AI Rivals Traditional Bite Wing Radiography in Detecting Proximal Secondary Caries in A Group of Egyptian Patients at Cairo University, Faculty OF Dentistry Hospital (Diagnostic Accuracy Study)

Dental caries are chronic diseases that results in the destruction of the hard tooth tissues. It is a multifactorial condition that often goes undiagnosed, especially when it is hidden or in its initial stages. Detecting non-cavitated lesions is crucial for their early management. The standard visual-tactile inspection often fails to identify early lesions on hard-to-reach surfaces, such as proximal areas and beneath restorations. Detecting proximal caries early is crucial for implementing effective treatments and achieving optimal outcomes. A common supplementary method for detecting early lesions on proximal surfaces and assessing their extent is bitewing radiography. The routine diagnostic approach combines clinical examination with radiographic evaluation. To increase the detection rate of proximal secondary caries, experts recommend integrating visual and clinical examinations with bitewing radiography. Intraoral bitewing radiographs can be captured using either film or digital sensors, with preference for digital systems due to their benefits of reduced patient exposure, time savings, image enhancement, and ease of image storage, retrieval, and transmission. Although more sensitive for detecting early lesions than visual-tactile assessments, bitewing evaluations comes with significant variance between examiners and a considerable proportion of false-positive or false-negative detections. Recent literature has explored the use of artificial intelligence (AI), a field of computer science focused on developing machines capable of mimicking human cognitive abilities, as a diagnostic tool for detecting caries lesions using dental (digital radiographic) images. As AI technology advances, an increasing number of studies have examined the diagnostic performance of AI-based models, emphasizing the importance of creating reliable tools like AI to enhance the diagnostic process. Numerous studies have assessed the performance of AI models on diverse types of dental radiographs, with a significant focus on bitewing radiographs (BWR). AI has been used for various applications in oral and dental health, including the detection of dental caries, endodontic treatment and diagnosis, periodontal issues, and the detection of oral lesion pathology. A reference dataset of caries diagnoses from bitewing radiographs by different examiners created this benchmark which serves as a crucial tool for comparing the diagnostic performance of AI models against human examiners, emphasizing the potential improvements in accuracy and reliability that AI can bring to dental diagnostics.