Estimation of Alveolar Bone Loss in Periodontitis Using Machine Learning

Artificial intelligence and personalized diagnostics in periodontology: A narrative review

Periodontal diseases pose a significant global health burden, requiring early detection and personalized treatment approaches. Traditional diagnostic approaches in periodontology often rely on a "one size fits all" approach, which may overlook the unique variations in disease progression and response to treatment among individuals. This narrative review explores the role of artificial intelligence (AI) and personalized diagnostics in periodontology, emphasizing the potential for tailored diagnostic strategies to enhance precision medicine in periodontal care. The review begins by elucidating the limitations of conventional diagnostic techniques. Subsequently, it delves into the application of AI models in analyzing diverse data sets, such as clinical records, imaging, and molecular information, and its role in periodontal training. Furthermore, the review also discusses the role of research community and policymakers in integrating personalized diagnostics in periodontal care. Challenges and ethical considerations associated with adopting AI-based personalized diagnostic tools are also explored, emphasizing the need for transparent algorithms, data safety and privacy, ongoing multidisciplinary collaboration, and patient involvement. In conclusion, this narrative review underscores the transformative potential of AI in advancing periodontal diagnostics toward a personalized paradigm, and their integration into clinical practice holds the promise of ushering in a new era of precision medicine for periodontal care.

Surveying the landscape of diagnostic imaging in dentistry's future: Four emerging technologies with promise

BACKGROUND

Advances in digital radiography for both intraoral and panoramic imaging and cone-beam computed tomography have led the way to an increase in diagnostic capabilities for the dental care profession. In this article, the authors provide information on 4 emerging technologies with promise.

TYPES OF STUDIES REVIEWED

The authors feature the following: artificial intelligence in the form of deep learning using convolutional neural networks, dental magnetic resonance imaging, stationary intraoral tomosynthesis, and second-generation cone-beam computed tomography sources based on carbon nanotube technology and multispectral imaging. The authors review and summarize articles featuring these technologies.

RESULTS

The history and background of these emerging technologies are previewed along with their development and potential impact on the practice of dental diagnostic imaging. The authors conclude that these emerging technologies have the potential to have a substantial influence on the practice of dentistry as these systems mature. The degree of influence most likely will vary, with artificial intelligence being the most influential of the 4.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The readers are informed about these emerging technologies and the potential effects on their practice going forward, giving them information on which to base decisions on adopting 1 or more of these technologies. The 4 technologies reviewed in this article have the potential to improve imaging diagnostics in dentistry thereby leading to better patient care and heightened professional satisfaction.

Dental Caries Detection and Classification in CBCT Images Using Deep Learning

OBJECTIVES

This study aimed to investigate the accuracy of deep learning algorithms to diagnose tooth caries and classify the extension and location of dental caries in cone beam computed tomography (CBCT) images. To the best of our knowledge, this is the first study to evaluate the application of deep learning for dental caries in CBCT images.

METHODS

The CBCT image dataset comprised 382 molar teeth with caries and 403 noncarious molar cases. The dataset was divided into a development set for training and validation and test set. Three images were obtained for each case, including axial, sagittal, and coronal. The test dataset was provided to a multiple-input convolutional neural network (CNN). The network made predictions regarding the presence or absence of dental decay and classified the lesions according to their depths and types for the provided samples. Accuracy, sensitivity, specificity, and F1 score values were measured for dental caries detection and classification.

RESULTS

The diagnostic accuracy, sensitivity, specificity, and F1 score for caries detection in carious molar teeth were 95.3%, 92.1%, 96.3%, and 93.2%, respectively, and for noncarious molar teeth were 94.8%, 94.3%, 95.8%, and 94.6%. The CNN network showed high sensitivity, specificity, and accuracy in classifying caries extensions and locations.

CONCLUSIONS

This research demonstrates that deep learning models can accurately identify dental caries and classify their depths and types with high accuracy, sensitivity, and specificity. The successful application of deep learning in this field will undoubtedly assist dental practitioners and patients in improving diagnostic and treatment planning in dentistry.

CLINICAL SIGNIFICANCE

This study showed that deep learning can accurately detect and classify dental caries. Deep learning can provide dental caries detection accurately. Considering the shortage of dentists in certain areas, using CNNs can lead to broader geographic coverage in detecting dental caries.

Applications of artificial intelligence in dentomaxillofacial imaging-a systematic review

BACKGROUND

Artificial intelligence (AI) technology has been increasingly developed in oral and maxillofacial imaging. The aim of this systematic review was to assess the applications and performance of the developed algorithms in different dentomaxillofacial imaging modalities.

STUDY DESIGN

A systematic search of PubMed and Scopus databases was performed. The search strategy was set as a combination of the following keywords: "Artificial Intelligence," "Machine Learning," "Deep Learning," "Neural Networks," "Head and Neck Imaging," and "Maxillofacial Imaging." Full-text screening and data extraction were independently conducted by two independent reviewers; any mismatch was resolved by discussion. The risk of bias was assessed by one reviewer and validated by another.

RESULTS

The search returned a total of 3,392 articles. After careful evaluation of the titles, abstracts, and full texts, a total number of 194 articles were included. Most studies focused on AI applications for tooth and implant classification and identification, 3-dimensional cephalometric landmark detection, lesion detection (periapical, jaws, and bone), and osteoporosis detection.

CONCLUSION

Despite the AI models' limitations, they showed promising results. Further studies are needed to explore specific applications and real-world scenarios before confidently integrating these models into dental practice.

Deep learning for classifying the stages of periodontitis on dental images: a systematic review and meta-analysis

BACKGROUND

The development of deep learning (DL) algorithms for use in dentistry is an emerging trend. Periodontitis is one of the most prevalent oral diseases, which has a notable impact on the life quality of patients. Therefore, it is crucial to classify periodontitis accurately and efficiently. This systematic review aimed to identify the application of DL for the classification of periodontitis and assess the accuracy of this approach.

METHODS

A literature search up to November 2023 was implemented through EMBASE, PubMed, Web of Science, Scopus, and Google Scholar databases. Inclusion and exclusion criteria were used to screen eligible studies, and the quality of the studies was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology with the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tool. Random-effects inverse-variance model was used to perform the meta-analysis of a diagnostic test, with which pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, and diagnostic odds ratio (DOR) were calculated, and a summary receiver operating characteristic (SROC) plot was constructed.

RESULTS

Thirteen studies were included in the meta-analysis. After excluding an outlier, the pooled sensitivity, specificity, positive LR, negative LR and DOR were 0.88 (95%CI 0.82-0.92), 0.82 (95%CI 0.72-0.89), 4.9 (95%CI 3.2-7.5), 0.15 (95%CI 0.10-0.22) and 33 (95%CI 19-59), respectively. The area under the SROC was 0.92 (95%CI 0.89-0.94).

CONCLUSIONS

The accuracy of DL-based classification of periodontitis is high, and this approach could be employed in the future to reduce the workload of dental professionals and enhance the consistency of classification.

Applying artificial intelligence to detect and analyse oral and maxillofacial bone loss-A scoping review

Radiographic evaluation of bone changes is one of the main tools in the diagnosis of many oral and maxillofacial diseases. However, this approach to assessment has limitations in accuracy, inconsistency and comparatively low diagnostic efficiency. Recently, artificial intelligence (AI)-based algorithms like deep learning networks have been introduced as a solution to overcome these challenges. Based on recent studies, AI can improve the detection accuracy of an expert clinician for periapical pathology, periodontal diseases and their prognostication, as well as peri-implant bone loss. Also, AI has been successfully used to detect and diagnose oral and maxillofacial lesions with a high predictive value. This study aims to review the current evidence on artificial intelligence applications in the detection and analysis of bone loss in the oral and maxillofacial regions.

Automatized Detection of Periodontal Bone Loss on Periapical Radiographs by Vision Transformer Networks

Several artificial intelligence-based models have been presented for the detection of periodontal bone loss (PBL), mostly using convolutional neural networks, which are the state of the art in deep learning. Given the emerging breakthrough of transformer networks in computer vision, we aimed to evaluate various models for automatized PBL detection. An image data set of 21,819 anonymized periapical radiographs from the upper/lower and anterior/posterior regions was assessed by calibrated dentists according to PBL. Five vision transformer networks (ViT-base/ViT-large from Google, BEiT-base/BEiT-large from Microsoft, DeiT-base from Facebook/Meta) were utilized and evaluated. Accuracy (ACC), sensitivity (SE), specificity (SP), positive/negative predictive value (PPV/NPV) and area under the ROC curve (AUC) were statistically determined. The overall diagnostic ACC and AUC values ranged from 83.4 to 85.2% and 0.899 to 0.918 for all evaluated transformer networks, respectively. Differences in diagnostic performance were evident for lower (ACC 94.1-96.7%; AUC 0.944-0.970) and upper anterior (86.7-90.2%; 0.948-0.958) and lower (85.6-87.2%; 0.913-0.937) and upper posterior teeth (78.1-81.0%; 0.851-0.875). In this study, only minor differences among the tested networks were detected for PBL detection. To increase the diagnostic performance and to support the clinical use of such networks, further optimisations with larger and manually annotated image data sets are needed.

Detection of Periodontal Bone Loss on Periapical Radiographs-A Diagnostic Study Using Different Convolutional Neural Networks

Interest in machine learning models and convolutional neural networks (CNNs) for diagnostic purposes is steadily increasing in dentistry. Here, CNNs can potentially help in the classification of periodontal bone loss (PBL). In this study, the diagnostic performance of five CNNs in detecting PBL on periapical radiographs was analyzed. A set of anonymized periapical radiographs (N = 21,819) was evaluated by a group of trained and calibrated dentists and classified into radiographs without PBL or with mild, moderate, or severe PBL. Five CNNs were trained over five epochs. Statistically, diagnostic performance was analyzed using accuracy (ACC), sensitivity (SE), specificity (SP), and area under the receiver operating curve (AUC). Here, overall ACC ranged from 82.0% to 84.8%, SE 88.8-90.7%, SP 66.2-71.2%, and AUC 0.884-0.913, indicating similar diagnostic performance of the five CNNs. Furthermore, performance differences were evident in the individual sextant groups. Here, the highest values were found for the mandibular anterior teeth (ACC 94.9-96.0%) and the lowest values for the maxillary posterior teeth (78.0-80.7%). It can be concluded that automatic assessment of PBL seems to be possible, but that diagnostic accuracy varies depending on the location in the dentition. Future research is needed to improve performance for all tooth groups.

Assessing the Effectiveness of Artificial Intelligence Models for Detecting Alveolar Bone Loss in Periodontal Disease: A Panoramic Radiograph Study

The assessment of alveolar bone loss, a crucial element of the periodontium, plays a vital role in the diagnosis of periodontitis and the prognosis of the disease. In dentistry, artificial intelligence (AI) applications have demonstrated practical and efficient diagnostic capabilities, leveraging machine learning and cognitive problem-solving functions that mimic human abilities. This study aims to evaluate the effectiveness of AI models in identifying alveolar bone loss as present or absent across different regions. To achieve this goal, alveolar bone loss models were generated using the PyTorch-based YOLO-v5 model implemented via CranioCatch software, detecting periodontal bone loss areas and labeling them using the segmentation method on 685 panoramic radiographs. Besides general evaluation, models were grouped according to subregions (incisors, canines, premolars, and molars) to provide a targeted evaluation. Our findings reveal that the lowest sensitivity and F1 score values were associated with total alveolar bone loss, while the highest values were observed in the maxillary incisor region. It shows that artificial intelligence has a high potential in analytical studies evaluating periodontal bone loss situations. Considering the limited amount of data, it is predicted that this success will increase with the provision of machine learning by using a more comprehensive data set in further studies.

Artificial intelligence (AI) diagnostic tools: utilizing a convolutional neural network (CNN) to assess periodontal bone level radiographically—a retrospective study

Background

The purpose of this investigation was to develop a computer-assisted detection system based on a deep convolutional neural network (CNN) algorithm and to evaluate the accuracy and usefulness of this system for the detection of alveolar bone loss in periapical radiographs in the anterior region of the dental arches. We also aimed to evaluate the usefulness of the system in categorizing the severity of bone loss due to periodontal disease.

Method

A data set of 1724 intraoral periapical images of upper and lower anterior teeth in 1610 adult patients were retrieved from the ROMEXIS software management system at King Saud bin Abdulaziz University for Health Sciences. Using a combination of pre-trained deep CNN architecture and a self-trained network, the radiographic images were used to determine the optimal CNN algorithm. The diagnostic and predictive accuracy, precision, confusion matrix, recall, F1-score, Matthews Correlation Coefficient (MCC), Cohen Kappa, were calculated using the deep CNN algorithm in Python.

Results

The periapical radiograph dataset was divided randomly into 70% training, 20% validation, and 10% testing datasets. With the deep learning algorithm, the diagnostic accuracy for classifying normal versus disease was 73.0%, and 59% for the classification of the levels of severity of the bone loss. The Model showed a significant difference in the confusion matrix, accuracy, precision, recall, f1-score, MCC and Matthews Correlation Coefficient (MCC), Cohen Kappa, and receiver operating characteristic (ROC), between both the binary and multi-classification models.

Conclusion

This study revealed that the deep CNN algorithm (VGG-16) was useful to detect alveolar bone loss in periapical radiographs, and has a satisfactory ability to detect the severity of bone loss in teeth. The results suggest that machines can perform better based on the level classification and the captured characteristics of the image diagnosis. With additional optimization of the periodontal dataset, it is expected that a computer-aided detection system can become an effective and efficient procedure for aiding in the detection and staging of periodontal disease.