Dental Imaging

Dental diagnosis from Orthopantomograms (OPGs) requires coordination of tooth detection, caries segmentation (CarSeg), anomaly detection (AD), and dental developmental staging (DDS). We propose Mamba-based Architectural Tooth Hierarchical Estimator and Holistic Evaluation Network for Anatomy (MATHENA), a unified framework leveraging Mamba's linear-complexity State Space Models (SSM) to address all four tasks. MATHENA integrates MATHE, a multi-resolution SSM-driven detector with four-directional Vision State Space (VSS) blocks for O(N) global context modeling, generating per-tooth crops. These crops are processed by HENA, a lightweight Mamba-UNet with a triple-head architecture and Global Context State Token (GCST). In the triple-head architecture, CarSeg is first trained as an upstream task to establish shared representations, which are then frozen and reused for downstream AD fine-tuning and DDS classification via linear probing, enabling stable, efficient learning. We also curate PARTHENON, a benchmark comprising 15,062 annotated instances from ten datasets. MATHENA achieves 93.78% mAP@50 in tooth detection, 90.11% Dice for CarSeg, 88.35% for AD, and 72.40% ACC for DDS.

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.

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.

3D intraoral scans (IOS) are increasingly adopted in routine dentistry due to abundant geometric evidence, and unified multi-disease diagnosis is desirable for clinical documentation and communication. While recent works introduce dental vision-language models (VLMs) to enable unified diagnosis and report generation on 2D images or multi-view images rendered from IOS, they do not fully leverage native 3D geometry. Such work is necessary and also challenging, due to: (i) heterogeneous scan forms and the complex IOS topology, (ii) multi-disease co-occurrence with class imbalance and fine-grained morphological ambiguity, (iii) limited paired 3D IOS-text data. Thus, we present IOSVLM, an end-to-end 3D VLM that represents scans as point clouds and follows a 3D encoder-projector-LLM design for unified diagnosis and generative visual question-answering (VQA), together with IOSVQA, a large-scale multi-source IOS diagnosis VQA dataset comprising 19,002 cases and 249,055 VQA pairs over 23 oral diseases and heterogeneous scan types. To address the distribution gap between color-free IOS data and color-dependent 3D pre-training, we propose a geometry-to-chromatic proxy that stabilizes fine-grained geometric perception and cross-modal alignment. A two-stage curriculum training strategy further enhances robustness. IOSVLM consistently outperforms strong baselines, achieving gains of at least +9.58% macro accuracy and +1.46% macro F1, indicating the effectiveness of direct 3D geometry modeling for IOS-based diagnosis.

Digital dentistry has made significant advances with the advent of deep learning. However, the majority of these deep learning-based dental image analysis models focus on very specific tasks such as tooth segmentation, tooth detection, cavity detection, and gingivitis classification. There is a lack of a specialized model that has holistic knowledge of teeth and can perform dental image analysis tasks based on that knowledge. Datasets of dental images with captions can help build such a model. To the best of our knowledge, existing dental image datasets with captions are few in number and limited in scope. In many of these datasets, the captions describe the entire mouth, while the images are limited to the anterior view. As a result, posterior teeth such as molars are not clearly visible, limiting the usefulness of the captions for training vision-language models. Additionally, the captions focus only on a specific disease (gingivitis) and do not provide a holistic assessment of each tooth. Moreover, tooth disease scores are typically assigned to individual teeth, and each tooth is treated as a separate entity in orthodontic procedures. Therefore, it is important to have captions for single-tooth images. As far as we know, no such dataset of single-tooth images with dental captions exists. In this work, we aim to bridge that gap by assessing the possibility of generating captions for dental images using Vision-Language Models (VLMs) and evaluating the extent and quality of those captions. Our findings suggest that guided prompts help VLMs generate meaningful captions. We show that the prompts generated by our framework are better anchored in describing the visual aspects of dental images. We selected RGB images as they have greater potential in consumer scenarios.

Panoramic dental radiographs require fine-grained spatial reasoning, bilateral symmetry understanding, and multi-step diagnostic verification, yet existing vision-language models operate under a static single-pass paradigm that limits their clinical reliability. In this paper, we introduce OralGPT-Plus, an agentic vision-language model designed to perform iterative and symmetry-aware diagnostic reasoning for panoramic dental radiograph analysis. To support this paradigm, we construct DentalProbe, a five-thousand-image dataset with expert-curated diagnostic trajectories that provide structured supervision for localized inspection and contralateral comparison. We further develop a Reinspection-driven reinforcement learning framework that encourages clinically meaningful re-examination and stabilizes long-horizon reasoning with rubric-based reward and conditioned diagnostic-driven reward. In parallel, we present MMOral-X, the first benchmark for holistic panoramic diagnosis, containing 300 open-ended questions and region-level annotations across multiple difficulty levels. OralGPT-Plus demonstrates consistent and reliable improvements over strong baselines on MMOral-X and established panoramic benchmarks, indicating the effectiveness of interactive and symmetry-informed reasoning. Our work highlights the value of agentic modeling for dental imaging and provides a foundation for future research in clinically aligned panoramic radiograph analysis.

Orthopantomograms (OPGs) are the standard panoramic radiograph in dentistry, used for full-arch screening across multiple diagnostic tasks. While Vision Language Models (VLMs) now allow multi-task OPG analysis through natural language, they underperform task-specific models on most individual tasks. Agentic systems that orchestrate specialized tools offer a path to both versatility and accuracy, this approach remains unexplored in the field of dental imaging. To address this gap, we propose OPGAgent, a multi-tool agentic system for auditable OPG interpretation. OPGAgent coordinates specialized perception modules with a consensus mechanism through three components: (1) a Hierarchical Evidence Gathering module that decomposes OPG analysis into global, quadrant, and tooth-level phases with dynamically invoking tools, (2) a Specialized Toolbox encapsulating spatial, detection, utility, and expert zoos, and (3) a Consensus Subagent that resolves conflicts through anatomical constraints. We further propose OPG-Bench, a structured-report protocol based on (Location, Field, Value) triples derived from real clinical reports, which enables a comprehensive review of findings and hallucinations, extending beyond the limitations of VQA indicators. On our OPG-Bench and the public MMOral-OPG benchmark, OPGAgent outperforms current dental VLMs and medical agent frameworks across both structured-report and VQA evaluation. Code will be released upon acceptance.

Interest in generating realistic synthetic medical images has grown in recent years. Such datasets can mitigate the scarcity of public data for artificial intelligence research and support education. Work on synthesizing dental panoramic radiographs (PRs) has so far relied almost exclusively on generative adversarial networks (GANs), and three limitations recur: the synthesized field of view is often restricted to a cropped dentoalveolar region rather than a complete PR; observer studies of GAN-generated PRs report that clinicians still identify synthetic images with accuracies of roughly 78-82%, implying persistent visible giveaways; and adversarial training remains sensitive to instability and mode collapse. Generating a full-size PR directly at diagnostic resolution with a diffusion model is an alternative, but sampling at that resolution is costly. We therefore present PanoDiff-SR, an end-to-end two-stage pipeline developed and evaluated specifically for panoramic radiography: a denoising diffusion implicit model (PanoDiff) generates a low-resolution (LR) seed PR ($256\times128$), which a fine-tuned hybrid attention transformer (HAT) super-resolution (SR) stage upscales to a high-resolution (HR) PR of $1024\times512$. Decoupling the expensive generative step from the resolution step yields complete, full-arch PRs at diagnostic resolution on a single 47 GB GPU. The Fréchet inception distance between 7243 real and synthetic HR images is 40.5. Inception scores were 2.68, 2.38, 2.90 and 2.98 for real HR, synthetic HR, real LR and synthetic LR images, respectively. Six clinical experts, each evaluating 100 synthetic and 100 real PRs under a time limit, distinguished real from synthetic images with an average accuracy of 68.5% (50% corresponds to random guessing), substantially closer to chance than reported for GAN-based studies. Project page: https://s4nyam.github.io/panodiff/