Occlusal Geometry in Closed Form for Orthodontic Report Generation

Maxillofacial report generation from cone beam computed tomography is scored here by a composite objective placing 80% of its weight on a large language model judgement of factual entailment and 20% on lexical overlap, of which only the lexical fifth is visible during development. The grader's BLEU-4 and METEOR routines are reproduced in pure Python and match the reference to machine precision, and an offline entailment surrogate, which tells a report written for one patient from one written for another at an area under the curve of 0.987, makes the composite objective cheap enough to optimise directly. Over the 622-case public release, a report selected against the visible lexical ranking scores 0.2909, whereas one selected against the composite objective scores 0.4122, because pursuing n-gram overlap drives entailment precision from 0.522 down to 0.266. A 29 million parameter encoder fine-tuned on the release reaches a prevalence-weighted out-of-fold area under the curve of 0.486 over 985 statements, indistinguishable from the corpus prior, while nine numbers read from the image header reach 0.945 for mandible coverage and 0.872 for condyle coverage, and acquisition centre alone predicts sentence choice at 0.718 against 0.663 for the image-derived model, identifying dictation convention rather than anatomy as the quantity the lexical metrics reward. The delivered system emits eight unconditional statements and five gated on header geometry under polarity, laterality and tooth-level consistency constraints, and reaches METEOR 0.3542 over 50 held-out cases from an unseen centre. The dataset and code are available at https://github.com/GIND123/CBCT-Clinical-Reasoner

Dento-maxillofacial cone-beam CT (CBCT) reports may contain dozens of tooth-specific, anatomical, and spatial findings from a single 3D scan. Learning to generate such reports from limited clinical data is challenging because routine reports may not exhaustively document image findings, and a non-mention may reflect either absence or non-reporting. We present EviDent-CBCT, an evidence-bottlenecked framework designed for this incomplete supervision. An anatomy-aware network maps each CBCT scan to a discrete record of tooth-level, global, and tooth-IAC evidence. A dental-logic consistency projection reconciles incompatible evidence before a deterministic renderer and an image-blind local language model generate the report using only this record. For tooth-level evidence, reliability-aware training uses eligible non-mentions as reduced-weight negatives, while unreported global and tooth-IAC labels remain unknown. A metal-sensitive input channel preserves intensity cues from dental materials. Across three validation runs, EviDent-CBCT achieves $0.666\pm0.006$ merged evidence set-F1 and $0.402\pm0.003$ RadFact-Lite-Dental logical-F1, versus $0.371\pm0.018$ for the strongest controlled direct baseline. In the ODIN 2026 challenge, it ranked second in automated evaluation and third in blinded clinical Arena comparison on the hidden test set. These results support the discrete evidence record as an effective and auditable interface for CBCT report generation.

Generative AI has advanced rapidly in medical report generation; however, its application to oral and maxillofacial CBCT reporting remains limited, largely because of the scarcity of high-quality paired CBCT-report data and the intrinsic complexity of volumetric CBCT interpretation. To address this, we introduce CBCTRepD, a bilingual oral and maxillofacial CBCT report-generation system designed for integration into routine radiologist-AI co-authoring workflows. We curated a large-scale, high-quality paired CBCT-report dataset comprising approximately 7,408 studies, covering 55 oral disease entities across diverse acquisition settings, and used it to develop the system. We further established a clinically grounded, multi-level evaluation framework that assesses both direct AI-generated drafts and radiologist-edited collaboration reports using automatic metrics together with radiologist- and clinician-centered evaluation. Using this framework, we show that CBCTRepD achieves superior report-generation performance and produces drafts with writing quality and standardization comparable to those of intermediate radiologists. More importantly, in radiologist-AI collaboration, CBCTRepD provides consistent and clinically meaningful benefits across experience levels: it helps novice radiologists improve toward intermediate-level reporting, enables intermediate radiologists to approach senior-level performance, and even assists senior radiologists by reducing omission-related errors, including clinically important missed lesions. By improving report structure, reducing omissions, and promoting attention to co-existing lesions across anatomical regions, CBCTRepD shows strong and reliable potential as a practical assistant for real-world CBCT reporting across multi-level care settings.