Diagnostic accuracy of an artificial intelligence-based platform in detecting periapical radiolucencies on cone-beam computed tomography scans of molars.

OBJECTIVE

This study aimed to evaluate the diagnostic performance of an artificial intelligence (AI)-based platform (Diagnocat) in detecting periapical radiolucencies (PARLs) in cone-beam computed tomography (CBCT) scans of molars. Specifically, we assessed Diagnocat's performance in detecting PARLs in non-root-filled molars and compared its diagnostic performance between preoperative and postoperative scans.

METHODS

This retrospective study analyzed preoperative and postoperative CBCT scans of 134 molars (327 roots). PARLs detected by Diagnocat were compared with assessments independently performed by two experienced endodontists, serving as the reference standard. Diagnostic performance was assessed at both tooth and root levels using sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), F1 score, and the area under the receiver operating characteristic curve (AUC-ROC).

RESULTS

In preoperative scans of non-root-filled molars, Diagnocat demonstrated high sensitivity (teeth: 93.9 %, roots: 86.2 %), moderate specificity (teeth: 65.2 %, roots: 79.9 %), accuracy (teeth: 79.1 %, roots: 82.6 %), PPV (teeth: 71.8 %, roots: 75.8 %), NPV (teeth: 91.8 %, roots: 88.8 %), and F1 score (teeth: 81.3 %, roots: 80.7 %) for PARL detection. The AUC was 0.76 at the tooth level and 0.79 at the root level. Postoperative scans showed significantly lower PPV (teeth: 54.2 %; roots: 46.9 %) and F1 scores (teeth: 67.2 %; roots: 59.2 %).

CONCLUSION

Diagnocat shows promise in detecting PARLs in CBCT scans of non-root-filled molars, demonstrating high sensitivity but moderate specificity, highlighting the need for human oversight to prevent overdiagnosis. However, diagnostic performance declined significantly in postoperative scans of root-filled molars. Further research is needed to optimize the platform's performance and support its integration into clinical practice.

CLINICAL SIGNIFICANCE: AI-based platforms such as Diagnocat can assist clinicians in detecting PARLs in CBCT scans, enhancing diagnostic efficiency and supporting decision-making. However, human expertise remains essential to minimize the risk of overdiagnosis and avoid unnecessary treatment.