Deep learning-based assessment of periapical radiographic image quality

The manual assessment of periapical radiographs (PAs) for image quality is inherently subjective, labor-intensive, and time-consuming. This leads to diagnostic uncertainty, unnecessary patient radiation from retakes, and a lack of systematic quality improvement. To address this, we developed an automated deep learning system for comprehensive PAs quality assessment. A retrospective dataset of 3594 PAs was utilized. Expert annotators labeled each image for ten clinically relevant tooth-position classes and six common quality defects: vertical angle, horizontal angle, crown coverage, apical coverage, cone cut, and scratch. We trained seven independent ResNet50 models-one for multi-class tooth position classification and six for binary defect detection. To enhance robustness and mitigate class imbalance, extensive data augmentation and oversampling strategies were implemented during training. Model performance was comprehensively evaluated using standard metrics, including the area under the receiver operating characteristic curve (AUC), accuracy, precision, recall, F1 score, and loss value. The models demonstrated excellent performance, achieving AUC values of 0.997 for tooth position, and 0.996 (poor vertical angle), 1.000 (poor horizontal angle), 1.000 (incomplete crown coverage), 0.994 (incomplete apical coverage), 0.999 (cone cut), and 0.924 (scratch) for the various quality defects. These results indicate that the ResNet50 algorithm provides an effective and highly accurate approach for the automated detection of image quality issues in PAs. This AI tool holds significant potential for clinical translation, its integration into digital dental imaging systems could offer real-time, objective feedback, thereby improving diagnostic accuracy, reducing retake rates to minimize patient radiation exposure, and enhancing overall workflow efficiency in dental clinics. Validation on independent, multi-center datasets is required before clinical deployment.