Art-6-Phulari
FORENSIC ODONTOLOGY www.stomaeduj.com
VIRTOPSY: A NEW DEVELOPING SCIENCE IN FORENSIC ODONTOLOGY
Review Articles
Rashmi GS Phulari1a* , Bharvi Solanki1b , Dharmesh Vasavada1c
¹Department of Oral and Maxillofacial Pathology and Microbiology, Manubhai Patel Dental College and Hospital, Maharaja Krishnakumarsinhji Bhavnagar
University, Vadodara, Gujarat, India
aMDS, Professor and Head; e-mail: drrashmi_g@mpdentalcollege.edu.in; ORCID-iD: https://orcid.org/0000-0002-5023-2921
bBDS, Postgraduate Student; e-mail: bharvis2020@mpdentalcollege.edu.in; ORCID-iD: https://orcid.org/ 0000-0002-6212-8857
cMDS, Reader; e-mail: drdharmesh_v@mpdentalcollege.edu.in; ORCID-iD: https://orcid.org/0000-0003-2075-1920
ABSTRACT https://doi.org/10.25241/stomaeduj.2022.9(3-4).art.6
Background ‘Virtopsy’ is made up of two words ‘virtual’ and ‘autopsy’. ‘Virtual’ means digitally available, while
‘autopsy’ means examination of deceased to find out the cause of death.
Objective This review aims to provide an overall view about virtopsy in forensic odontology.
Data sources A narrative review was performed with a literature search in the PubMed and Google Scholar
electronic databases.
Study selection Reference lists included full papers of any study design, published in peer-viewed English
till June 2022.
Data extraction Current literature indicates various methods and applications of virtopsy in forensic
odontology. Moreover, recent advances in forensic odontology are discussed.
Data synthesis Virtopsy is a virtual alternative to traditional autopsy. Conventional autopsy has its own
pitfalls as it is an invasive procedure and not socially as well as emotionally accepted in certain religions.
Virtual autopsy is a better adjunct for conventional autopsy. Virtual autopsy has its own advantages as
digital storage of data can be done. Virtopsy used in forensic odontology is known as ‘Virdentopsy’. Various
equipment and robotic science have also developed in this field of Virdentopsy.
KEYWORDS
Dental autopsy; Forensic odontology; Human identification; Virdentopsy; Virtopsy
1. INTRODUCTION is being adjusting itself to the “new normal” things.
Social distancing has become major part of day-to-
In the field of medicine, conventional autopsy day life as well as medical field. Thus, it is desirable
procedure has a mainstay role. It aids in establishing to have every procedure touch-free and online
the final diagnosis, relates the cause of death to the during victim identification for forensic purposes
associated pathologies as well as it explains the as well. Virtopsy is a step forward in this direction.
interaction between them. According to underlying The research question formulated was ‘Can
purpose of this procedure, there are mainly 2 types virtopsy be equally efficient as conventional
of autopsies: Clinical and Forensic. Clinical autopsy autopsy in forensic odontology?’. This literature
is one which is performed in a clinical set up, by the review focuses on history, equipment, robotic
pathologist with the positive consent of the family science, methodology, application, advantages and
members of deceased to find out the cause of death. disadvantages of virtopsy in forensic odontology.
Forensic autopsy is performed in case of suspicious,
violent, mass disaster or unknown cause of death [1]. 2. METHODOLOGY
Conventional autopsy is an invasive procedure which
includes dissection, interpretation and cataloguing A literature search was performed for the
[2]. The corpse is handed over to family for last rituals narrative review in the PubMed and Google
after performing conventional autopsy procedure and Scholar electronic databases. Reference list
thus, it is not possible to re-examine the decision if included full papers on the subject of virtopsy
needed, while practicing conventional autopsy [3]. published in English language till June 2022.
Sometimes, family of the deceased may not give
consent for conventional autopsy owing to possible 3. RESULTS
mutilation involved and also for certain religion
believes [4,5]. These drawbacks of conventional Out of 30 references, 19 review articles, 5
autopsy led to genesis of emerging branch, original articles, 4 books, 1 case report and 1
virtual autopsy procedure, namely “Virtopsy” [6]. active trademark are included. 10 review articles
Because of the Covid-19 pandemic, the whole world are concentrated in Indian subcontinents.
OPEN ACCESS This is an Open Access article under the CC BY-NC 4.0 license.
Peer-Reviewed Article
Citation: Phulari RGS, Solanki B, Vasavada D. Virtopsy: a new developing science in forensic odontology. Stoma Edu J. 2022;9(3-4):115-119.
Received: September 30, 2022; Revised: November 11, 2022; Accepted: November 23, 2022; Published: November 23, 2022.
*Corresponding author: Dr. Rashmi GS Phulari, MDS, Professor and Head of Department of Oral and Maxillofacial Pathology and Microbiology
Address: Manubhai Patel Dental College, Vishwajyoti Ashram, Near Vidyakunj School, Munj mahuda, Vadodara 390011, Gujarat, India.
Tel./Fax: +91 9601896824; e-mail: rashugs@rediffmail.com
Copyright: © 2022 the Editorial Council for the Stomatology Edu Journal.
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4. DISCUSSION Computer Tomography-scan is used to examine hard
Review Articles
tissues within the body: the teeth and skeleton. They are
“Virtopsy” is combination of two terminologies ‘virtual’ much easier to interpret than conventional radiographs
and ‘autopsy’ [6]. Virtopsy can be employed for broad and as it shows two-dimensional views of three-dimensional
systemic examination of whole body. As an alternative of objects. It helps in age estimation, identification, trauma
conventional autopsy, virtopsy is less time consuming, analysis and disaster victim identification [19].
aids better in final diagnosis and render respect to Magnetic Resonance imaging features soft tissue
religious sentiments [7]. condition. Soft tissue changes can be identified with
the help of MRI. It is used to explore the cause of death
4.1 History as an alternative to traditional autopsy [20].
Way back to 3000 BCE, the ancient Egyptian civilization 3D Surface Scanning photogrammetry is a science of
practised mummification, the removal and examination making measurements using photographs. Numbers
of internal organs of human for religious causes. In 44 of photographs are taken from different angles and
BCE, after famous Julius Cesar’s murder by rival senator analysed by software [6].
by stabbing him 23 times, his official autopsy was Cone Beam Computed Tomography serves as a
conducted. In 150 BC ancient Romans had established reliable source of evidence for ante-mortem and post-
parameters for the legal practice of autopsy [8]. mortem records and assists in age estimation, gender
Dissections of dead bodies were done by Erasistratus determination and personal identification. Figure
and Herophilus to study organ and nerves [9]. “The seats 1 shows equipments used for virtopsy in forensic
and causes of disease” book including 700 autopsies odontology.
performed by Giovanni & Morgagni was published in
1761 [10]. Credit for teaching autopsy as a part of medical
education goes to William Osler (1800) [11].
German physicist Wilhelm Rongten first discovered plain
X-rays were on November 8, 1895. In 1999 first body
scan was done for high-profile case using project names
such as “digital-autopsy” or “scalpel-free autopsy” [12].
Prof. Richard Dirnhofer, the former head of Institute of
Forensic Medicine of the University of Bern, Switzerland
got registered trademark for the term ‘Virtopsy’ on 9th
November 2001 [13].
4.2 Equipment for virtopsy in forensic odontology
Figure 1. Equipments used for virtopsy in forensic odontology
Various types of records are used for virtopsy in forensic
odontology. Digital Dental records are used to compare 4.3 Robotic science for virtopsy
ante-mortem records with post-mortem records which Robotic science is used in many fields. Along with the
aids in personal identification. conventional imaging techniques, robotic science can
Digital photography has a major role in practicing also be utilized to perform virtopsy. Many robotic smart
virtopsy in forensic odontology. It aids in cases involving devices such as Virtobot, Virto mobiles and smart glasses
identification, human abuse and most significantly, bite are used to perform virtopsy.
mark cases. Digital photography is essential for evidence Virtobot is an all-in-one machine. Virtobot is developed
collection and preservation which plays major role in by PROFACTOR GmbH (SteyrGleink, Austria) according
future legal processing [14]. 3D digital scanning of bite to Iso-9283: 1998. [21] It integrates the various imaging
marks enables accurate and fast recording of the bite modalities to practice virtopsy. Within a single 3D
marks in soft substances such as cheese, chocolate, pears, space, combined surface and body volume acquisition
apples, and human skin without further distortion of the can be done with Virtobot. With the help of Virtobot,
evidence during impression taking [15,16]. Exposure to interpersonal inaccuracies can be avoided [22]. They are
pathogens can be minimized and several steps can be gigantic machines of which their utility in field of disaster
eliminated using digital scanner [17]. Computer-assisted is not always feasible [6].
overlays in bite-mark analysis is useful in case of personal Virto mobiles are relatively new to this field dating from
assault and rape cases. It preserves 3D information in 2D. late 1990s to early 2000s [23]. Vitro mobiles are compact
Digital dental radiography aids in dental practice as well devices as compared to Virtobots. They work almost
as forensic odontology. It can be intraoral or extraoral similar to Virtobots. They are mounted on a trailer which
radiography. It has advantages over conventional makes its transport easy at the site of disaster [24].
radiography such as lower exposure to radiation, ease of Smart glasses are also being used for practicing virtopsy.
storing of images and elimination of chemical processing While one forensic expert examines the corpse wearing
[18]. Digital dental radiographs can be used to find out if these glasses and team of forensic experts (who are not
the victim had undergone any restorative or endodontic present at the site of disaster) can examine the same
treatment. In most of the cases, it can serve as unique thing online on their respective computer devices [2].
identity of an individual if ante-mortem records are Virtopsy table is a large touch-sensitive liquid crystal
present. display screen. It represents the operating table
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displaying the image of the body [19]. It was developed 4.5.2 For identification of individuals
Review Articles
by Dr. Anders Perrson. Gender, age and personal identification is a challenge
Virtopsy Table allows medical professionals to explore in difficult forensic cases. Disaster victim identification
the inside of human body without need for invasive can be done using dental identification procedures
procedures. A large touch sensitive liquid-crystal display by comparing post-mortem data with ante-mortem
(LCD) screen represents the operating table displaying data, dental deoxyribonucleic acid techniques and
the image of the body. At the swipe of a finger, layers of development of dental post-mortem victim details.
skin and muscle are dissected. Also zooming in and out Post-mortem dental data plays major role in dental
of the organs for their assessment and slicing through identification. Visual examination is difficult in victims
with charred bodies and damaged oral cavities. In such
tissue using a virtual knife are possible [27]. Virtopsy table
cases, virtopsy comes to our aid.
is well suited for medical training programs and police
Smith et al. (2002) published a case report of positive
departments.
identification of deceased individual which was
accomplished by performing a CT scan on unidentified
4.4 How to perform virtopsy? cranium and comparing multiple landmarks, images
Virtopsy includes 3D imaging techniques as well as 3D with corresponding features in an ante-mortem CT scan
surface scan and all other digital recording techniques of a missing man [28].
for mapping external surface of the body [26]. 4.5.3 For toxicological examination
4.4.1 3D-Surface Scanning In cases of drug abuse, Virtopsy can be used as a tool to
With the help of virtobot, the corpse is first prepared. determine the death of person.
Virtobot places markers on exterior surface of the 4.5.4 Virtopsy in road traffic accidents and assaults
body accurately for the alignment of surface scan and Post-mortem MSCT and MRI can be used in cases of fatal
interior scans more easily. After placement of markers, blunt head injury. Identification of foreign bodies, bullet
virtobot creates 3D colour model of corpse. Scan uses tract can be done. 3D reconstruction of face can be done
stereoscopic cameras to capture colour image. It takes in case of completely mutilated bodies. Comparison of
10 seconds for robot to move over the body and create bite mark on human body or any other object can be
3D image. done.
4.4.2 3D-Imaging 4.5.5 Virtopsy in hanging or manual strangulation
After 3D surface scanning, the body(corpse) is double- Post-mortem MSCT and MRI helps in identification of
covered inside a blue bag through which x-rays can strangulation signs in victims of hanging or manual
strangulation.
easily pass through and it also prevents contamination,
4.5.6 Virtopsy in death due to burns
it respects privacy of deceased person, maintenance
Radiological methods of MSCT and MRI made it possible
of hygiene and to remain undisturbed by non-forensic
to document the injuries caused by burn as well as
personal in room. X-ray, CT-scan, CBCT, MRI can be done. forensic relevant vital reactions (air embolism and blood
All data is then stored in computer. aspiration).
Forensic odontologist can study the records anytime and Post-mortem imaging is a good forensic visualization
images can adjusted up and down & rotated at various tool with a great potential for forensic documentation
angles, which provides flexibility which is absent in of completely charred bodies.
conventional autopsy.
4.4.3 Biopsy 4.6 Advantages [29,30]
After 3D surface scanning and 3D-imaging, needle biopsy • As it is a scalpel-free, it is a fast procedure
can be done if internal body samples are needed. All data • It has a better social acceptance as it is a minimally
of biopsy also can be scanned and saved in computer. invasive procedure
• Minimal risk of infection to the forensic experts and
4.5 Applications of virtopy associated workers
The preliminary results, based on concept of ‘Virtopsy’ • 3D analysis can be done
are promising enough. Radiological investigations can • Effective visualization and localization of fracture lines
be used in Disaster Victim Identification in cases such • Depthof invasion of foreign body can be assessed
as cranial, skeletal or tissue trauma. With the help of • Autopsy result with all the details can be digitally stored,
thus amenable for re-examination and second opinion
MSCT (Multi-slice computed tomography) and MRI,
even after a long time
some forensic vital reactions can be diagnosed [12].
• Results will be observer independent
Applications of virtopsy include determining cause of
death, gender & age determination in difficult forensic 4.7 Disadvantages [29,30]
cases, identification of distinct foreign bodies and injuries, • Instruments and set-up used to practice biopsy are
forensic 3D reconstructions, bullet tract identification, expensive
investigation of bite marks and for research purposes • Artefacts are difficult to identify
[27]. • Very fine structures cannot be studied
4.5.1 Determining the timing and cause of Death • Odour and colour change cannot be recorded
MSCT and MRI can be used to determine timing of death • Irregularity of body shape may affect screening
in head injury cases. • Some loss of details can get while merging of data
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5. CONCLUSION
Review Articles Table 1. Difference between traditional autopsy and virtopsy.
TRADITIONAL VIRTOPSY
Virtopsy emerges as a useful tool for forensic
AUTOPSY
investigations. With the help of virtopsy, improved
1. Invasive procedure and 1. Minimally invasive data collection can be made. Without damaging the
results in destruction of procedure and does not body, one can visualize 3D anatomical structures
tissue. cause destruction of tissue. thoroughly. After covid-era, absence of contamination
2. Examination can only be 2. Creates an objective 3D from cadaver’s substances is also beneficial for
done by experts present at data set that can be shared forensic experts’ health. Computed approach in
the time of procedure. with other experts who are virtopsy provides the review of the case even after
not present at the time of several years of death, improved data organization
procedure. and communication between the forensic experts.
3. Less social acceptance 3. More social acceptance Recently, the term VIRDENTOPSY has been coined
that merges the “virtual’ and “dental autopsy”. It
4. Inter-observer variation 4. Results are independent of
is a registered brand by Nuzzolese E in 2021 with
can be present in results. Inter-observer variation.
a dedicated website in order to offer a remote
5. High risk of infection to 5. Minimal risk of infection to forensic odonatological assessment of post mortem
experts & associated workers experts & associated workers. dental data of unidentified human remains.[25]
6. No digital storage of 6. Digital storage of details. Virtopsy still remains underused in forensic
details. So, re-examination So, re-examination and odontology requires further exploration to maximize
and second opinion cannot second opinion can be done its benefits to expand its space in dentistry.
be done after long time. even after long time.
7. Difficult to access depth of 7. Feasible to access depth of CONFLICT OF INTEREST
invasion of foreign body invasion of foreign body The authors have certified that there is no conflict of interest.
8. Odour and colour change 8. Odour and colour change
AUTHOR CONTRIBUTIONS
can be examined. cannot be examined. RP, BS: reviewed articles. RP, DV, BS: critically revised revised the
9. Cost effective 9. Investment of expensive manuscript.
instruments is needed.
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Rashmi GS PHULARI
Professor & Head of Department
Oral and Maxillofacial Pathology and Microbiology
Manubhai Patel Dental College and Hospital
Vadodara, Gujarat, India
CV
Dr. Rashmi GS Phulari, Professor & Head of Department of Oral and Maxillofacial Pathology and Microbiology, Manubhai Patel
Dental College and Hospital, Vadodara, Gujarat. She has authored a textbook titled 'Textbook of Dental Anatomy Physiology and
Occlusion' and a monography titled 'Age Estimation in Forensic Odontology'. She has also published articles in several national
and international indexed journals.
Questions
1. What is the purpose of performing autopsy?
qa. Clinical;
qb. Forensic;
qc. A and B both;
qd. None of the Above.
2. Which of the following is an invention of robotic science?
qa. Virtobot;
qb. 3D surface scanning;
qc. MRI;
qd. Intraoral radiographs.
3. Who registered the trademark for Virtopsy?
qa. Wilhelm Rongten;
qb. William Osler;
qc. Prof. Richard Dirnhofer;
qd. Giovanni & Morgagni.
4. Which of the following is not an advantage of Virtopsy?
qa. Better social acceptancel;
qb. Odor and color change can be recorded;
qc. 3D analysis can be done;
qd. Minimal risk of infection for the forensic experts and associated experts.
Stoma Edu J. 2022;9(3-4):115-119 pISSN 2360-2406; eISSN 2502-0285 119