Automatic detection of periodontal compromised teeth in digital panoramic radiographs using faster regional convolutional neural networks

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.

Can deep learning identify humans by automatically constructing a database with dental panoramic radiographs?

The aim of this study was to propose a novel method to identify individuals by recognizing dentition change, along with human identification process using deep learning. Recent and past images of adults aged 20-49 years with more than two dental panoramic radiographs (DPRs) were assumed as postmortem (PM) and antemortem (AM) images, respectively. The dataset contained 1,029 paired PM-AM DPRs from 2000 to 2020. After constructing a database of AM dentition, the degree of similarity was calculated and sorted in descending order. The matched rank of AM identical to an unknown PM was measured by extracting candidate groups (CGs). The percentage of rank was calculated as the success rate, and similarity scores were compared based on imaging time intervals. The matched AM images were ranked in the CG with success rates of 83.2%, 72.1%, and 59.4% in the imaging time interval for extracting the top 20.0%, 10.0%, and 5.0%, respectively. The success rates depended on sex, and were higher for women than for men: the success rates for the extraction of the top 20.0%, 10.0%, and 5.0% were 97.2%, 81.1%, and 66.5%, respectively, for women and 71.3%, 64.0%, and 52.0%, respectively, for men. The similarity score differed significantly between groups based on the imaging time interval of 17.7 years. This study showed outstanding performance of convolutional neural network using dental panoramic radiographs in effectively reducing the size of AM CG in identifying humans.

A YOLO-V5 approach for the evaluation of normal fillings and overhanging fillings: an artificial intelligence study

Dental fillings, frequently used in dentistry to address various dental tissue issues, may pose problems when not aligned with the anatomical contours and physiology of dental and periodontal tissues. Our study aims to detect the prevalence and distribution of normal and overhanging filling restorations using a deep CNN architecture trained through supervised learning, on panoramic radiography images. A total of 10480 fillings and 2491 overhanging fillings were labeled using CranioCatch software from 2473 and 1850 images, respectively. After the data obtaining phase, validation (80%), training 10%), and test-groups (10%) were formed from images for both labelling. The YOLOv5x architecture was used to develop the AI model. The model's performance was assessed through a confusion matrix and sensitivity, precision, and F1 score values of the model were calculated. For filling, sensitivity is 0.95, precision is 0.97, and F1 score is 0.96; for overhanging were determined to be 0.86, 0.89, and 0.87, respectively. The results demonstrate the capacity of the YOLOv5 algorithm to segment dental radiographs efficiently and accurately and demonstrate proficiency in detecting and distinguishing between normal and overhanging filling restorations.

Toward Digital Periodontal Health: Recent Advances and Future Perspectives

Periodontal diseases, ranging from gingivitis to periodontitis, are prevalent oral diseases affecting over 50% of the global population. These diseases arise from infections and inflammation of the gums and supporting bones, significantly impacting oral health. The established link between periodontal diseases and systemic diseases, such as cardiovascular diseases, underscores their importance as a public health concern. Consequently, the early detection and prevention of periodontal diseases have become critical objectives in healthcare, particularly through the integration of advanced artificial intelligence (AI) technologies. This paper aims to bridge the gap between clinical practices and cutting-edge technologies by providing a comprehensive review of current research. We examine the identification of causative factors, disease progression, and the role of AI in enhancing early detection and treatment. Our goal is to underscore the importance of early intervention in improving patient outcomes and to stimulate further interest among researchers, bioengineers, and AI specialists in the ongoing exploration of AI applications in periodontal disease diagnosis.

Artificial Intelligence-Related Dental Research: Bibliometric and Altmetric Analysis

BACKGROUND

Recent years have witnessed an explosive surge in dental research related to artificial intelligence (AI). These applications have optimised dental workflows, demonstrating significant clinical importance. Understanding the current landscape and trends of this topic is crucial for both clinicians and researchers to utilise and advance this technology. However, a comprehensive scientometric study regarding this field had yet to be performed.

METHODS

A literature search was conducted in the Web of Science Core Collection database to identify eligible "research articles" and "reviews." Literature screening and exclusion were performed by 2 investigators. Thereafter, VOSviewer was utilised in co-occurrence analysis and CiteSpace in co-citation analysis. R package Bibliometrix was employed to automatically calculate scientific impacts, determining the core authors and journals. Altmetric data were described narratively and supplemented with Spearman correlation analysis.

RESULTS

A total of 1558 research publications were included. During the past 5 years, AI-related dental publications drastically increased in number, from 36 to 581. Diagnostics and Scientific Reports published the most articles, whereas Journal of Dental Research received the highest number of citations per article. China, the US, and South Korea emerged as the most prolific countries, whilst Germany received the highest number of citations per article (23.29). Charité Universitätsmedizin Berlin was the institution with the highest number of publications and citations per article (29.16). Altmetric Attention Score was correlated with News Mentions (P < .001), and significant associations were observed amongst Dimension Citations, Mendeley Readers, and Web of Science Citations (P < .001).

CONCLUSIONS

The publication numbers regarding AI-related dental research have been rising rapidly and may continue their upwards trend. China, the US, South Korea, and Germany had promoted the progress of AI-related dental research. Disease diagnosis, orthodontic applications, and morphology segmentation were current hotspots. Attention mechanism, explainable AI, multimodal data fusion, and AI-generated text assistants necessitate future research and exploration.

Periodontitis diagnosis: A review of current and future trends in artificial intelligence

BACKGROUND

Artificial intelligence (AI) acts as the state-of-the-art in periodontitis diagnosis in dentistry. Current diagnostic challenges include errors due to a lack of experienced dentists, limited time for radiograph analysis, and mandatory reporting, impacting care quality, cost, and efficiency.

OBJECTIVE

This review aims to evaluate the current and future trends in AI for diagnosing periodontitis.

METHODS

A thorough literature review was conducted following PRISMA guidelines. We searched databases including PubMed, Scopus, Wiley Online Library, and ScienceDirect for studies published between January 2018 and December 2023. Keywords used in the search included "artificial intelligence," "panoramic radiograph," "periodontitis," "periodontal disease," and "diagnosis."

RESULTS

The review included 12 studies from an initial 211 records. These studies used advanced models, particularly convolutional neural networks (CNNs), demonstrating accuracy rates for periodontal bone loss detection ranging from 0.76 to 0.98. Methodologies included deep learning hybrid methods, automated identification systems, and machine learning classifiers, enhancing diagnostic precision and efficiency.

CONCLUSIONS

Integrating AI innovations in periodontitis diagnosis enhances diagnostic accuracy and efficiency, providing a robust alternative to conventional methods. These technologies offer quicker, less labor-intensive, and more precise alternatives to classical approaches. Future research should focus on improving AI model reliability and generalizability to ensure widespread clinical adoption.

Applications of Machine Learning in Periodontology and Implantology: A Comprehensive Review

Machine learning (ML) has led to significant advances in dentistry, easing the workload of professionals and improving the performance of various medical processes. The fields of periodontology and implantology can profit from these advances for tasks such as determining periodontally compromised teeth, assisting doctors in the implant planning process, determining types of implants, or predicting the occurrence of peri-implantitis. The current paper provides an overview of recent ML techniques applied in periodontology and implantology, aiming to identify popular models for different medical tasks, to assess the impact of the training data on the success of the automatic algorithms and to highlight advantages and disadvantages of various approaches. 48 original research papers, published between 2016 and 2023, were selected and divided into four classes: periodontology, implant planning, implant brands and types, and success of dental implants. These papers were analyzed in terms of aim, technical details, characteristics of training and testing data, results, and medical observations. The purpose of this paper is not to provide an exhaustive survey, but to show representative methods from recent literature that highlight the advantages and disadvantages of various approaches, as well as the potential of applying machine learning in dentistry.

Deep Convolutional Neural Network for Automated Staging of Periodontal Bone Loss Severity on Bite-wing Radiographs: An Eigen-CAM Explainability Mapping Approach

Periodontal disease is a significant global oral health problem. Radiographic staging is critical in determining periodontitis severity and treatment requirements. This study aims to automatically stage periodontal bone loss using a deep learning approach using bite-wing images. A total of 1752 bite-wing images were used for the study. Radiological examinations were classified into 4 groups. Healthy (normal), no bone loss; stage I (mild destruction), bone loss in the coronal third (< 15%); stage II (moderate destruction), bone loss is in the coronal third and from 15 to 33% (15-33%); stage III-IV (severe destruction), bone loss extending from the middle third to the apical third with furcation destruction (> 33%). All images were converted to 512 × 400 dimensions using bilinear interpolation. The data was divided into 80% training validation and 20% testing. The classification module of the YOLOv8 deep learning model was used for the artificial intelligence-based classification of the images. Based on four class results, it was trained using fivefold cross-validation after transfer learning and fine tuning. After the training, 20% of test data, which the system had never seen, were analyzed using the artificial intelligence weights obtained in each cross-validation. Training and test results were calculated with average accuracy, precision, recall, and F1-score performance metrics. Test images were analyzed with Eigen-CAM explainability heat maps. In the classification of bite-wing images as healthy, mild destruction, moderate destruction, and severe destruction, training performance results were 86.100% accuracy, 84.790% precision, 82.350% recall, and 84.411% F1-score, and test performance results were 83.446% accuracy, 81.742% precision, 80.883% recall, and 81.090% F1-score. The deep learning model gave successful results in staging periodontal bone loss in bite-wing images. Classification scores were relatively high for normal (no bone loss) and severe bone loss in bite-wing images, as they are more clearly visible than mild and moderate damage.

Efficiency of oral keratinized gingiva detection and measurement based on convolutional neural network

BACKGROUND

With recent advances in artificial intelligence, the use of this technology has begun to facilitate comprehensive tissue evaluation and planning of interventions. This study aimed to assess different convolutional neural networks (CNN) in deep learning algorithms to detect keratinized gingiva based on intraoral photos and evaluate the ability of networks to measure keratinized gingiva width.

METHODS

Six hundred of 1200 photographs taken before and after applying a disclosing agent were used to compare the neural networks in segmenting the keratinized gingiva. Segmentation performances of networks were evaluated using accuracy, intersection over union, and F1 score. Keratinized gingiva width from a reference point was measured from ground truth images and compared with the measurements of clinicians and the DeepLab image that was generated from the ResNet50 model. The effect of measurement operators, phenotype, and jaw on differences in measurements was evaluated by three-factor mixed-design analysis of variance (ANOVA).

RESULTS

Among the compared networks, ResNet50 distinguished keratinized gingiva at the highest accuracy rate of 91.4%. The measurements between deep learning and clinicians were in excellent agreement according to jaw and phenotype. When analyzing the influence of the measurement operators, phenotype, and jaw on the measurements performed according to the ground truth, there were statistically significant differences in measurement operators and jaw (p < 0.05).

CONCLUSIONS

Automated keratinized gingiva segmentation with the ResNet50 model might be a feasible method for assisting professionals. The measurement results promise a potentially high performance of the model as it requires less time and experience.

PLAIN LANGUAGE SUMMARY

With recent advances in artificial intelligence (AI), it is now possible to use this technology to evaluate tissues and plan medical procedures thoroughly. This study focused on testing different AI models, specifically CNN, to identify and measure a specific type of gum tissue called keratinized gingiva using photos taken inside the mouth. Out of 1200 photos, 600 were used in the study to compare the performance of different CNN in identifying gingival tissue. The accuracy and effectiveness of these models were measured and compared to human clinician ratings. The study found that the ResNet50 model was the most accurate, correctly identifying gingival tissue 91.4% of the time. When the AI model and clinicians' measurements of gum tissue width were compared, the results were very similar, especially when accounting for different jaws and gum structures. The study also analyzed the effect of various factors on the measurements and found significant differences based on who took the measurements and jaw type. In conclusion, using the ResNet50 model to identify and measure gum tissue automatically could be a practical tool for dental professionals, saving time and requiring less expertise.

Empowering Modern Dentistry: The Impact of Artificial Intelligence on Patient Care and Clinical Decision Making

Advancements in artificial intelligence (AI) are poised to catalyze a transformative shift across diverse dental disciplines including endodontics, oral radiology, orthodontics, pediatric dentistry, periodontology, prosthodontics, and restorative dentistry. This narrative review delineates the burgeoning role of AI in enhancing diagnostic precision, streamlining treatment planning, and potentially unveiling innovative therapeutic modalities, thereby elevating patient care standards. Recent analyses corroborate the superiority of AI-assisted methodologies over conventional techniques, affirming their capacity for personalization, accuracy, and efficiency in dental care. Central to these AI applications are convolutional neural networks and deep learning models, which have demonstrated efficacy in diagnosis, prognosis, and therapeutic decision making, in some instances surpassing traditional methods in complex cases. Despite these advancements, the integration of AI into clinical practice is accompanied by challenges, such as data security concerns, the demand for transparency in AI-generated outcomes, and the imperative for ongoing validation to establish the reliability and applicability of AI tools. This review underscores the prospective benefits of AI in dental practice, envisioning AI not as a replacement for dental professionals but as an adjunctive tool that fortifies the dental profession. While AI heralds improvements in diagnostics, treatment planning, and personalized care, ethical and practical considerations must be meticulously navigated to ensure responsible development of AI in dentistry.

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.

Detection of periodontal bone loss patterns and furcation defects from panoramic radiographs using deep learning algorithm: a retrospective study

BACKGROUND

This retrospective study aimed to develop a deep learning algorithm for the interpretation of panoramic radiographs and to examine the performance of this algorithm in the detection of periodontal bone losses and bone loss patterns.

METHODS

A total of 1121 panoramic radiographs were used in this study. Bone losses in the maxilla and mandibula (total alveolar bone loss) (n = 2251), interdental bone losses (n = 25303), and furcation defects (n = 2815) were labeled using the segmentation method. In addition, interdental bone losses were divided into horizontal (n = 21839) and vertical (n = 3464) bone losses according to the defect patterns. A Convolutional Neural Network (CNN)-based artificial intelligence (AI) system was developed using U-Net architecture. The performance of the deep learning algorithm was statistically evaluated by the confusion matrix and ROC curve analysis.

RESULTS

The system showed the highest diagnostic performance in the detection of total alveolar bone losses (AUC = 0.951) and the lowest in the detection of vertical bone losses (AUC = 0.733). The sensitivity, precision, F1 score, accuracy, and AUC values were found as 1, 0.995, 0.997, 0.994, 0.951 for total alveolar bone loss; found as 0.947, 0.939, 0.943, 0.892, 0.910 for horizontal bone losses; found as 0.558, 0.846, 0.673, 0.506, 0.733 for vertical bone losses and found as 0.892, 0.933, 0.912, 0.837, 0.868 for furcation defects (respectively).

CONCLUSIONS

AI systems offer promising results in determining periodontal bone loss patterns and furcation defects from dental radiographs. This suggests that CNN algorithms can also be used to provide more detailed information such as automatic determination of periodontal disease severity and treatment planning in various dental radiographs.

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.

Convolutional neural networks for automated tooth numbering on panoramic radiographs: A scoping review

Purpose

The objective of this scoping review was to investigate the applicability and performance of various convolutional neural network (CNN) models in tooth numbering on panoramic radiographs, achieved through classification, detection, and segmentation tasks.

Material and Methods

An online search was performed of the PubMed, Science Direct, and Scopus databases. Based on the selection process, 12 studies were included in this review.

Results

Eleven studies utilized a CNN model for detection tasks, 5 for classification tasks, and 3 for segmentation tasks in the context of tooth numbering on panoramic radiographs. Most of these studies revealed high performance of various CNN models in automating tooth numbering. However, several studies also highlighted limitations of CNNs, such as the presence of false positives and false negatives in identifying decayed teeth, teeth with crown prosthetics, teeth adjacent to edentulous areas, dental implants, root remnants, wisdom teeth, and root canal-treated teeth. These limitations can be overcome by ensuring both the quality and quantity of datasets, as well as optimizing the CNN architecture.

Conclusion

CNNs have demonstrated high performance in automated tooth numbering on panoramic radiographs. Future development of CNN-based models for this purpose should also consider different stages of dentition, such as the primary and mixed dentition stages, as well as the presence of various tooth conditions. Ultimately, an optimized CNN architecture can serve as the foundation for an automated tooth numbering system and for further artificial intelligence research on panoramic radiographs for a variety of purposes.

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.

Application of Artificial Intelligence in Clinical Dentistry, a Comprehensive Review of Literature

Statement of the Problem

In recent years, the use of artificial intelligence (AI) has become increasingly popular in dentistry because it facilitates the process of diagnosis and clinical decision-making. However, AI holds multiple prominent drawbacks, which restrict its wide application today. It is necessary for dentists to be aware of AI's pros and cons before its implementation.

Purpose

Therefore, the present study was conducted to comprehensively review various applications of AI in all dental branches along with its advantages and disadvantages.

Materials and Method

For this review article, a complete query was carried out on PubMed and Google Scholar databases and the studies published during 2010-2022 were collected using the keywords "Artificial Intelligence", "Dentistry," "Machine learning," "Deep learning," and "Diagnostic System." Ultimately, 116 relevant articles focused on artificial intelligence in dentistry were selected and evaluated.

Results

In new research AI applications in detecting dental abnormalities and oral malignancies based on radiographic view and histopathological features, designing dental implants and crowns, determining tooth preparation finishing line, analyzing growth patterns, estimating biological age, predicting the viability of dental pulp stem cells, analyzing the gene expression of periapical lesions, forensic dentistry, and predicting the success rate of treatments, have been mentioned. Despite AI's benefits in clinical dentistry, three controversial challenges including ease of use, financial return on investment, and evidence of performance exist and need to be managed.

Conclusion

As evidenced by the obtained results, the most crucial progression of AI is in oral malignancies' diagnostic systems. However, AI's newest advancements in various branches of dentistry require further scientific work before being applied to clinical practice. Moreover, the immense use of AI in clinical dentistry is only achievable when its challenges are appropriately managed.

Artificial intelligence models for diagnosing gingivitis and periodontal disease: A systematic review

STATEMENT OF PROBLEM

Artificial intelligence (AI) models have been developed for periodontal applications, including diagnosing gingivitis and periodontal disease, but their accuracy and maturity of the technology remain unclear.

PURPOSE

The purpose of this systematic review was to evaluate the performance of the AI models for detecting dental plaque and diagnosing gingivitis and periodontal disease.

MATERIAL AND METHODS

A review was performed in 4 databases: MEDLINE/PubMed, World of Science, Cochrane, and Scopus. A manual search was also conducted. Studies were classified into 4 groups: detecting dental plaque, diagnosis of gingivitis, diagnosis of periodontal disease from intraoral images, and diagnosis of alveolar bone loss from periapical, bitewing, and panoramic radiographs. Two investigators evaluated the studies independently by applying the Joanna Briggs Institute critical appraisal. A third examiner was consulted to resolve any lack of consensus.

RESULTS

Twenty-four articles were included: 2 studies developed AI models for detecting plaque, resulting in accuracy ranging from 73.6% to 99%; 7 studies assessed the ability to diagnose gingivitis from intraoral photographs reporting an accuracy between 74% and 78.20%; 1 study used fluorescent intraoral images to diagnose gingivitis reporting 67.7% to 73.72% accuracy; 3 studies assessed the ability to diagnose periodontal disease from intraoral photographs with an accuracy between 47% and 81%, and 11 studies evaluated the performance of AI models for detecting alveolar bone loss from radiographic images reporting an accuracy between 73.4% and 99%.

CONCLUSIONS

AI models for periodontology applications are still in development but might provide a powerful diagnostic tool.

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.

Contemporary Role and Applications of Artificial Intelligence in Dentistry

Artificial Intelligence (AI) technologies play a significant role and significantly impact various sectors, including healthcare, engineering, sciences, and smart cities. AI has the potential to improve the quality of patient care and treatment outcomes while minimizing the risk of human error. Artificial Intelligence (AI) is transforming the dental industry, just like it is revolutionizing other sectors. It is used in dentistry to diagnose dental diseases and provide treatment recommendations. Dental professionals are increasingly relying on AI technology to assist in diagnosis, clinical decision-making, treatment planning, and prognosis prediction across ten dental specialties. One of the most significant advantages of AI in dentistry is its ability to analyze vast amounts of data quickly and accurately, providing dental professionals with valuable insights to enhance their decision-making processes. The purpose of this paper is to identify the advancement of artificial intelligence algorithms that have been frequently used in dentistry and assess how well they perform in terms of diagnosis, clinical decision-making, treatment, and prognosis prediction in ten dental specialties; dental public health, endodontics, oral and maxillofacial surgery, oral medicine and pathology, oral & maxillofacial radiology, orthodontics and dentofacial orthopedics, pediatric dentistry, periodontics, prosthodontics, and digital dentistry in general. We will also show the pros and cons of using AI in all dental specialties in different ways. Finally, we will present the limitations of using AI in dentistry, which made it incapable of replacing dental personnel, and dentists, who should consider AI a complimentary benefit and not a threat.

Efficiency and accuracy of artificial intelligence in the radiographic detection of periodontal bone loss: A systematic review

Purpose

Artificial intelligence (AI) is poised to play a major role in medical diagnostics. Periodontal disease is one of the most common oral diseases. The early diagnosis of periodontal disease is essential for effective treatment and a favorable prognosis. This study aimed to assess the effectiveness of AI in diagnosing periodontal bone loss through radiographic analysis.

Materials and Methods

A literature search involving 5 databases (PubMed, ScienceDirect, Scopus, Health and Medical Collection, Dentistry and Oral Sciences) was carried out. A specific combination of keywords was used to obtain the articles. The PRISMA guidelines were used to filter eligible articles. The study design, sample size, type of AI software, and the results of each eligible study were analyzed. The CASP diagnostic study checklist was used to evaluate the evidence strength score.

Results

Seven articles were eligible for review according to the PRISMA guidelines. Out of the 7 eligible studies, 4 had strong CASP evidence strength scores (7-8/9). The remaining studies had intermediate CASP evidence strength scores (3.5-6.5/9). The highest area under the curve among the reported studies was 94%, the highest F1 score was 91%, and the highest specificity and sensitivity were 98.1% and 94%, respectively.

Conclusion

AI-based detection of periodontal bone loss using radiographs is an efficient method. However, more clinical studies need to be conducted before this method is introduced into routine dental practice.

Deep Learning in Diagnosis of Dental Anomalies and Diseases: A Systematic Review

Deep learning and diagnostic applications in oral and dental health have received significant attention recently. In this review, studies applying deep learning to diagnose anomalies and diseases in dental image material were systematically compiled, and their datasets, methodologies, test processes, explainable artificial intelligence methods, and findings were analyzed. Tests and results in studies involving human-artificial intelligence comparisons are discussed in detail to draw attention to the clinical importance of deep learning. In addition, the review critically evaluates the literature to guide and further develop future studies in this field. An extensive literature search was conducted for the 2019-May 2023 range using the Medline (PubMed) and Google Scholar databases to identify eligible articles, and 101 studies were shortlisted, including applications for diagnosing dental anomalies (n = 22) and diseases (n = 79) using deep learning for classification, object detection, and segmentation tasks. According to the results, the most commonly used task type was classification (n = 51), the most commonly used dental image material was panoramic radiographs (n = 55), and the most frequently used performance metric was sensitivity/recall/true positive rate (n = 87) and accuracy (n = 69). Dataset sizes ranged from 60 to 12,179 images. Although deep learning algorithms are used as individual or at least individualized architectures, standardized architectures such as pre-trained CNNs, Faster R-CNN, YOLO, and U-Net have been used in most studies. Few studies have used the explainable AI method (n = 22) and applied tests comparing human and artificial intelligence (n = 21). Deep learning is promising for better diagnosis and treatment planning in dentistry based on the high-performance results reported by the studies. For all that, their safety should be demonstrated using a more reproducible and comparable methodology, including tests with information about their clinical applicability, by defining a standard set of tests and performance metrics.

Artificial Intelligence for Classifying the Relationship between Impacted Third Molar and Mandibular Canal on Panoramic Radiographs

The purpose of this investigation was to evaluate the diagnostic performance of two convolutional neural networks (CNNs), namely ResNet-152 and VGG-19, in analyzing, on panoramic images, the rapport that exists between the lower third molar (MM3) and the mandibular canal (MC), and to compare this performance with that of an inexperienced observer (a sixth year dental student). Utilizing the k-fold cross-validation technique, 142 MM3 images, cropped from 83 panoramic images, were split into 80% as training and validation data and 20% as test data. They were subsequently labeled by an experienced radiologist as the gold standard. In order to compare the diagnostic capabilities of CNN algorithms and the inexperienced observer, the diagnostic accuracy, sensitivity, specificity, and positive predictive value (PPV) were determined. ResNet-152 achieved a mean sensitivity, specificity, PPV, and accuracy, of 84.09%, 94.11%, 92.11%, and 88.86%, respectively. VGG-19 achieved 71.82%, 93.33%, 92.26%, and 85.28% regarding the aforementioned characteristics. The dental student's diagnostic performance was respectively 69.60%, 53.00%, 64.85%, and 62.53%. This work demonstrated the potential use of deep CNN architecture for the identification and evaluation of the contact between MM3 and MC in panoramic pictures. In addition, CNNs could be a useful tool to assist inexperienced observers in more accurately identifying contact relationships between MM3 and MC on panoramic images.

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.

Tooth Type Enhanced Transformer for Children Caries Diagnosis on Dental Panoramic Radiographs

The objective of this study was to introduce a novel deep learning technique for more accurate children caries diagnosis on dental panoramic radiographs. Specifically, a swin transformer is introduced, which is compared with the state-of-the-art convolutional neural network (CNN) methods that are widely used for caries diagnosis. A tooth type enhanced swin transformer is further proposed by considering the differences among canine, molar and incisor. Modeling the above differences in swin transformer, the proposed method was expected to mine domain knowledge for more accurate caries diagnosis. To test the proposed method, a children panoramic radiograph database was built and labeled with a total of 6028 teeth. Swin transformer shows better diagnosis performance compared with typical CNN methods, which indicates the usefulness of this new technique for children caries diagnosis on panoramic radiographs. Furthermore, the proposed tooth type enhanced swin transformer outperforms the naive swin transformer with the accuracy, precision, recall, F1 and area-under-the-curve being 0.8557, 0.8832, 0.8317, 0.8567 and 0.9223, respectively. This indicates that the transformer model can be further improved with a consideration of domain knowledge instead of a copy of previous transformer models designed for natural images. Finally, we compare the proposed tooth type enhanced swin transformer with two attending doctors. The proposed method shows higher caries diagnosis accuracy for the first and second primary molars, which may assist dentists in caries diagnosis.

Artificial Intelligence in Periodontology: A Scoping Review

Artificial intelligence (AI) is the development of computer systems whereby machines can mimic human actions. This is increasingly used as an assistive tool to help clinicians diagnose and treat diseases. Periodontitis is one of the most common diseases worldwide, causing the destruction and loss of the supporting tissues of the teeth. This study aims to assess current literature describing the effect AI has on the diagnosis and epidemiology of this disease. Extensive searches were performed in April 2022, including studies where AI was employed as the independent variable in the assessment, diagnosis, or treatment of patients with periodontitis. A total of 401 articles were identified for abstract screening after duplicates were removed. In total, 293 texts were excluded, leaving 108 for full-text assessment with 50 included for final synthesis. A broad selection of articles was included, with the majority using visual imaging as the input data field, where the mean number of utilised images was 1666 (median 499). There has been a marked increase in the number of studies published in this field over the last decade. However, reporting outcomes remains heterogeneous because of the variety of statistical tests available for analysis. Efforts should be made to standardise methodologies and reporting in order to ensure that meaningful comparisons can be drawn.

Determination of the stage and grade of periodontitis according to the current classification of periodontal and peri-implant diseases and conditions (2018) using machine learning algorithms

PURPOSE

The current Classification of Periodontal and Peri-Implant Diseases and Conditions, published and disseminated in 2018, involves some difficulties and causes diagnostic conflicts due to its criteria, especially for inexperienced clinicians. The aim of this study was to design a decision system based on machine learning algorithms by using clinical measurements and radiographic images in order to determine and facilitate the staging and grading of periodontitis.

METHODS

In the first part of this study, machine learning models were created using the Python programming language based on clinical data from 144 individuals who presented to the Department of Periodontology, Faculty of Dentistry, Süleyman Demirel University. In the second part, panoramic radiographic images were processed and classification was carried out with deep learning algorithms.

RESULTS

Using clinical data, the accuracy of staging with the tree algorithm reached 97.2%, while the random forest and k-nearest neighbor algorithms reached 98.6% accuracy. The best staging accuracy for processing panoramic radiographic images was provided by a hybrid network model algorithm combining the proposed ResNet50 architecture and the support vector machine algorithm. For this, the images were preprocessed, and high success was obtained, with a classification accuracy of 88.2% for staging. However, in general, it was observed that the radiographic images provided a low level of success, in terms of accuracy, for modeling the grading of periodontitis.

CONCLUSIONS

The machine learning-based decision system presented herein can facilitate periodontal diagnoses despite its current limitations. Further studies are planned to optimize the algorithm and improve the results.

Recognition of Digital Dental X-ray Images Using a Convolutional Neural Network

Digital dental X-ray images are an important basis for diagnosing dental diseases, especially endodontic and periodontal diseases. Conventional diagnostic methods depend on the experience of doctors, so they are highly subjective and consume more energy than other approaches. The current computer-aided interpretation technology has low accuracy and poor lesion classification. This study proposes an efficient and accurate method for identifying common lesions in digital dental X-ray images by a convolutional neural network (CNN). In total, 188 digital dental X-ray images that were previously diagnosed as periapical periodontitis, dental caries, periapical cysts, and other common dental diseases by dentists in Qilu Hospital of Shandong University were collected and augmented. The images and labels were inputted into four CNN models for training, including visual geometry group (VGG)-16, InceptionV3, residual network (ResNet)-50, and densely connected convolutional networks (DenseNet)-121. The average classification accuracy of the four trained network models on the test set was 95.9%, while the classification accuracy of the trained DenseNet-121 network model reached 99.5%. It is demonstrated that the use of CNNs to interpret digital dental X-ray images is an efficient and accurate way to conduct auxiliary diagnoses of dental diseases.

Machine Learning in Dentistry: A Scoping Review

Machine learning (ML) is being increasingly employed in dental research and application. We aimed to systematically compile studies using ML in dentistry and assess their methodological quality, including the risk of bias and reporting standards. We evaluated studies employing ML in dentistry published from 1 January 2015 to 31 May 2021 on MEDLINE, IEEE Xplore, and arXiv. We assessed publication trends and the distribution of ML tasks (classification, object detection, semantic segmentation, instance segmentation, and generation) in different clinical fields. We appraised the risk of bias and adherence to reporting standards, using the QUADAS-2 and TRIPOD checklists, respectively. Out of 183 identified studies, 168 were included, focusing on various ML tasks and employing a broad range of ML models, input data, data sources, strategies to generate reference tests, and performance metrics. Classification tasks were most common. Forty-two different metrics were used to evaluate model performances, with accuracy, sensitivity, precision, and intersection-over-union being the most common. We observed considerable risk of bias and moderate adherence to reporting standards which hampers replication of results. A minimum (core) set of outcome and outcome metrics is necessary to facilitate comparisons across studies.

Clinical Decision Support System for Geriatric Dental Treatment Using a Bayesian Network and a Convolutional Neural Network

OBJECTIVES

The aim of this study was to evaluate the performance of a clinical decision support system (CDSS) for therapeutic plans in geriatric dentistry. The information that needs to be considered in a therapeutic plan includes not only the patient's oral health status obtained from an oral examination, but also other related factors such as underlying diseases, socioeconomic characteristics, and functional dependency.

METHODS

A Bayesian network (BN) was used as a framework to construct a model of contributing factors and their causal relationships based on clinical knowledge and data. The faster R-CNN (regional convolutional neural network) algorithm was used to detect oral health status, which was part of the BN structure. The study was conducted using retrospective data from 400 patients receiving geriatric dental care at a university hospital between January 2020 and June 2021.

RESULTS

The model showed an F1-score of 89.31%, precision of 86.69%, and recall of 82.14% for the detection of periodontally compromised teeth. A receiver operating characteristic curve analysis showed that the BN model was highly accurate for recommending therapeutic plans (area under the curve = 0.902). The model performance was compared to that of experts in geriatric dentistry, and the experts and the system strongly agreed on the recommended therapeutic plans (kappa value = 0.905).

CONCLUSIONS

This research was the first phase of the development of a CDSS to recommend geriatric dental treatment. The proposed system, when integrated into the clinical workflow, is expected to provide general practitioners with expert-level decision support in geriatric dental care.

Detecting the presence of taurodont teeth on panoramic radiographs using a deep learning-based convolutional neural network algorithm

OBJECTIVES

Artificial intelligence (AI) techniques like convolutional neural network (CNN) are a promising breakthrough that can help clinicians analyze medical imaging, diagnose taurodontism, and make therapeutic decisions. The purpose of the study is to develop and evaluate the function of CNN-based AI model to diagnose teeth with taurodontism in panoramic radiography.

METHODS

434 anonymized, mixed-sized panoramic radiography images over the age of 13 years were used to develop automatic taurodont tooth segmentation models using a Pytorch implemented U-Net model. Datasets were split into train, validation, and test groups of both normal and masked images. The data augmentation method was applied to images of trainings and validation groups with vertical flip images, horizontal flip images, and both flip images. The Confusion Matrix was used to determine the model performance.

RESULTS

Among the 43 test group images with 126 labels, there were 109 true positives, 29 false positives, and 17 false negatives. The sensitivity, precision, and F1-score values of taurodont tooth segmentation were 0.8650, 0.7898, and 0.8257, respectively.

CONCLUSIONS

CNN's ability to identify taurodontism produced almost identical results to the labeled training data, and the CNN system achieved close to the expert level results in its ability to detect the taurodontism of teeth.

Personalized dental medicine, artificial intelligence, and their relevance for dentomaxillofacial imaging

Personalized medicine refers to the tailoring of diagnostics and therapeutics to individuals based on one's biological, social, and behavioral characteristics. While personalized dental medicine is still far from being a reality, advanced artificial intelligence (AI) technologies with improved data analytic approaches are expected to integrate diverse data from the individual, setting, and system levels, which may facilitate a deeper understanding of the interaction of these multilevel data and therefore bring us closer to more personalized, predictive, preventive, and participatory dentistry, also known as P4 dentistry. In the field of dentomaxillofacial imaging, a wide range of AI applications, including several commercially available software options, have been proposed to assist dentists in the diagnosis and treatment planning of various dentomaxillofacial diseases, with performance similar or even superior to that of specialists. Notably, the impact of these dental AI applications on treatment decision, clinical and patient-reported outcomes, and cost-effectiveness has so far been assessed sparsely. Such information should be further investigated in future studies to provide patients, providers, and healthcare organizers a clearer picture of the true usefulness of AI in daily dental practice.

Comparison of Multi-Label U-Net and Mask R-CNN for panoramic radiograph segmentation to detect periodontitis

Purpose

Periodontitis, the most prevalent chronic inflammatory condition affecting teeth-supporting tissues, is diagnosed and classified through clinical and radiographic examinations. The staging of periodontitis using panoramic radiographs provides information for designing computer-assisted diagnostic systems. Performing image segmentation in periodontitis is required for image processing in diagnostic applications. This study evaluated image segmentation for periodontitis staging based on deep learning approaches.

Materials and Methods

Multi-Label U-Net and Mask R-CNN models were compared for image segmentation to detect periodontitis using 100 digital panoramic radiographs. Normal conditions and 4 stages of periodontitis were annotated on these panoramic radiographs. A total of 1100 original and augmented images were then randomly divided into a training (75%) dataset to produce segmentation models and a testing (25%) dataset to determine the evaluation metrics of the segmentation models.

Results

The performance of the segmentation models against the radiographic diagnosis of periodontitis conducted by a dentist was described by evaluation metrics (i.e., dice coefficient and intersection-over-union [IoU] score). Multi-Label U-Net achieved a dice coefficient of 0.96 and an IoU score of 0.97. Meanwhile, Mask R-CNN attained a dice coefficient of 0.87 and an IoU score of 0.74. U-Net showed the characteristic of semantic segmentation, and Mask R-CNN performed instance segmentation with accuracy, precision, recall, and F1-score values of 95%, 85.6%, 88.2%, and 86.6%, respectively.

Conclusion

Multi-Label U-Net produced superior image segmentation to that of Mask R-CNN. The authors recommend integrating it with other techniques to develop hybrid models for automatic periodontitis detection.

Context Aware Convolutional Neural Network for Children Caries Diagnosis on Dental Panoramic Radiographs

The objective of this study is to improve traditional convolutional neural networks for more accurate children dental caries diagnosis on panoramic radiographs. A context aware convolutional neural network (CNN) is proposed by considering information among adjacent teeth, based on the fact that caries of teeth often affects each other due to the same growing environment. Specifically, when performing caries diagnosis on a tooth, information from its adjacent teeth will be collected and adaptively fused for final classification. Children panoramic radiographs of 210 patients with one or more caries and 94 patients without caries are utilized, among which there are a total of 6028 teeth with 3039 to be caries. The proposed context aware CNN outperforms typical CNN baseline with the accuracy, precision, recall, F1 score, and area-under-the-curve (AUC) being 0.8272, 0.8538, 0.8770, 0.8652, and 0.9005, respectively, showing potential to improve typical CNN instead of just copying them in previous works. Specially, the proposed method performs better than two five-year attending doctors for the second primary molar caries diagnosis. Considering the results obtained, it is beneficial to promote CNN based deep learning methods for assisting dentists for caries diagnosis in hospitals.

Evaluation of the Progression of Periodontitis with the Use of Neural Networks

Periodontitis is an inflammatory disease of the tissues surrounding the tooth that results in loss of periodontal attachment detected as clinical attachment loss (CAL). The mildest form of periodontal disease is gingivitis, which is a necessary condition for periodontitis development. We can distinguish also some modifying factors which have an influence on the rate of development of periodontitis from which the most important are smoking and poorly controlled diabetes. According to the new classification from 2017, we can identify four stages of periodontitis and three grades of periodontitis. Grades tell us about the periodontitis progression risk and may be helpful in treatment planning and motivating the patients. Artificial neural networks (ANN) are widely used in medicine and in dentistry as an additional tool to support clinicians in their work. In this paper, ANN was used to assess grades of periodontitis in the group of patients. Gender, age, nicotinism approximal plaque index (API), bleeding on probing (BoP), clinical attachment loss (CAL), and pocket depth (PD) were taken into consideration. There were no statistically significant differences in the clinical periodontal assessment in relation to the neural network assessment. Based on the definition of the sensitivity and specificity in medicine we obtained 85.7% and 80.0% as a correctly diagnosed and excluded disease, respectively. The quality of the neural network, defined as the percentage of correctly classified patients according to the grade of periodontitis was 84.2% for the training set. The percentage of incorrectly classified patients according to the grade of periodontitis was 15.8%. Artificial neural networks may be useful tool in everyday dental practice to assess the risk of periodontitis development however more studies are needed.

Federated Learning in Dentistry: Chances and Challenges

Building performant and robust artificial intelligence (AI)-based applications for dentistry requires large and high-quality data sets, which usually reside in distributed data silos from multiple sources (e.g., different clinical institutes). Collaborative efforts are limited as privacy constraints forbid direct sharing across the borders of these data silos. Federated learning is a scalable and privacy-preserving framework for collaborative training of AI models without data sharing, where instead the knowledge is exchanged in form of wisdom learned from the data. This article aims at introducing the established concept of federated learning together with chances and challenges to foster collaboration on AI-based applications within the dental research community.

Collaborative deep learning model for tooth segmentation and identification using panoramic radiographs

Panoramic radiographs are an integral part of effective dental treatment planning, supporting dentists in identifying impacted teeth, infections, malignancies, and other dental issues. However, screening for anomalies solely based on a dentist's assessment may result in diagnostic inconsistency, posing difficulties in developing a successful treatment plan. Recent advancements in deep learning-based segmentation and object detection algorithms have enabled the provision of predictable and practical identification to assist in the evaluation of a patient's mineralized oral health, enabling dentists to construct a more successful treatment plan. However, there has been a lack of efforts to develop collaborative models that enhance learning performance by leveraging individual models. The article describes a novel technique for enabling collaborative learning by incorporating tooth segmentation and identification models created independently from panoramic radiographs. This collaborative technique permits the aggregation of tooth segmentation and identification to produce enhanced results by recognizing and numbering existing teeth (up to 32 teeth). The experimental findings indicate that the proposed collaborative model is significantly more effective than individual learning models (e.g., 98.77% vs. 96% and 98.44% vs.91% for tooth segmentation and recognition, respectively). Additionally, our models outperform the state-of-the-art segmentation and identification research. We demonstrated the effectiveness of collaborative learning in detecting and segmenting teeth in a variety of complex situations, including healthy dentition, missing teeth, orthodontic treatment in progress, and dentition with dental implants.

Improved diagnosis of rheumatoid arthritis using an artificial neural network

Rheumatoid arthritis (RA) is chronic systemic disease that can cause joint damage, disability and destructive polyarthritis. Current diagnosis of RA is based on a combination of clinical and laboratory features. However, RA diagnosis can be difficult at its disease onset on account of overlapping symptoms with other arthritis, so early recognition and diagnosis of RA permit the better management of patients. In order to improve the medical diagnosis of RA and evaluate the effects of different clinical features on RA diagnosis, we applied an artificial neural network (ANN) as the training algorithm, and used fivefold cross-validation to evaluate its performance. From each sample, we obtained data on 6 features: age, sex, rheumatoid factor, anti-citrullinated peptide antibody (CCP), 14-3-3η, and anti-carbamylated protein (CarP) antibodies. After training, this ANN model assigned each sample a probability for being either an RA patient or a non-RA patient. On the validation dataset, the F1 for all samples by this ANN model was 0.916, which was higher than the 0.906 we previously reported using an optimal threshold algorithm. Therefore, this ANN algorithm not only improved the accuracy of RA diagnosis, but also revealed that anti-CCP had the greatest effect while age and anti-CarP had a weaker on RA diagnosis.

Potential and impact of artificial intelligence algorithms in dento-maxillofacial radiology

OBJECTIVES

Novel artificial intelligence (AI) learning algorithms in dento-maxillofacial radiology (DMFR) are continuously being developed and improved using advanced convolutional neural networks. This review provides an overview of the potential and impact of AI algorithms in DMFR.

MATERIALS AND METHODS

A narrative review was conducted on the literature on AI algorithms in DMFR.

RESULTS

In the field of DMFR, AI algorithms were mainly proposed for (1) automated detection of dental caries, periapical pathologies, root fracture, periodontal/peri-implant bone loss, and maxillofacial cysts/tumors; (2) classification of mandibular third molars, skeletal malocclusion, and dental implant systems; (3) localization of cephalometric landmarks; and (4) improvement of image quality. Data insufficiency, overfitting, and the lack of interpretability are the main issues in the development and use of image-based AI algorithms. Several strategies have been suggested to address these issues, such as data augmentation, transfer learning, semi-supervised training, few-shot learning, and gradient-weighted class activation mapping.

CONCLUSIONS

Further integration of relevant AI algorithms into one fully automatic end-to-end intelligent system for possible multi-disciplinary applications is very likely to be a field of increased interest in the future.

CLINICAL RELEVANCE

This review provides dental practitioners and researchers with a comprehensive understanding of the current development, performance, issues, and prospects of image-based AI algorithms in DMFR.

Automatic detection of teeth and dental treatment patterns on dental panoramic radiographs using deep neural networks

Disaster victim identification issues are especially critical and urgent after a large-scale disaster. The aim of this study was to suggest an automatic detection of natural teeth and dental treatment patterns based on dental panoramic radiographs (DPRs) using deep learning to promote its applicability as human identifiers. A total of 1 638 DPRs, of which the chronological age ranged from 20 to 49 years old, were collected from January 2000 to November 2020. This dataset consisted of natural teeth, prostheses, teeth with root canal treatment, and implants. The detection of natural teeth and dental treatment patterns including the identification of teeth number was done with a pre-trained object detection network which was a convolutional neural network modified by EfficientDet-D3. The objective metrics for the average precision were 99.1% for natural teeth, 80.6% for prostheses, 81.2% for treated root canals, and 96.8% for implants, respectively. The values for the average recall were 99.6%, 84.3%, 89.2%, and 98.1%, in the same order, respectively. This study showed outstanding performance of convolutional neural network using dental panoramic radiographs in automatically identifying teeth number and detecting natural teeth, prostheses, treated root canals, and implants.

It is useful to use dental panoramic radiographs to perform the disaster victim identification (DVI).

Current applications and development of artificial intelligence for digital dental radiography

In the last few years, artificial intelligence (AI) research has been rapidly developing and emerging in the field of dental and maxillofacial radiology. Dental radiography, which is commonly used in daily practices, provides an incredibly rich resource for AI development and attracted many researchers to develop its application for various purposes. This study reviewed the applicability of AI for dental radiography from the current studies. Online searches on PubMed and IEEE Xplore databases, up to December 2020, and subsequent manual searches were performed. Then, we categorized the application of AI according to similarity of the following purposes: diagnosis of dental caries, periapical pathologies, and periodontal bone loss; cyst and tumor classification; cephalometric analysis; screening of osteoporosis; tooth recognition and forensic odontology; dental implant system recognition; and image quality enhancement. Current development of AI methodology in each aforementioned application were subsequently discussed. Although most of the reviewed studies demonstrated a great potential of AI application for dental radiography, further development is still needed before implementation in clinical routine due to several challenges and limitations, such as lack of datasets size justification and unstandardized reporting format. Considering the current limitations and challenges, future AI research in dental radiography should follow standardized reporting formats in order to align the research designs and enhance the impact of AI development globally.

Automatic classification and detection of oral cancer in photographic images using deep learning algorithms

BACKGROUND

Oral cancer is a deadly disease among the most common malignant tumors worldwide, and it has become an increasingly important public health problem in developing and low-to-middle income countries. This study aims to use the convolutional neural network (CNN) deep learning algorithms to develop an automated classification and detection model for oral cancer screening.

METHODS

The study included 700 clinical oral photographs, collected retrospectively from the oral and maxillofacial center, which were divided into 350 images of oral squamous cell carcinoma and 350 images of normal oral mucosa. The classification and detection models were created by using DenseNet121 and faster R-CNN, respectively. Four hundred and ninety images were randomly selected as training data. In addition, 70 and 140 images were assigned as validating and testing data, respectively.

RESULTS

The classification accuracy of DenseNet121 model achieved a precision of 99%, a recall of 100%, an F1 score of 99%, a sensitivity of 98.75%, a specificity of 100%, and an area under the receiver operating characteristic curve of 99%. The detection accuracy of a faster R-CNN model achieved a precision of 76.67%, a recall of 82.14%, an F1 score of 79.31%, and an area under the precision-recall curve of 0.79.

CONCLUSION

The DenseNet121 and faster R-CNN algorithm were proved to offer the acceptable potential for classification and detection of cancerous lesions in oral photographic images.

Machine Learning and Intelligent Diagnostics in Dental and Orofacial Pain Management: A Systematic Review

Purpose

The study explored the clinical influence, effectiveness, limitations, and human comparison outcomes of machine learning in diagnosing (1) dental diseases, (2) periodontal diseases, (3) trauma and neuralgias, (4) cysts and tumors, (5) glandular disorders, and (6) bone and temporomandibular joint as possible causes of dental and orofacial pain.

Method

Scopus, PubMed, and Web of Science (all databases) were searched by 2 reviewers until 29^th October 2020. Articles were screened and narratively synthesized according to PRISMA-DTA guidelines based on predefined eligibility criteria. Articles that made direct reference test comparisons to human clinicians were evaluated using the MI-CLAIM checklist. The risk of bias was assessed by JBI-DTA critical appraisal, and certainty of the evidence was evaluated using the GRADE approach. Information regarding the quantification method of dental pain and disease, the conditional characteristics of both training and test data cohort in the machine learning, diagnostic outcomes, and diagnostic test comparisons with clinicians, where applicable, were extracted.

Results

34 eligible articles were found for data synthesis, of which 8 articles made direct reference comparisons to human clinicians. 7 papers scored over 13 (out of the evaluated 15 points) in the MI-CLAIM approach with all papers scoring 5+ (out of 7) in JBI-DTA appraisals. GRADE approach revealed serious risks of bias and inconsistencies with most studies containing more positive cases than their true prevalence in order to facilitate machine learning. Patient-perceived symptoms and clinical history were generally found to be less reliable than radiographs or histology for training accurate machine learning models. A low agreement level between clinicians training the models was suggested to have a negative impact on the prediction accuracy. Reference comparisons found nonspecialized clinicians with less than 3 years of experience to be disadvantaged against trained models.

Conclusion

Machine learning in dental and orofacial healthcare has shown respectable results in diagnosing diseases with symptomatic pain and with improved future iterations and can be used as a diagnostic aid in the clinics. The current review did not internally analyze the machine learning models and their respective algorithms, nor consider the confounding variables and factors responsible for shaping the orofacial disorders responsible for eliciting pain.

Artificial intelligence in oral and maxillofacial radiology: what is currently possible?

Artificial intelligence, which has been actively applied in a broad range of industries in recent years, is an active area of interest for many researchers. Dentistry is no exception to this trend, and the applications of artificial intelligence are particularly promising in the field of oral and maxillofacial (OMF) radiology. Recent researches on artificial intelligence in OMF radiology have mainly used convolutional neural networks, which can perform image classification, detection, segmentation, registration, generation, and refinement. Artificial intelligence systems in this field have been developed for the purposes of radiographic diagnosis, image analysis, forensic dentistry, and image quality improvement. Tremendous amounts of data are needed to achieve good results, and involvement of OMF radiologist is essential for making accurate and consistent data sets, which is a time-consuming task. In order to widely use artificial intelligence in actual clinical practice in the future, there are lots of problems to be solved, such as building up a huge amount of fine-labeled open data set, understanding of the judgment criteria of artificial intelligence, and DICOM hacking threats using artificial intelligence. If solutions to these problems are presented with the development of artificial intelligence, artificial intelligence will develop further in the future and is expected to play an important role in the development of automatic diagnosis systems, the establishment of treatment plans, and the fabrication of treatment tools. OMF radiologists, as professionals who thoroughly understand the characteristics of radiographic images, will play a very important role in the development of artificial intelligence applications in this field.