Forensic interpretation of dental trauma: Morphological criteria, differential diagnosis, and distinction between antemortem, perimortem, and postmortem alterations.

Abstract

Perimortem traumatic dental injuries (PTDIs) can provide critical forensic information for reconstructing events occurring around the time of death. Accurate assessment and differentiation of traumatic dental injuries (TDIs) may contribute to the interpretation of injury patterns, the evaluation of possible causes and manners of death, and forensic investigations. However, accurately determining the timing of dental trauma, particularly distinguishing PTDIs from antemortem dental injuries (ADIs) and postmortem (PM) alterations, remains a significant forensic challenge. To provide a structured forensic framework for interpretation, a comprehensive literature search was conducted across three major electronic databases, PubMed, Scopus, and Web of Science. In accordance with structured narrative review recommendations (SANRA criteria), experimental, clinical, and observational studies published between 1965 and 2025 (including early electronic records from 2026) in English addressing morphological, biomechanical, taphonomic, and imaging characteristics of dental trauma were eligible for inclusion. Screening was performed in four distinct stages, incorporating a preliminary calibration exercise where two independent reviewers assessed a 20% sample of titles to ensure consistent application of eligibility criteria. Following full-text assessment, a total of 34 studies were finally selected. Evidence indicates that injury patterns result from the interaction between the impact characteristics and the biomechanical properties of dental and supporting tissues. PM alterations, particularly weathering-related changes and non-traumatic fractures, may mimic traumatic lesions and complicate diagnosis. Accurate differentiation relies on fracture morphology, surface characteristics, staining patterns, and evidence of bone biological response. Future research on advanced imaging, including cone-beam computed tomography (CBCT) and micro-computed tomography (micro-CT), could enhance non-destructive documentation. Integrating biomechanical and imaging data may improve diagnostic reliability in forensic contexts and supports robust medico-legal interpretation.