Portable CBCT in the forensic dental identification of the October 7th 2023 Israeli victims

Mass-fatality incidents involving severe thermal injury pose major challenges for disaster victim identification, particularly when access to the oral cavity is limited and conventional dental radiography cannot be performed. This study reports the first large-scale, real-world deployment of a portable cone-beam computed tomography (CBCT) system during the forensic identification of civilian victims following the October 7, 2023 attack in Israel and evaluates its contribution to odontological identification. We conducted an observational analysis of cases examined by the Israel Police forensic odontology teams, documenting body condition, availability of antemortem dental records, imaging modality used, and final identification outcomes. Portable CBCT was used primarily in victims with severe burns or restricted oral access. All scans were diagnostically interpretable, and repeat acquisition was required in only five cases. CBCT contributed directly to positive identification in 40 of 170 scanned victims (23%), all of which were later confirmed by DNA testing. Most identifications were based on dental treatment patterns, followed by dental morphology and jaw morphology. Brief hands-on training enabled rapid proficiency among forensic odontologists, allowing continuous use under field conditions. These findings demonstrate that portable CBCT is a practical, non-invasive imaging solution in mass-fatality settings, providing diagnostically useful data when conventional methods are not feasible and supporting timely forensic identification.