Altamura Man is one of the most complete and best preserved Neanderthal skeletons ever discovered. His fossilized bones, however, have remained hidden from view at the bottom of a sinkhole near Altamura, a town in southern Italy.

That’s where he fell and starved to death more than 130,000 years ago.

Cavers came face to face with his skull, covered in limestone deposits, for the first time in 1993. Frustratingly for scientists, though, its inaccessible location – a 20-minute journey from the surface through narrow crevices – has made study of the skeleton extremely difficult. The body remains lodged in a small chamber deep in the karst cave system.

“They used the rope to bring me down and many of my colleagues. For me, it was a totally amazing experience. When you get in that corner and you see the skeleton there, you’re really blown away,” said Jacopo Moggi-Cecchi, a professor in the department of biology at the University of Florence.

“This individual must have fallen down a shaft. Maybe he didn’t see the hole in the ground. We think he sat there and died,” said Moggi-Cecchi. “The original shaft he fell through is no longer there. It’s been filled by sediment so we are confident the entire skeleton is there. No animals could have got there.”

This new research, published in the journal PLOS on Wednesday by Moggi-Cecchi and his colleagues, is beginning to yield more information about the man.

Based on pH๏τos, videoscope footage and X-rays taken in the depth of cave, scientists have published an initial study of the man’s jaw, including an almost complete set of teeth. They suggest that the man was of adult age, but not old, and he had also lost two teeth before he died.

“The tooth loss is something interesting. We have a large fossil record of Neanderthals, and it’s not typical. In terms of oral health, they were in good shape,” said Moggi-Cecchi.

The roots of some teeth were exposed, which could suggest gum disease was at play, he said. Some teeth in the lower jaw also had deposits of dental calculus – calcified plaque that’s familiar to dentists today.

Homo neanderthalensis walked the Earth for a period of about 350,000 years before they disappeared, living in what’s now Europe and parts of Asia. They disappeared about 40,000 years ago – although it’s believed that they overlapped with Homo sapiens geographically for a period of more than 30,000 years after some humans migrated out of Africa.

Earlier research, published in 2016 based on DNA analysis of the man’s shoulder bone, confirmed that the body was indeed Neanderthal and that he had lived between 130,000 to 172,000 years ago.

Toothy grin and ‘third hand’

Like other Neanderthals, this ancient man’s front teeth are larger than those of modern humans – but his molars are the same size as those of humans. Neanderthal jaws are broader, and they lack the protruding chin that’s typical of modern humans.

Analysis of wear marks and calculus on other Neanderthal teeth has given us information about the Neanderthal diet and how they used their teeth for tasks other than eating.

Our archaic relatives used their front teeth almost as a “third hand” to hold meat while cutting it or to hold skins or leather for preparation, Moggi-Cecchi explained. Altamura Man had “marked wear” that might be related to this kind of activity.

For a more detailed analysis, however, Moggi-Cecchi said that it would be necessary to get the skull inside a lab as the teeth, like the rest of the skeleton, are covered in calcite – mineral deposits from the limestone karst.

Scientists hope one day that the skeleton, or at least part of it, will be removed from the cave to allow in-depth study.

Ultimately, Moggi-Cecchi said the man could become a Neanderthal version of Otzi the Iceman – whose 5,300-year-old frozen body was found by a couple hiking in the North Italian Alps in 1991. Otzi has become a window into early human history for scientists and tourists alike. Nearly every part of him has been analyzed, including what he may have sounded like, the contents in his stomach and how he died.

“The fact that we can get this kind of information simply by looking at the specimen in situ, imagine what the possibilities are if we can extract the specimen from the cave. “