MATHENA: Mamba-based Architectural Tooth Hierarchical Estimator and Holistic Evaluation Network for Anatomy

Automatic tooth segmentation and identification from intra-oral scanned 3D models are fundamental problems in digital dentistry, yet most existing approaches rely on task-specific 3D neural networks trained with densely annotated datasets, resulting in high annotation cost and limited generalization to scans from unseen sources. Thus, we propose TSegAgent, which addresses these challenges by reformulating dental analysis as a zero-shot geometric reasoning problem rather than a purely data-driven recognition task. The key idea is to combine the representational capacity of general-purpose foundation models with explicit geometric inductive biases derived from dental anatomy. Instead of learning dental-specific features, the proposed framework leverages multi-view visual abstraction and geometry-grounded reasoning to infer tooth instances and identities without task-specific training. By explicitly encoding structural constraints such as dental arch organization and volumetric relationships, the method reduces uncertainty in ambiguous cases and mitigates overfitting to particular shape distributions. Experimental results demonstrate that this reasoning-oriented formulation enables accurate and reliable tooth segmentation and identification with low computational and annotation cost, while exhibiting strong generalization across diverse and previously unseen dental scans.

Oral health issues affect billions globally, but the cost and limited access to professional dental care hinder preventive oral healthcare. Research relies on clinical-grade radiographs or intraoral camera images, unavailable for public self-screening. This study introduces a tooth localisation and numbering model for smartphone photographs. We developed a customised Mask Region-based Convolutional Neural Network (Mask R-CNN) pipeline trained on 1,272 annotated smartphone images. To address variability in patient-generated health data, the pipeline incorporates two domain-informed mechanisms: a masked gray-world white-balancing algorithm to mitigate artificial colour casts and an anatomically constrained detection layer to enforce structural validity and suppress false positives. Evaluation comprised four stages: internal held-out testing, independent external testing, a descriptive ablation study, and fold-based training stability analysis using the same internal test set. On the internal test set, the model achieved an instance-mask AP@50 of 0.818, class-aware PQ of 0.780, and operational F1 of 0.884. Training stability showed limited between-model variation: across ten runs, instance-mask AP@50 had a standard deviation of 0.009. On the external dataset, the model achieved an instance-mask AP@50 of 0.901, class-aware PQ of 0.832, and operational F1 of 0.928 despite differences in population, sensors, and acquisition protocols. The inference pipeline is available as an open-source, containerised API. These results demonstrate that consumer-grade smartphone imagery can support automated tooth-level anatomical mapping, offering a scalable, potentially low-cost foundation for remote screening and tele-dentistry in resource-constrained environments.

Accurate evaluation of multimodal large language models (MLLMs) in dental panoramic radiography (orthopantomogram, OPG) is limited by the lack of fine-grained, clinically reliable benchmarks that reflect expert interpretation. This work introduces PanDent, a large-scale, clinically grounded OPG benchmark built upon fine-grained, expert-validated tooth-level annotations. The dataset comprises 9,524 high-quality OPGs, each associated with comprehensive structured annotations produced by experienced dentists and further validated by an oral and maxillofacial radiologist, providing clinically reliable supervision for tooth-level diagnosis and reasoning. Clinically consistent radiology reports are constructed from expert-validated findings using clinician-defined reporting logic, establishing explicit correspondence between structured clinical evidence and free-text descriptions. This design enables evaluation of whether MLLMs generate reports that are not only linguistically coherent but also clinically consistent with expert-validated tooth-level findings. Experiments are conducted on diverse MLLMs, including state-of-the-art (SOTA) proprietary models, general-domain open-source models, and medical-specific models. Results show that current MLLMs can generate fluent reports, yet fail to produce clinically consistent descriptions, exhibiting substantial errors in fine-grained localization and tooth-level diagnosis. Fine-tuning on PanDent significantly improves structure-language consistency, substantially enhancing visual localization accuracy and diagnostic correctness, and bringing model outputs closer to expert dental interpretation. These results establish PanDent as a rigorous benchmark for evaluating tooth-level clinical reasoning in MLLMs and a valuable resource for clinically grounded dental AI.