The ADEPT study: a comparative study of dentists' ability to detect enamel-only proximal caries in bitewing radiographs with and without the use of AssistDent artificial intelligence software

Abstract

Introduction Reversal of enamel-only proximal caries by non-invasive treatments is important in preventive dentistry. However, detecting such caries using bitewing radiography is difficult and the subtle patterns are often missed by dental practitioners.Aims To investigate whether the ability of dentists to detect enamel-only proximal caries is enhanced by the use of AssistDent artificial intelligence (AI) software.Materials and methods In the ADEPT (AssistDent Enamel-only Proximal caries assessmenT) study, 23 dentists were randomly divided into a control arm, without AI assistance, and an experimental arm, in which AI assistance provided on-screen prompts indicating potential enamel-only proximal caries. All participants analysed a set of 24 bitewings in which an expert panel had previously identified 65 enamel-only carious lesions and 241 healthy proximal surfaces.Results The control group found 44.3% of the caries, whereas the experimental group found 75.8%. The experimental group incorrectly identified caries in 14.6% of the healthy surfaces compared to 3.7% in the control group. The increase in sensitivity of 71% and decrease in specificity of 11% are statistically significant (p <0.01).Conclusions AssistDent AI software significantly improves dentists' ability to detect enamel-only proximal caries and could be considered as a tool to support preventive dentistry in general practice.

Applications, functions, and accuracy of artificial intelligence in restorative dentistry: A literature review

“…102 When using bitewing radiographs for diagnosis of enamel-only proximal caries, dentists without AI-assistance (Assist-Dent, Manchester Imaging Ltd, Manchester, UK) could detect 44.3% of caries cases; however, dentists with the AI-assistance correctly predicted 75.8% of caries cases in an investigation. 93 Comparably, in another investigation, a CNN architecture (U-Net) revealed an accuracy of 80%; nonetheless, dentists' average accuracy was about 71% with a minimum of 61% and a maximum of 78%. 103 Though digital bitewing radiography provides better detection of proximal enamel and dentin caries compared to other detecting methods such as nearinfrared light transillumination and laser fluorescence, 104 AI can improve dentists' detecting accuracy by enhancing their sensitivity for prediction of enamel lesions while raising the risk of invasive therapy.…”

“…86,88 order to improve caries diagnosis in terms of accuracy and precision. 89,90 AI models can employ intraoral digital images, bitewing radiographs, or panoramic radiographs to recognize caries lesions and offer appropriate treatments accordingly; [91][92][93][94] however, panoramic radiographs may be less viable when it comes to caries detection. 95 3.2 | Function of AI for caries detection DL using CNNs has been mostly used to develop an AI-based system for caries detection.…”

“…AI and DL models have been proposed as assistance to dental examiners when analyzing radiographic and/or photographic images in order to improve caries diagnosis in terms of accuracy and precision 89,90 . AI models can employ intraoral digital images, bitewing radiographs, or panoramic radiographs to recognize caries lesions and offer appropriate treatments accordingly; 91–94 however, panoramic radiographs may be less viable when it comes to caries detection 95 …”

Where Is the Artificial Intelligence Applied in Dentistry? Systematic Review and Literature Analysis

“…Cochrane library provided only two results of AI in dentistry. Both were trials from 2021; one was a comparative study of dentists’ ability to detect caries in bitewings with and without AI support [ 202 ], and the second clinical trial focused on management of edentulous patients with AI utilization [ 203 ].…”

Dental Students’ Ability to Detect Only-Enamel Proximal Caries on Bitewing Radiographs

“…Further, it is included in the undergraduate curriculum during training in the operative/restorative dentistry syllabus. Training in early detection of enamel-only caries can be useful in retaining most of the tooth structure and minimizes the cycle of treatment and retreatment [ 8 ].…”