IOSVLM: A 3D Vision-Language Model for Unified Dental Diagnosis from Intraoral Scans

Vision-Language Models (VLMs) have demonstrated significant potential in medical image analysis, yet their application in intraoral photography remains largely underexplored due to the lack of fine-grained, annotated datasets and comprehensive benchmarks. To address this, we present MetaDent, a comprehensive resource that includes (1) a novel and large-scale dentistry image dataset collected from clinical, public, and web sources; (2) a semi-structured annotation framework designed to capture the hierarchical and clinically nuanced nature of dental photography; and (3) comprehensive benchmark suites for evaluating state-of-the-art VLMs on clinical image understanding. Our labeling approach combines a high-level image summary with point-by-point, free-text descriptions of abnormalities. This method enables rich, scalable, and task-agnostic representations. We curated 60,669 dental images from diverse sources and annotated a representative subset of 2,588 images using this meta-labeling scheme. Leveraging Large Language Models (LLMs), we derive standardized benchmarks: approximately 15K Visual Question Answering (VQA) pairs and an 18-class multi-label classification dataset, which we validated with human review and error analysis to justify that the LLM-driven transition reliably preserves fidelity and semantic accuracy. We then evaluate state-of-the-art VLMs across VQA, classification, and image captioning tasks. Quantitative results reveal that even the most advanced models struggle with a fine-grained understanding of intraoral scenes, achieving moderate accuracy and producing inconsistent or incomplete descriptions in image captioning. We publicly release our dataset, annotations, and tools to foster reproducible research and accelerate the development of vision-language systems for dental applications.

Background: Oral diseases affect nearly 3.5 billion people worldwide, yet the comparative clinical potential of large-scale AI models in dentistry remains poorly understood. Three distinct model categories have emerged: language-generative models, discriminative vision foundation models, and dental-specific foundation models, with no unified review examining their relationships and collective limitations. Methods: Following PRISMA-ScR guidelines, we systematically searched four databases (PubMed, Google Scholar, Scopus, arXiv), screened independently by two reviewers. After applying inclusion/exclusion criteria, 97 studies (2020-2026) were included. We propose a two-dimensional classification framework organizing models by architectural paradigm and dental specialization degree. Results: Language-generative models excel at text-based tasks (clinical reasoning, licensing exams, patient communication) but show inconsistent performance on image-dependent diagnostics. Adapted SAM and CLIP variants achieve strong tooth segmentation and lesion detection results. Dental-specific models (DentVFM, DentVLM, OralGPT) demonstrate strongest performance on complex multimodal tasks. Integrated pipelines consistently outperform single-model approaches. A data asymmetry is observed: dental-specific pretraining concentrates almost entirely in the vision domain, reflecting scarce large-scale dental text corpora. Conclusions: General-purpose and dental-specific models play complementary roles; the most effective systems combine both within structured pipelines. Safe autonomous deployment requires resolving three persistent barriers: hallucination in generative models, limited annotated dental datasets, and absent standardized clinical evaluation benchmarks.

Vision-language models (VLMs) remain largely unreliable on panoramic dental radiographs and can rely on learned anatomical priors rather than evidence in the image. This is particularly problematic for tooth localization and spatial reasoning, and fine-tuned dental VLMs can retain the same spatial biases. We present AgenTeeth, a model-agnostic, tool-augmented framework that grounds frozen VLMs using seven specialized dental vision experts. A question-aware orchestrator selects the relevant tools, whose detections are mapped to FDI tooth numbers or anatomical regions and returned as structured findings together with annotated image overlays. A fresh synthesis call then answers the question using this evidence, without fine-tuning the underlying VLM. On MMOral-OPG-Bench, AgenTeeth improves four backbone VLMs by 12.9-23.0 percentage points over their baselines. Our strongest configuration reaches 65.66% on open-ended VQA, compared with 45.35% for OralGPT-Plus. The advantage also holds at matched scale: a frozen Qwen2.5-VL-7B-Instruct with AgenTeeth reaches 48.11%, exceeding OralGPT-Plus built on the same backbone after supervised fine-tuning and reinforcement learning for tool use. We release the framework, all seven expert models, and a dentist-annotated dataset for alveolar bone-loss detection in panoramic radiographs.