Does third molar agenesis influence the second lower molar mineralization?

Different studies have established that the mineralization stages of the second mandibular molar can be used in forensic age estimation. Nowadays, the estimate's accuracy is an ethical concern, producing as few false positives (individuals incorrectly classified as older than a determined threshold) and false negatives (individuals incorrectly classified as younger than a determined threshold) as possible. Some have hypothesized that changes in teeth number may influence tooth mineralization, altering the age estimate process. This paper analyzes whether third molar agenesis affects the second mandibular molar mineralization time frame. To do so, 355 orthopantomograms were evaluated for third molar agenesis, and the second mandibular molar mineralization stage was assessed using the Demirjian stages. Student's t-test was used to compare the difference in the mean age at which the various stages of 37 mineralization were reached in the groups with and without third molar agenesis. The level of statistical significance was set at 5%. The results pointed to a delay in second mandibular molar mineralization in the case of agenesis, suggesting the need to consider this when estimating age using dental techniques.

Cheiloscopy in sex estimation: a systematic review

This study aimed to conduct a systematic review to gather evidence to clarify if cheiloscopy can be used in sex estimation and identify the reasons behind the lack of consensus in the scientific community. The systematic review was performed following the PRISMA guidelines. A bibliographic survey was conducted in PubMed, Scopus, and Web of Science databases, restricted to articles published between 2010 and 2020. Studies were selected according to eligibility criteria, and then the study data were collected. The risk of bias in each study was assessed and applied as additional inclusion or exclusion criteria. The results of the articles eligible for analysis were synthesized using a descriptive approach. In the 41 included studies, several methodological flaws and variations between studies that contribute to the discrepancy in results were identified. The data gathered allowed us to conclude that there is no strong scientific evidence to support the use of cheiloscopy in sex estimation, as there is no specific pattern for each sex, which reduces the criminalistic interest of cheiloscopy in estimating this parameter.

Study of secondary dentine deposition in central incisors as an age estimation method for adults

This work aimed to assess the pulp/tooth area ratio's utility in the upper central incisors using orthopantomograms. A convenience sample of 801 adult patient orthopantomograms was studied. Image J® software was used to measure the pulp/tooth area ratio, and a regression model was developed. Our results conclude that the methodology assessing upper incisors' pulp/tooth area ratio using orthopantomograms can lead to age overestimation and statistically significant differences between chronological and estimated age. For those over 50, no correlation between pulp/tooth area ratio and chronological age was found, suggesting that this may be the upper limit of this technique in this population. This methodology may not be suitable for age estimation, particularly in older adults.

Bisphosphonates and osteonecrosis of the jaws: Clinical and forensic aspects

OBJECTIVE

This manuscript aims to provide a comprehensive review of the current knowledge in the pathophysiology, diagnosis, prevention, and other relevant clinical and forensic aspects of a potentially severe complication known as medication-related osteonecrosis of the jaw (MRONJ) while synthesizing state-of-the-art information on bisphosphonates and introducing a possible differential diagnosis.

DESIGN

An extensive search was conducted in PubMed (U.S. National Library of Medicine) without a time or language constraint, focusing on the epidemiology, pathophysiology, risk factors, site specificity, signs and symptoms, differential diagnosis, prevention, and forensic aspects of MRONJ. All types of original articles, reviews, case reports, short communications, opinion articles, guidelines, and letters to editors were considered to produce a complete review on this subject.

RESULTS

MRONJ prevention relies on a multidisciplinary approach and is critical since truly effective treatments are lacking. This therapeutic challenge is partly due to uncertainty regarding this condition's pathophysiology. Differential diagnosis of osteonecrosis of the jaws associated with krokodil abuse, one of the most dangerous and homemade psychoactive illicit substances, should be considered.

CONCLUSIONS

Further research into the etiology and site specificity of MRONJ is encouraged, aiming to develop novel treatment prospects. Indeed, comprehending this would allow for increased efficacy and therapeutic options while emphasizing the importance of prevention. In addition, we advocate for greater consensus among the various societies regarding MRONJ's treatment and management.

Microbiology and postmortem interval: a systematic review

This systematic review aims to learn if and how it is possible to use the human microbiome to indicate the time elapsed after death. Articles were searched on the PubMed database using predefined data fields and keywords; reviews, systematic reviews, and meta-analyses were excluded. The final selection included 14 papers (out of 144). The results indicated that the microorganisms present in the cadaveric island succeed predictably over time, with markers between the stages of decomposition constituting a potential innovative tool for postmortem interval (PMI) estimation. The human microbiome has the potential to be used for PMI estimation and may present advantages as microbes are present in all seasons, in all habitats, including the most extreme ones, and because microbial communities respond predictably to environmental changes.

Fluctuating asymmetry in third molar agenesis as an aid to estimate socioeconomic status

Traditionally, dental identification techniques are used to establish identity or assist in reconstructing an individual's biological profile. However, other aspects of identity, namely socioeconomic status (SES), can be estimated through teeth. This work aims to evaluate the influence of SES on third molar agenesis in a Portuguese population. X-rays from 448 subjects (223 belonging to a high and 225 to a low socioeconomic status) were assessed and demographic data (age, sex) and dental history were registered. Frequencies and associations between the variables were analyzed using the chi-square test. For each group, differences between third molar agenesis were studied using the Wilcoxon test. The significance level was 5%. X-rays displaying at least one agenesis were more common in females (in both SES groups). Differences between socioeconomic status were found in female subjects' upper right and lower left third molars, with a higher frequency of agenesis in the lower SES group. Agenesis of lower third molars displayed fluctuant asymmetry in both groups, whereas agenesis of upper third molars was also present in the lower SES group. These results suggest that socioeconomic status can affect third molar agenesis prevalence, and fluctuant asymmetry seems more prevalent in the lower SES, as it affects all third molars.

Are lip prints hereditary? A systematic review

Hereditary lip prints have been studied by several researchers. However, the literature shows no consensus among the scientific community regarding this topic. Therefore, the aim of this study was to conduct a systematic review to gather evidence to clarify whether the surface structure of lip prints is hereditary and, consequently, if a familial relationship between individuals can be established through the analysis of lip prints. The systematic review was performed following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. A bibliographic survey was conducted in PubMed, Scopus, and Web of Science databases, restricted to articles published between 2010 and 2020. Studies were selected according to eligibility criteria, and then the study data were collected. The risk of bias of each study was assessed and applied as additional inclusion or exclusion criteria. The results of the articles eligible for analysis were synthesized by a descriptive approach. In the seven included studies, methodological variations, including the definition of similarity, that contribute to the heterogeneity of results were identified. The data gathered allowed to conclude that there is no strong scientific evidence to support the hypothesis of the existence of heredity in the surface structure of lip prints, since it was not proven that similarities between parents and children occur systematically in all families.

Lipidic compounds found in soils surrounding human decomposing bodies and its use in forensic investigations – a narrative review

Following decomposition of a human body, a variety of decomposition products, such as lipids, are released into the surrounding environment, e.g. soils. The long-lasting preservation in soils and their high diagnostic potential have been neglected in forensic research. Furthermore, little is known about the preservation, chemical transformation, or degradation of those human derived lipids in soils. To date, several studies identified various lipids such as long-chain free fatty acids and steroids in soils that contained decomposition fluids. Those lipids are preserved in soils over time and could serve as markers of human decomposition in forensic investigations, e.g. for estimating the post-mortem interval or identifying the burial location of a human body. Therefore, this review focuses on the current literature regarding fatty acid and steroid that have been detected in soils and associated with human body decomposition. After a short introduction about human decomposition processes, this review summarises fatty acid and steroid analysis applied in current case studies and studies related to taphonomic research. This review provides an overview of the available studies that have used fatty acids and steroids as identifiers of human decomposition fluid in soils in a forensic context and discusses the potential for developing this innovative field of research with direct application in a forensic context.

Forensic microbiology and bite marks: a systematic review

The forensic role of microbiology in bite mark analysis as evidence in a court of law has not yet been explored, as the analysis of bite marks is mostly morphology-based. The aim of this systematic review is to investigate if the analysis of the oral microbiota may be helpful as a complementary forensic tool. Articles were searched on the PubMed database, using predefined data fields and keywords. The final selection included a total of 6 papers (out of 42). Our results indicated that the Streptococcus genus is a key player in the analysis of bite mark microbiology from a forensic perspective and its genomic analysis may facilitate the association of a bite mark to the perpetrator. However, much more research is still needed before this forensic strategy can be applied in real scenarios. There is a need to optimize and standardize the methods of microbiome analysis and to determine several factors that may influence the results, such as the frequency of bacterial genotypes in the human population and the temporal stability of the oral microbiome on human skin.

Socioeconomic differences in permanent teeth mineralization of Portuguese girls and boys from Porto, Portugal

Purpose: Socioeconomic differences in dental maturation can be used to examine the impact of environmental factors on dental maturation. The purpose of this study is to assess socioeconomic differences in dental maturation of the seven permanent mandibular teeth (I1-M2). Methods: A total of 2114 panoramic radiographs of Portuguese children, adolescents and young adults were studied. The sample was divided into a high socioeconomic status (SES) (n = 925), and a low SES group (n = 1189). Ages ranged between 5 and 26 years. Demirjian's stages were used to assess the maturation of the seven mandibular teeth on the left side. Median-age of attainment of each stage and each tooth was calculated and compared between groups using binary logistic regression. Results: Low SES girls showed a consistent advancement in dental maturation across the entire dentition. Low SES boys, however, showed more often a delayed maturation relative to their high SES counterparts, but this pattern was not consistent and a clear socioeconomic difference seems to be absent in boys. Conclusions: While this study was not able to further explore the causes of the dental advancement in girls, it is hypothesized that it might be related to a higher prevalence of overweight/obesity, and possibly caries, in low SES girls, compared to the SES difference in prevalence in boys.

Characterization of lip prints in a Portuguese twins' population

Lip print patterns are referred to as unique to each individual, but controversy exists surrounding twins. In this study, the lip prints of 19 pairs of monozygotic and 47 pairs of dizygotic twins were studied. The left lower lip was photographed and the furrows were classified using Renaud's classification. Results showed the same lip pattern was found only in one monozygotic pair (5.3%) and in 4 dizygotic pairs (8.5%), and no significant statistical differences were found between groups (p > 0.05). In monozygotic twins only type C furrows presence displayed statistical significant differences (p=0.034). As for dizygotic twins, there were statistical significant differences in the frequency of type A (p=0.005) and type G furrows (p=0.018). As for the most common types, both groups displayed a higher prevalence of vertical furrows (type B: 97.4% and 96.8%, type A: 86.8% and 87.2%, in monozygotic and dizygotic, respectively). The least frequent furrow type was type I and type E in monozygotic (2.6% and 5.3%, respectively) and types E, F and I, in dizygotic (6.4%, 7.4%. and 7.4%, respectively). Our results seem to point out that lip print patterns should be useful carefully in twins' identification.

Physical Violence Against Children and Adolescents in Porto: A 5-Year Study

The aim of the present study was to analyze the prevalence of physical violence against children and adolescents (PVCA) in a 5-year period in the city of Porto, Portugal. All forensic reports between 2009 and 2013 in the clinical services of the North Branch of the National Institute of Legal Medicine and forensic sciences were analyzed. Victims were classified according to sex, age, relationship with perpetrator, traumatic consequences of the event, and year of occurrence. Statistical analysis was performed using SPSS (Version 22.0). Continuous variables were described when appropriated frequencies were displayed. The association between variables was evaluated using chi-square, Fisher's exact test, or Kruskal-Wallis test, when appropriate and a logistic regression was performed. The margin of error for the statistical tests was 5.0%. A total of 2,148 occurrences were evaluated. Most subjects were male, and mean victim age was 13 years. The single most frequent perpetrator was an unknown individual, but most offenders were known to the victim. The majority site of injury was the face. The larger number of complaints of aggression maintained a similar frequency over the 5 years analyzed. A physical examination to confirm the reasons between the complaint and the type of aggression was performed and shown a high relationship. Adolescents were more susceptible to violence than younger children were. The most affected region was the face.

Historical, demographic, curatorial and legal aspects of the BoneMedLeg human skeletal reference collection (Porto, Portugal)

The BoneMedLeg research project was developed to address current research concerns related to the use of skeletal reference collections for forensic purposes. These concerns were partly addressed by amassing a new reference collection which incorporates unclaimed human remains sourced from two municipal cemeteries in the city of Porto, Portugal. Amassed between 2012 and 2014 the collection was developed with permission from and in partnership with the Municipality of Porto, in a manner that is similar to that of other skeletal reference collections in Portugal. Traditionally, municipalities have bequeathed human remains that are cleared from temporary primary and secondary burial plots at local cemeteries and deemed unclaimed, to museums and universities for research purposes. The BoneMedLeg collection currently includes a total of 95 individuals, of which only 81 are fully identified (38 males and 43 females), with ages ranging from 21 days to 94 years, and a mean age of about 62 years. Years of death range from 1969 to 2003, and years of birth from 1891 to 1969. Only about half of the individuals are documented as to cause of death, which includes a considerable diversity of etiologies, from oncological to cardiovascular system disorders, and also traumatic injuries. The collection is more representative of an unskilled working class and aged population, due to one of the main sourced cemeteries disproportionately serving more socioeconomic disadvantaged communities and reflecting the demographics of the city over the past 40 years. In addition to describing the history and curatorial process of the collection in detail, this paper also discusses its broad legal framework and potential biases in its profile and composition which can inform and help plan future research projects.

Physical violence against children and adolescents in Recife: a 5-year retrospective study

The aim of the present study was to analyze the prevalence results of physical violence against children and adolescents in a 5-year period in Recife, Brazil. Inter-personal violence is one of the most recognizable forms of child aggression and has become as an imperative public health issue. All violence related forensic reports performed between 2009 and 2013 in the clinical services of the Institute of Legal Medicine Antônio Percivo Cunha were analyzed. Victims were classified according to sex, age, relationship with perpetrator, injuries and year of occurrence. Statistical analysis was performed using the SPSS (version 22.0). Continuous variables were described and when appropriate, frequencies were displayed and compared. The association between variables was evaluated using chi-square and Fisher's exact test. The margin of error for the statistical tests was 5.0%. A total of 9783 occurrences were evaluated, involving mainly male subjects (n=5447, 55.7%). Victims' mean age was 13.9 years, the most common perpetrators were victims' acquaintances (n=2538, 25.9%). Facial injuries were the most frequent affecting a little over a fifth of the total sample (n=3673, 20.1%). These findings support the important role dentists can play in identifying and reporting physical violence against children and adolescents.

Evolution and Analysis of Cultural and Cognitive Factors Related With Domestic Violence Against Women

Despite the occurrence of encouraging political and social changes in the past few years, many beliefs about women's role in intimate relationships persist, influencing their response to domestic violence (DV). This study aims to analyze the influence of recent policies against DV in Portugal, concerning particularly intimate partner violence against women and their perceptions about the victimization process. Two samples of women ( n = 126 each) reporting an aggressive act allegedly perpetrated by the current or former male partner were interviewed with a hiatus of 5 years (before and after some most relevant policy updates). Results suggest a positive influence of the recent policies against DV. Many significant and encouraging changes were found in the more recent women sample (S2) relatively to the first sample (S1) regarding their information, awareness, perceptions, and attitudes toward DV. They seem to show less tolerance and endurance to DV, placing responsibility on the offender, as well as seem more empowered to report. In S2, there was a decrease in the acceptance of violent behaviors as normal and of reasons to explain violence; the fears, shame, and helplessness about DV; the elapsed time between the beginning of the abuse and its report; and the prevalence of more severe types of physical abuse. In S2, there was an increase on the acknowledgment of DV as a crime, the number of reports in cases without cohabitation, the report of psychological abuses, and the feeling of safety and assurance while reporting.

Post-mortem microbiology in sudden death: sampling protocols proposed in different clinical settings

BACKGROUND

Autopsies, including minimally invasive autopsies, are a powerful tool for determination of the cause of death. When a patient dies from an infection, microbiology is crucial to identify the causative organism. Post-mortem microbiology (PMM) aims to detect unexpected infections causing sudden deaths; confirm clinically suspected but unproven infection; evaluate the efficacy of antimicrobial therapy; identify emergent pathogens; and recognize medical errors. Additionally, the analysis of the thanatomicrobiome may help to estimate the post-mortem interval.

AIMS

The aim was to provide advice in the collection of PMM samples and to propose sampling guidelines for microbiologists advising autopsy pathologists facing different sudden death scenarios.

SOURCES

A multidisciplinary team with experts in various fields of microbiology and autopsies on behalf of the ESGFOR (ESCMID - European Society of Clinical Microbiology and Infectious Diseases - study group of forensic and post-mortem microbiology and in collaboration with the European Society of Pathology) developed this narrative review based on a literature search using MedLine and Scopus electronic databases supplemented with their own expertise.

CONTENT

These guidelines address measures to prevent sample contamination in autopsy microbiology; general PMM sampling technique; protocols for PMM sampling in different scenarios and using minimally invasive autopsy; and potential use of the evolving post-mortem microbiome to estimate the post-mortem interval.

IMPLICATIONS

Adequate sampling is paramount to identify the causative organism. Meaningful interpretation of PMM results requires careful evaluation in the context of clinical history, macroscopic and histological findings. Networking and closer collaboration among microbiologists and autopsy pathologists is vital to maximize the yield of PMM.

Orofacial Injuries in Children and Adolescents (2009-2013): A 5-Year Study In Porto, Portugal

Abstract The aim of this study was to verify the prevalence of acts of aggression to the head, face and neck towards victims of Physical Violence against Children and Adolescents (PVCA) who were examined at the National Institute of Legal Medicine and Forensic Sciences Delegation North (INMLCF-DN) in Porto, Portugal. A study was carried out on 2,148 complaints of physical aggression against children and adolescents (0 to less than 18 years old) occurred between 2009 and 2013 and which were retrieved from information about violence held on INMLCF-DN data files. Continuous variables were described and the association between them was verified by Chi-square or Fischer’s Exact tests with 5% significance level. Within the 5-year timespan, 1,380 cases were identified with clinical relation with physical aggression. Most subjects evaluated were male adolescents and the most affected body region was the face, to which 747 injuries (24.7%) were recorded, with statistically significant association between sex and region (head and face). Victims in 15-17-year-old age group are more susceptible to violence than those in the 0-14-year-old age range. Dentists routinely examine the face, neck and skull, which make them the most appropriate health professionals to identify cases of aggression early.

The Oral Microbiome in Health and Its Implication in Oral and Systemic Diseases

The oral microbiome can alter the balance between health and disease, locally and systemically. Within the oral cavity, bacteria, archaea, fungi, protozoa, and viruses may all be found, each having a particular role, but strongly interacting with each other and with the host, in sickness or in health. A description on how colonization occurs and how the oral microbiome dynamically evolves throughout the host's life is given. In this chapter the authors also address oral and nonoral conditions in which oral microorganisms may play a role in the etiology and progression, presenting the up-to-date knowledge on oral dysbiosis as well as the known underlying pathophysiologic mechanisms involving oral microorganisms in each condition. In oral pathology, oral microorganisms are associated with several diseases, namely dental caries, periodontal diseases, endodontic infections, and also oral cancer. In systemic diseases, nonoral infections, adverse pregnancy outcomes, cardiovascular diseases, and diabetes are among the most prevalent pathologies linked with oral cavity microorganisms. The knowledge on how colonization occurs, how oral microbiome coevolves with the host, and how oral microorganisms interact with each other may be a key factor to understand diseases etiology and progression.

A new approach to sex estimation using the mandibular canine index

Rao et al.'s mandibular canine index (MCI) is a simple odontometric method which uses the mandibular canine as the key to sex estimation. This index is defined as the ratio between the right canine mesiodistal dimension and the mandibular canine arch width. The aim of this study was to contribute to sex estimation using dental techniques by analysing the MCI efficiency, and to propose a new approach for its use. Measurements were taken from 120 plaster casts (70 females) in the 16-30 year age group. Although statistically significant sexual dimorphism was observed in both the mesiodistal dimension and the mandibular canine arch width, the MCI showed a low accuracy in sex classification (54.2% correct identifications). This accuracy was improved to 64.2% using receiver operating characteristics curve analysis. Yet, despite the better accuracy, these results reinforce the idea that the MCI may not be particularly useful in sex prediction, since it may not reflect the same degree of sexual dimorphism as its absolute measures.

Human identification using dental techniques: A case report

Dental identification of skeletal remains frequently relies on data comparison. Comparative dental identification is used to establish with a high degree of certainty that the remains of a corpse and a person represented by ante-mortem dental records are the same individual. There is no minimum number of concordant points necessary to perform a positive identification; rather, each case is unique and should be treated as such. In this paper, we present a report of a case in which positive identification was made by a paramolar tubercle in both upper first deciduous molars.

Prevalence of talon cusps in a Portuguese population: Forensic identification significance of a rare trait

BACKGROUND

Dental techniques are frequently used in human identification; some of those include comparative analyses of dental features that, being rare or unique to an individual, can establish a positive identification. The usefulness of each feature depends on its population, frequency, and uniqueness. The aim of this study was to determine the prevalence of talon cusps in a Portuguese population.

MATERIALS AND METHODS

A prospective study was performed. Three hundred and two patients were studied, and talon cusps presence was assessed. Statistical tests were carried out using Statistical Package for the Social Sciences (SPSS) 17 software (SPSS Inc., Chicago, IL, USA). Statistical analysis relied primarily on descriptive statistics and crosstabs, with Chi-square analysis.

RESULTS

Results showed that talon cusps were observed in only 6.3% of patients. The maxillary lateral incisors were the most common teeth showing this feature (82.1% of all teeth).

CONCLUSION

It can be concluded that talon cusps are an uncommon trait in these Portuguese population, and therefore, it is a feature that can be potentially very useful in forensic human identification, when antemortem dental records are available.

Orohanditest: A new method for orofacial damage assessment

BACKGROUND

Currently, orofacial sequelae are recognized as very influential on the quality-of-life for a victim of orofacial damage. Therefore, correct forensic assessment for indenisation purposes is mandatory. However, orofacial damage is frequently reduced to organic components, which results in a forensic assessment process, which are inadequate. This study aims to improve the orofacial damage assessment through the development of an auxiliary tool, the orohanditest.

MATERIALS AND METHODS

A preliminary inventory was constructed, using relevant bibliographic elements and retrospective study of forensic examinations reports concerning orofacial trauma. This inventory was then utilized in the assessment of 265 orofacial trauma victims for validation. Validity was studied by analyzing the internal construct validity (exploring factorial validity and assessing internal consistency) and the external construct validity (assessing convergent validity and discriminant validity). The level of significance was defined as P < 0.05.

RESULTS

The final inventory (orohanditest) was comprised of the three components of body (8 items), functions (10 items) and situations (24 items), which were found to be statistically reliable and valid for assessment. The final score (orofacial damage coefficient) reflects the orofacial damage severity.

CONCLUSION

Orohanditest provides a reliable, precise, and complete orofacial damage description and quantification. Therefore, this method can be useful as an auxiliary tool in the orofacial damage assessment process.

Oral injuries in victims involving intimate partner violence

INTRODUCTION

Current literature states that dental medicine can have an important role in diagnosing situations of domestic violence, namely cases of intimate partner violence, since many of the injuries that occur in this context concern the head and neck areas. The aim of this study was to characterize oral injuries in these cases in a Portuguese population, and to determine the kind of permanent consequences that they might represent.

MATERIAL AND METHODS

332 forensic reports of domestic violence survivors were analysed. The reports concerned examinations performed in the North Branch of the National Institute of Legal Medicine of Portugal in 2007. Reports were assessed in order to obtain data regarding victim and offender demographic characteristics, and to characterize the nature and number of sustained injuries and their permanent consequences.

MAIN RESULTS

Most victims were females with a mean age of 33.7 years; the most frequent offender was the spouse; the majority of oral injuries affected soft tissues; permanent body consequences were found mainly in the teeth and periodontal tissues; permanent functional consequences were described as chewing difficulties, feeling pain or soft tissue mobility changes; permanent consequences for life activities referred mostly to social life aspects.

CONCLUSIONS

Oral injuries and their consequences were observed in 13.4% of intimate partner violence cases, and though being suggestive of this kind of violence, oral injuries alone are insufficient to identify this kind of abuse, and additional diagnostic criteria and evidence should be used.

Establishing identity using cheiloscopy and palatoscopy

Establishing a person's identity can be a very difficult process. Dental, fingerprint and DNA comparisons are probably the most common techniques used in this context, allowing fast and secure identification processes. However, since they cannot always be used, sometimes it is necessary to apply different and less known techniques. In this paper, the authors describe two unusual techniques: cheiloscopy and palatoscopy. It is known that due to their special features, both lip grooves and palatal rugae can be used successfully in human identification. This paper reviews the techniques of cheiloscopy and palatoscopy, and describes the different classifications and their advantages and limitations.