Dentists could fail to notice periapical lesions (PLs) while examining panoramic radiographs. Accordingly, this study aimed to develop an artificial intelligence (AI) designed to address this problem. Materials and methods: a total of 18618 periapical root areas (PRA) on 713 panoramic radiographs were annotated and classified as having or not having PLs. An AI model consisting of two convolutional neural networks (CNNs), a detector and a classifier, was trained on the images. The detector localized PRAs using a bounding-box-based object detection model, while the classifier classified the extracted PRAs as PL or not-PL using a fine-tuned CNN. The classifier was trained and validated on a balanced subset of the original dataset that included 3249 PRAs, and tested on 707 PRAs. Results: the detector achieved an average precision of 74.95%, while the classifier accuracy, sensitivity and specificity were 84%, 81% and 86%, respectively. When integrating both detection and classification models, the proposed method accuracy, sensitivity, and specificity were 84.6%, 72.2%, and 85.6%, respectively. Conclusion: a two-stage CNN model consisting of a detector and a classifier can successfully detect periapical lesions on panoramic radiographs.

BackgroundGrowing evidence suggests a significant association between vitamin D deficiency and RAS. Hence, the present meta-analysis and trial sequential analysis sought to investigate the potential association between low serum vitamin D levels and RAS.MethodsPubMed, Scopus, Embase, and Web of Science were comprehensively searched on December 1st, 2022 to retrieve all relevant studies. The grey literature was also searched via ProQuest. All case-control studies on the association between vitamin D and RAS were considered. The quality appraisal of the included studies was done using Newcastle-Ottawa scale. RevMan 5.0 and trial sequential analysis (TSA) programs were used for analyses.ResultsA total of 14 case-control studies with 1468 subjects (721 RAS patients and 747 controls) were included. The pooled data revealed a significant association between low serum levels of vitamin D and the risk of RAS (mean difference = – 8.73, 95% CI: – 12.02 to – 5.44, I2 = 94%, P < 0.00001). Additionally, TSA findings indicated that the current studies surpassed the required information size, confirming that the differences were reliable.ConclusionThe available evidence suggests that Vitamin D deficiency may have a role in the pathogenesis of RAS. Therefore, evaluation of vitamin D should be considered in RAS patients. Additionally, the results support the possibility of using vitamin D supplements in the management of RAS patients with inadequate serum levels of vitamin D. Future interventional studies are required to evaluate the benefits of vitamin D replacement in prevention and treatment of RAS.

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