can be performed quickly with inexpensive, portable equipment.

Age estimation based on pulp chamber volume of first molars from cone-beam computed tomography images

AIM

To establish a method that can be used for human age estimation on the basis of pulp chamber volume of first molars and to identify whether the method is good enough for age estimation in real human cases.

MATERIALS AND METHODS

CBCT images of 373 maxillary first molars and 372 mandibular first molars were collected to establish the mathematical model from 190 female and 213 male patients whose age between 12 and 69 years old. The inclusion criteria of the first molars were: no caries, no excessive tooth wear, no dental restorations, no artifacts due to metal restorative materials present in adjacent teeth, and no pulpal calcification. All the CBCT images were acquired with a CBCT unit NewTom VG (Quantitative Radiology, Verona, Italy) and reconstructed with a voxel-size of 0.15mm. The images were subsequently exported as DICOM data sets and imported into an open source 3D image semi-automatic segmenting and voxel-counting software ITK-SNAP 2.4 for the calculation of pulp chamber volumes. A logarithmic regression analysis was conducted with age as dependent variable and pulp chamber volume as independent variables to establish a mathematical model for the human age estimation. To identify the precision and accuracy of the model for human age estimation, another 104 maxillary first molars and 103 mandibular first molars from 55 female and 57 male patients whose age between 12 and 67 years old were collected, too. Mean absolute error and root mean square error between the actual age and estimated age were used to determine the precision and accuracy of the mathematical model. The study was approved by the Institutional Review Board of Peking University School and Hospital of Stomatology.

RESULTS

A mathematical model was suggested for: AGE=117.691-26.442×ln (pulp chamber volume). The regression was statistically significant (p=0.000<0.01). The coefficient of determination (R(2)) was 0.564. There is a mean absolute error of 8.122 and root mean square error of 5.603 between the actual age and estimated age for all the tested teeth.

CONCLUSION

The pulp chamber volume of first molar is a useful index for the estimation of human age with reasonable precision and accuracy.

Age estimation in archaeological skeletal remains: evaluation of four non-destructive age calculation methods

Estimation of age at death is an essential part of reconstructing information from skeletal material. The aim of the investigation was to reconstruct the chronological age of an archaeological sample from Croatia using cranial skeletal remains as well as to make an evaluation of the methods used for age estimation. For this purpose, four age calculation methods were used: palatal suture closure, occlusal tooth wear, tooth root translucency and pulp/tooth area ratio. Cramer's V test was used to test the association between the age calculation methods. Cramer's V test showed high association (0.677) between age determination results using palatal suture closure and occlusal tooth wear, and low association (0.177) between age determination results using palatal suture closure and pulp/tooth area ratio. Simple methods like palatal suture closure can provide data about age at death for large number of individuals, but with less accuracy. More complex methods which require qualified and trained personnel can provide data about age for a smaller number of individuals, but with more accuracy. Using different (both simple and complex) age calculation methods in archaeological samples can raise the level of confidence and percentage of success in determining age.

Age and individual foraging behavior predict tooth wear in Amboseli baboons

Teeth represent an essential component of the foraging apparatus for any mammal, and tooth wear can have significant implications for survival and reproduction. This study focuses on tooth wear in wild baboons in Amboseli, southern Kenya. We obtained mandibular and maxillary tooth impressions from 95 baboons and analyzed digital images of replicas made from these impressions. We measured tooth wear as the percent dentine exposure (PDE, the percent of the occlusal surface on which dentine was exposed), and we examined the relationship of PDE to age, behavior, and life history variables. We found that PDE increased significantly with age for both sexes in all three molar types. In females, we also tested the hypotheses that long-term patterns of feeding behavior, social dominance rank, and one measure of maternal investment (the cumulative number of months that a female had dependent infants during her lifetime) would predict tooth wear when we controlled for age. The hypothesis that feeding behavior predicted tooth wear was supported. The percent of feeding time spent consuming grass corms predicted PDE when controlling for age. However, PDE was not associated with social dominance rank or maternal investment.

Human dental age estimation by calculation of pulp-tooth volume ratios yielded on clinically acquired cone beam computed tomography images of monoradicular teeth

Secondary dentine is responsible for a decrease in the volume of the dental pulp cavity with aging. The aim of this study is to evaluate a human dental age estimation method based on the ratio between the volume of the pulp and the volume of its corresponding tooth, calculated on clinically taken cone beam computed tomography (CBCT) images from monoradicular teeth. On the 3D images of 111 clinically obtained CBCT images (Scanora(®) 3D dental cone beam unit) of 57 female and 54 male patients ranging in age between 10 and 65 years, the pulp-tooth volume ratio of 64 incisors, 32 canines, and 15 premolars was calculated with Simplant(®) Pro software. A linear regression model was fit with age as dependent variable and ratio as predictor, allowing for interactions of specific gender or tooth type. The obtained pulp-tooth volume ratios were the strongest related to age on incisors.

Estimating age of majority on third molars developmental stages in young adults from Thailand using a modified scoring technique

The aim of this study was to achieve a referral database for dental age estimation of unaccompanied minors of Thai nationality. A total of 1199 orthopantomograms were collected from original Thai women and men equally divided in age categories between 15 and 24 years. On the radiographs, the developmental stage of the third molars was scored applying a modified scoring technique. Inter- and intra-observer reliabilities were tested using kappa statistics. Correlation between the scores of all four wisdom teeth and left-right symmetry were evaluated with Pearson's correlation coefficient. Student's t-test on asymmetry was performed and regression formulas were calculated. The present database was the first to assemble third molar developmental scores on radiographs of Thai individuals and provides more appropriate dental age estimation of unaccompanied Thai minors. Future research on similar databases of different nationalities worldwide may expose ethnical influences on dental development.

Occlusal tooth wear in male F344/N rats with aging

With the aim of clarifying the aging properties of an animal model, the progress of occlusal tooth wear (OTW) of molars in male F344/N rats was monitored. Dried maxilla and mandible specimens from 61 male F344/N rats, aged 7 to >30 months, were used. The levels of OTW of all molars were monitored with aging. The cuspis dentis of molar teeth were worn out by 7 months (M) of age, and the occlusal surface became flat. As for each molar tooth (M(1-3), numbered in accordance with its position), OTW of M(1) was more severe in the lower than in the upper jaw, whereas M(3) was more severe in the upper than the lower jaw. OTW of M(2) in both the upper and the lower jaws progressed rapidly after 27M. OTW in male F344/N rats progressed faster than in females. However, when compensated for life span, both genders had similar profiles in OTW progress with aging. This study suggested that male rats were more convenient than females as a model for gerodontological research because of the earlier course of OTW progress.

Occlusal tooth wear in female F344/N rats with aging

OBJECTIVES

This study was conducted to ascertain whether laboratory rats are an adequate animal model for aging oral cavity research, especially on occlusal tooth wear (OTW), which progresses with aging and causes abnormal occlusions. Mastication has been reported to relate to cognition in the elderly. Thus, it is important to care for the oral cavity, especially in the frail elderly, for the maintenance of all-round quality of life. Adequate and appropriate animal models are essential for basic and clinical research on the oral cavity.

METHODS

Dried maxilla and mandible specimens from 98 young, aging or aged female F344/N rats were used.

RESULTS

The levels of OTW of all molars were monitored with aging. The molar tooth began to wear at 1-month old (M) and progressed rapidly till 12M. Subsequently, OTW progressed slowly till 30M, and then rapidly again after 35M.

CONCLUSIONS

This study showed that progress of OTW is well correlated with the entire life span of the rat, and suggested that the rat aged over 12M would be an adequate animal model for research on OTW in middle-aged and elderly people.

Recommendations for the forensic diagnosis of sex and age from skeletons

In both diagnostic fields a two-stage strategy is recommended: to first use "field" methods that are quick and easy but more imprecise and then "laboratory" methods that are time consuming but more precise. In preparing skeletal work, individuality of a skeleton should be checked, traces of diseases sought and time since death assessed. For sexing non-adults, the field methods are tooth mineralisation, long bone length and a few morphological skull and pelvis characteristics, for adults it is the morphology of pelvis and skull, and for both age groups the advanced laboratory method is molecular biology. For ageing non-adults the methods are mineralisation of teeth, long bone length and epiphysis development. For ageing adults the advanced laboratory method is aspartic acid racemisation. Less accurate laboratory methods are cement ring counts and histology of bones and teeth. Quick morphological methods using the pubic symphysis and other traits in combinations follow. Finally, cranial sutures and tooth number give a quick and rough impression. For the selection of a method and the assessment of its value the stochastic error produced for the reference sample is the decisive criterion; it should also be used to assess the reliability of a single diagnosis. Prerequisites for all work with skeletons are not only a complete knowledge of the relevant biology as well as specific techniques but also initial detailed instructions and with forensic applications, personal experience.

Intelligent dental identification system (IDIS) in forensic medicine

This study reports the design and development of the intelligent dental identification system (IDIS), including its efficiency and reliability. Five hundred patients were randomly selected from the Dental Department at Police General Hospital in Thailand to create a population of 3000 known subjects. From the original 500 patients, 100 were randomly selected to create a sample of 1000 unidentifiable subjects (400 subjects with completeness and possible alterations of dental information corresponding to natural occurrences and general dental treatments after the last clinical examination, such as missing teeth, dental caries, dental restorations, and dental prosthetics, 100 subjects with completeness and no alteration of dental information, 500 subjects with incompleteness and no alteration of dental information). Attempts were made to identify the unknown subjects utilizing IDIS. The use of IDIS advanced method resulted in consistent outstanding identification in the range of 82.61-100% with minimal error 0-1.19%. The results of this study indicate that IDIS can be used to support dental identification. It supports not only all types of dentitions: primary, mixed, and permanent but also for incomplete and altered dental information. IDIS is particularly useful in providing the huge quantity and redundancy of related documentation associated with forensic odontology. As a computerized system, IDIS can reduce the time required for identification and store dental digital images with many processing features. Furthermore, IDIS establishes enhancements of documental dental record with odontogram and identification codes, electrical dental record with dental database system, and identification methods and algorithms. IDIS was conceptualized based on the guidelines and standards of the American Board of Forensic Odontology (ABFO) and International Criminal Police Organization (INTERPOL).