Panognostics-Plus: An Integrated Multi-Task AI Framework for Automated Panoramic Radiograph Interpretation with Dental Charting and Structured Reporting—Development and Technical Validation Study

Abstract Dental charting from panoramic radiographs is essential for clinical assessment, yet remains time-consuming. This study presents Panognostics-Plus, an automated cloud-based AI framework for panoramic radiograph analysis integrating dental charting and structured radiological reporting. Panognostics-Plus was developed using a retrospective dataset of 1,595 panoramic radiographs and a YOLO-based architecture comprising modules for dental anatomy, dental treatment, and periapical diagnostics. Anatomical structures and dental treatments were analyzed using a two-stage pipeline, whereas periapical lesions were analyzed by detection-and-classification. YOLOv8m, YOLOv9m, YOLO11m, and YOLO26m were benchmarked. Detection was evaluated by precision, sensitivity, F1-score, AP, and mAP; segmentation by IoU and Dice; and processing time. Model differences were assessed using Friedman tests with Holm-adjusted Wilcoxon signed-rank post-hoc comparisons. YOLO26m achieved the highest overall performance. The largest mAP0@50:0.95 gains were observed for crowns (+ 21.3%), radicular cysts (+ 20.5%), root canal treatments (+ 17.3%), bridges (+ 14.3%), periodontal bone level (+ 14.3%), and periapical granulomas (+ 13.5%). Dental implants achieved precision, sensitivity, and F1-score of 0.99, 0.98, and 0.98, respectively. Radicular cysts achieved precision, sensitivity, and F1-score of 0.95, 0.93, and 0.94 versus 0.92, 0.90, and 0.91 for periapical granulomas. Significant differences were observed in 8 of 10 detection tasks and all segmentation tasks (all p < 0.001); periodontal bone level ( p = 0.193) and dental fillings ( p = 0.073) were nonsignificant. Dice coefficients reached 0.97 for dental anatomy and 0.96 for dental treatments. The workflow generated a segmentation overlay, dental chart, and structured radiological report in 15 ± 1.4 s per radiograph. Panognostics-Plus may improve panoramic radiograph analysis and clinical efficiency, although further validation is required.