EXPLORING ODONTOGENIC CYSTS IN FORENSIC DENTAL IDENTIFICATION: A SCOPING REVIEW AND PRACTITIONER SURVEY

Abstract

Background: Forensic odontology aids with human identification, particularly when decomposition or fire compromises conventional methods. Odontogenic cysts, which originate from odontogenic epithelium, present unique radiographic and clinical features, such as specific tooth associations and anatomical alterations. These characteristics may hold significant potential as forensic markers but remain insufficiently underexplored.

Aims: This study explored the forensic significance of odontogenic cysts in comparative dental analysis by conducting a scoping review of existing literature on their prevalence, radiographic features, and forensic implications, and investigating the knowledge and practices of forensic odontologists and students through an anonymous online survey.

Materials and Methods: The first part of the study (P1) included a scoping review following PRISMA guidelines. Systematic searches in PubMed, Scopus, and LILACS identified studies published in English between 2000 and 2024 that investigated the prevalence and forensic significance of odontogenic cysts. The second part of the study (P2) comprised the creation of an e-survey, created using JISC V3, and distributed to professionals and students of Forensic Odontology worldwide. The survey aimed to explore knowledge gaps, practices, and diagnostic capabilities related to odontogenic cysts in forensic identification. Quantitative data were analysed using descriptive statistics in Microsoft Excel (Version 16.89, 2024), while qualitative data from open-ended questions underwent manual thematic analysis to identify recurring themes.

Results: The scoping review identified 25 studies published between 2007 and 2024 from an initial 1,168 records. Prevalence rates of odontogenic cysts ranged from 3.45% to 65.4%, with a median prevalence of 14.40% and an interquartile range of 10.48% to 17.34%. Dentigerous cysts were mentioned most frequently, followed by radicular cysts and odontogenic keratocysts. Only 8% (n=2) of studies addressed forensic applications. The e-survey received 41 responses from forensic odontologists and students across 15 countries, with most respondents (78%, n=32) being practicing professionals. Self-rated familiarity with odontogenic cyst identification averaged 3.37 out of 5. Diagnostic accuracy for combined forensic matching and cyst identification was highest for radicular cysts (70.7%, n=29) and lowest for dentigerous cysts (12.2%, n=5). Forensic match-only accuracy was also highest for radicular cysts (80.5%, n=33) and lowest for dentigerous cysts (21.9%, n=9). Root morphology and cyst characteristics were the most frequently reported diagnostic features.

Conclusion: Odontogenic cysts hold underrecognised potential as supplementary markers for forensic dental identification due to their high prevalence and distinctive diagnostic features. However, scarce literature, terminology inconsistencies, geographic variability, and practitioner knowledge highlight challenges to their effective use. This study presented evidence that more consideration is needed for odontogenic cysts in forensic workflows.