Automated Prognostic Evaluation of First Permanent Molar Extractions Using YOLOv8 with Oriented Bounding Boxes on Pediatric Panoramic Radiographs

Background/Objectives: The first permanent molar (M1) is critical for occlusal development but is highly susceptible to caries and molar–incisor hypomineralization (MIH). When M1 prognosis is poor, extraction may be necessary, requiring accurate evaluation for post-extraction space management. This study aims to develop and validate an automated deep learning framework using YOLOv8n with oriented bounding boxes (OBB) to predict the likelihood of spontaneous space closure following M1 extractions, thereby reducing diagnostic subjectivity and inter-observer variability. Methods: A dataset of 200 pediatric panoramic radiographs was segmented into quadrants and annotated for second permanent molars (M2s) and third molars (M3s). The YOLOv8n-OBB architecture was trained on 640 × 640 pixel images over 100 epochs. The framework integrated M3 presence, M2 Demirjian developmental maturity (proxied by bounding box height), and M2 angulation (via rotation vectors) to map inputs onto an evidence-based clinical decision matrix for prognostic stratification. Results: The model achieved exceptional detection and localization performance with an overall mean average precision (mAP@0.5) of 0.983. Class-specific validation showed high accuracy for M2 (F1-score = 0.978) and M3 (F1-score = 0.904). Quantitative cross-referencing confirmed a seamless mapping of spatial coordinates onto clinical success classes without error propagation. Conclusions: These findings substantiate the YOLOv8n-OBB model as a robust and interpretable decision-support tool. By standardizing prognostic assessments and optimizing treatment planning workflows, the framework serves as an effective aid in pediatric dentistry for managing M1 extractions.