Detection of caries around restorations on bitewings using deep learning

Objective: Secondary caries lesions adjacent to restorations, a leading cause of restoration failure, require accurate diagnostic methods to ensure an optimal treatment outcome. Traditional diagnostic strategies rely on visual inspection complemented by radiographs. Recent advancements in artificial intelligence (AI), particularly deep learning, provide potential improvements in caries detection. This study aimed to develop a convolutional neural network (CNN)-based algorithm for detecting primary caries and secondary caries around restorations using bitewings. Methods: Clinical data from 7 general dental practices in the Netherlands, comprising 425 bitewings of 383 patients, were utilized. The study used the Mask-RCNN architecture, for instance, segmentation, supported by the Swin Transformer backbone. After data augmentation, model training was performed through a ten-fold cross-validation. The diagnostic accuracy of the algorithm was evaluated by calculating the area under the Free-Response Receiver Operating Characteristics curve, sensitivity, precision, and F1 scores. Results: The model achieved areas under FROC curves of 0.806 and 0.804, and F1-scores of 0.689 and 0.719 for primary and secondary caries detection, respectively. Conclusion: An accurate CNN-based automated system was developed to detect primary and secondary caries lesions on bitewings, highlighting a significant advancement in automated caries diagnostics. Clinical significance: An accurate algorithm that integrates the detection of both primary and secondary caries will permit the development of automated systems to aid clinicians in their daily clinical practice.