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.