Advancing antemortem human identification through smile photography: a systematic review

Smile photography has emerged as a valuable source of antemortem data in forensic odontology, particularly when conventional methods such as DNA analysis and fingerprint examination are inaccessible. This study aimed to analyse the current status of smile photography for antemortem human identification. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol guidelines. The protocol for this systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO number: CRD420251040131). Literature searches were performed in PubMed, Scopus, Sage Journals and ScienceDirect (December 2024—February 2025) using combinations of 'antemortem', 'forensic odontology', 'forensic identification', 'human identification' and 'smile photographs'. Eligible studies included publications from 2015 to 2025 that were written in English, available as open access full text, and focused on the use of smile photography as an antemortem data source in forensic odontology. Thirteen studies met the inclusion criteria. The evidence shows that smile photographs can support comparison between antemortem and postmortem images, aided by advancements, such as 3D modelling and digital overlay. However, variation in image quality, lighting, facial posture, and the absence of standardised protocols limit accuracy. Smile photography shows potential as supplementary source of antemortem data for forensic identification, provided that image authenticity is verified. Integration with digital technologies and standardised protocols may improve its reliability, particularly in mass disaster scenarios where conventional methods are unavailable. 1. Smile photography may have application in human identification, particularly when DNA or fingerprints are unavailable. 2. Advanced technologies have increased the accuracy of smile-based forensic odontology identification. 3. While casual photographs may hold forensic value, their quality can vary considerably between images. 4. It is supported by literature to utilize smile-related anatomic parameters as landmarks, when visible in photos, for forensic comparison. 5. The review underscores the need for standardized and validated smile photography protocols with further investigation.