Patient-Level, Leakage-Aware Deep Learning for Cross-Center Periapical Radiograph Classification

As dental caries appear as subtle, low-contrast lesions in intraoral imaging, existing deep learning models face significant challenges in the early detection of caries. While recent Transformer-based detectors have shown promising results in natural images, they often fail to capture the domain-specific anatomical priors crucial for dental caries detection. In this paper, we propose Caries-DETR, a specialized Transformer framework for caries detection in intraoral images. A Tooth Structure-aware Query Initialization (TSQI) is designed, leveraging large-scale intraoral photograph pre-training and a structure perception branch (SPB) to integrate high-frequency structural priors, guiding the model to focus on anatomically significant lesion areas. Furthermore, we design a Lesion-aware Dynamic Loss Refinement (LDLR) to implement quality-driven hard mining through adaptive loss reweighting based on lesion size, anatomical relevance, and prediction quality, optimizing detection for subtle lesions. Extensive experiments on two public datasets (i.e., AlphaDent and DentalAI) demonstrate that Caries-DETR achieves a state-of-the-art performance compared to existing methods and exhibits good generalization and robustness. Code and data at https://github.com/XuefenLiu-SZU/Caries-DETR}{https://github.com/XuefenLiu-SZU/Caries-DETR.

This study developed a computer-aided diagnosis (CAD) system for detecting caries and molar-incisor hypomineralization (MIH) in intraoral photographs. These lesions share similar appearances, making clinical differentiation challenging, especially given their small size and variability in imaging conditions.

The scarcity and high cost of expert annotations in dental imaging present a significant challenge for the development of AI in dentistry. DINOv3, a state-of-the-art, self-supervised vision foundation model pre-trained on 1.7 billion images, offers a promising pathway to mitigate this issue. However, its reliability when transferred to the dental domain, with its unique imaging characteristics and clinical subtleties, remains unclear. To address this, we introduce DinoDental, a unified benchmark designed to systematically evaluate whether DINOv3 can serve as a reliable, off-the-shelf encoder for comprehensive dental image analysis without requiring domain-specific pre-training. Constructed from multiple public datasets, DinoDental covers a wide range of tasks, including classification, detection, and instance segmentation on both panoramic radiographs and intraoral photographs. We further analyze the model's transfer performance by scaling its size and input resolution, and by comparing different adaptation strategies, including frozen features, full fine-tuning, and the parameter-efficient Low-Rank Adaptation (LoRA) method. Our experiments show that DINOv3 can serve as a strong unified encoder for dental image analysis across both panoramic radiographs and intraoral photographs, remaining competitive across tasks while showing particularly clear advantages for intraoral image understanding and boundary-sensitive dense prediction. Collectively, DinoDental provides a systematic framework for comprehensively evaluating DINOv3 in dental analysis, establishing a foundational benchmark to guide efficient and effective model selection and adaptation for the dental AI community.