{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T22:48:00Z","timestamp":1794005280382,"version":"4.8.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,6,21]],"date-time":"2019-06-21T00:00:00Z","timestamp":1561075200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2019,6,21]],"date-time":"2019-06-21T00:00:00Z","timestamp":1561075200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The approximity of the inferior alveolar nerve (IAN) to the roots of lower third molars (M3) is a risk factor for the occurrence of nerve damage and subsequent sensory disturbances of the lower lip and chin following the removal of third molars. To assess this risk, the identification of M3 and IAN on dental panoramic radiographs (OPG) is mandatory. In this study, we developed and validated an automated approach, based on deep-learning, to detect and segment the M3 and IAN on OPGs. As a reference, M3s and IAN were segmented manually on 81 OPGs. A deep-learning approach based on U-net was applied on the reference data to train the convolutional neural network (CNN) in the detection and segmentation of the M3 and IAN. Subsequently, the trained U-net was applied onto the original OPGs to detect and segment both structures. Dice-coefficients were calculated to quantify the degree of similarity between the manually and automatically segmented M3s and IAN. The mean dice-coefficients for M3s and IAN were 0.947\u2009\u00b1\u20090.033 and 0.847\u2009\u00b1\u20090.099, respectively. Deep-learning is an encouraging approach to segment anatomical structures and later on in clinical decision making, though further enhancement of the algorithm is advised to improve the accuracy.<\/jats:p>","DOI":"10.1038\/s41598-019-45487-3","type":"journal-article","created":{"date-parts":[[2019,6,21]],"date-time":"2019-06-21T10:02:56Z","timestamp":1561111376000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":153,"title":["Automated detection of third molars and mandibular nerve by deep learning"],"prefix":"10.1038","volume":"9","author":[{"given":"Shankeeth","family":"Vinayahalingam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Xi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefaan","family":"Berg\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Maal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"de Jong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,6,21]]},"reference":[{"key":"45487_CR1","doi-asserted-by":"publisher","first-page":"1554","DOI":"10.2105\/AJPH.2006.100271","volume":"97","author":"JW Friedman","year":"2007","unstructured":"Friedman, J. W. The prophylactic extraction of third molars: A public health hazard. American Journal of Public Health 97, 1554\u20131559 (2007).","journal-title":"American Journal of Public Health"},{"key":"45487_CR2","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1177\/0022034515581644","volume":"94","author":"K Carter","year":"2015","unstructured":"Carter, K. & Worthington, S. Morphologic and demographic predictors of third molar agenesis: A systematic review and meta-analysis. Journal of Dental Research 94, 886\u2013894 (2015).","journal-title":"Journal of Dental Research"},{"issue":"4","key":"45487_CR3","doi-asserted-by":"publisher","first-page":"229","DOI":"10.4103\/2141-9248.160177","volume":"5","author":"P Santosh","year":"2015","unstructured":"Santosh, P. Impacted mandibular third molars: Review of literature and a proposal of a combined clinical and radiological classification. Annals of Medical and Health Sciences Research, https:\/\/doi.org\/10.4103\/2141-9248.160177 (2015).","journal-title":"Annals of Medical and Health Sciences Research"},{"issue":"6","key":"45487_CR4","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.tripleo.2011.02.013","volume":"111","author":"Takumi Hasegawa","year":"2011","unstructured":"Hasegawa, T., Ri, S., Umeda, M. & Komori, T. Multivariate relationships among risk factors and hypoesthesia of the lower lip after extraction of the mandibular third molar. In Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, https:\/\/doi.org\/10.1016\/j.tripleo.2011.02.013 (2011).","journal-title":"Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology"},{"key":"45487_CR5","doi-asserted-by":"publisher","first-page":"2158","DOI":"10.1016\/j.jcms.2015.10.009","volume":"43","author":"H Ghaeminia","year":"2015","unstructured":"Ghaeminia, H. et al. Clinical relevance of cone beam computed tomography in mandibular third molar removal: A multicentre, randomised, controlled trial. Journal of Cranio-Maxillofacial Surgery 43, 2158\u20132167 (2015).","journal-title":"Journal of Cranio-Maxillofacial Surgery"},{"key":"45487_CR6","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1054\/ijom.2001.0057","volume":"30","author":"D G\u00fclicher","year":"2001","unstructured":"G\u00fclicher, D. & Gerlach, K. L. Sensory impairment of the lingual and inferior alveolar nerves following removal of impacted mandibular third molars. International Journal of Oral and Maxillofacial Surgery 30, 306\u2013312 (2001).","journal-title":"International Journal of Oral and Maxillofacial Surgery"},{"issue":"7","key":"45487_CR7","doi-asserted-by":"publisher","first-page":"1867","DOI":"10.1016\/j.joms.2010.10.039","volume":"69","author":"Gerold Eyrich","year":"2011","unstructured":"Eyrich, G. et al. 3-Dimensional imaging for lower third molars: Is there an implication for surgical removal? Journal of Oral and Maxillofacial Surgery, https:\/\/doi.org\/10.1016\/j.joms.2010.10.039 (2011).","journal-title":"Journal of Oral and Maxillofacial Surgery"},{"key":"45487_CR8","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1016\/j.ijom.2009.06.007","volume":"38","author":"H Ghaeminia","year":"2009","unstructured":"Ghaeminia, H. et al. Position of the impacted third molar in relation to the mandibular canal. Diagnostic accuracy of cone beam computed tomography compared with panoramic radiography. International Journal of Oral and Maxillofacial Surgery 38, 964\u2013971 (2009).","journal-title":"International Journal of Oral and Maxillofacial Surgery"},{"issue":"8","key":"45487_CR9","doi-asserted-by":"publisher","first-page":"20140172","DOI":"10.1259\/dmfr.20140172","volume":"43","author":"L H Matzen","year":"2014","unstructured":"Matzen, L. H., Schou, S., Christensen, J., Hintze, H. & Wenzel, A. Audit of a 5-year radiographic protocol for assessment of mandibular third molars before surgical intervention. Dentomaxillofacial Radiology, https:\/\/doi.org\/10.1259\/dmfr.20140172 (2014).","journal-title":"Dentomaxillofacial Radiology"},{"issue":"1","key":"45487_CR10","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.joms.2011.03.030","volume":"70","author":"Gemma Sanmart\u00ed-Garcia","year":"2012","unstructured":"Sanmart\u00ed-Garcia, G., Valmaseda-Castell\u00f3n, E. & Gay-Escoda, C. Does computed tomography prevent inferior alveolar nerve injuries caused by lower third molar removal? Journal of Oral and Maxillofacial Surgery, https:\/\/doi.org\/10.1016\/j.joms.2011.03.030 (2012).","journal-title":"Journal of Oral and Maxillofacial Surgery"},{"issue":"8","key":"45487_CR11","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1016\/j.ijom.2011.02.032","volume":"40","author":"H. Ghaeminia","year":"2011","unstructured":"Ghaeminia, H. et al. The use of cone beam CT for the removal of wisdom teeth changes the surgical approach compared with panoramic radiography: A pilot study. International Journal of Oral and Maxillofacial Surgery, https:\/\/doi.org\/10.1016\/j.ijom.2011.02.032 (2011).","journal-title":"International Journal of Oral and Maxillofacial Surgery"},{"issue":"9","key":"45487_CR12","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1053\/joms.2001.25823","volume":"59","author":"Pascal X. Pinto","year":"2001","unstructured":"Pinto, P. X., Pinto, P. X., Mommaerts, M. Y., Wreakes, G. & Jacobs, W. V. G. J. A. Immediate postexpansion changes following the use of the transpalatal distractor. Journal of Oral and Maxillofacial Surgery, https:\/\/doi.org\/10.1053\/joms.2001.25823 (2001).","journal-title":"Journal of Oral and Maxillofacial Surgery"},{"key":"45487_CR13","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/0266-4356(90)90005-6","volume":"28","author":"JP Rood","year":"1990","unstructured":"Rood, J. P. & Shehab, B. A. The radiological prediction of inferior alveolar nerve injury during third molar surgery. The British journal of oral & maxillofacial surgery 28, 20\u20135 (1990).","journal-title":"The British journal of oral & maxillofacial surgery"},{"key":"45487_CR14","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1111\/adj.12326","volume":"60","author":"W Liu","year":"2015","unstructured":"Liu, W., Yin, W., Zhang, R., Li, J. & Zheng, Y. Diagnostic value of panoramic radiography in predicting inferior alveolar nerve injury after mandibular third molar extraction: A meta-analysis. Australian Dental Journal 60, 233\u2013239 (2015).","journal-title":"Australian Dental Journal"},{"key":"45487_CR15","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.media.2017.07.005","volume":"42","author":"G Litjens","year":"2017","unstructured":"Litjens, G. et al. A survey on deep learning in medical image analysis. Medical Image Analysis 42, 60\u201388 (2017).","journal-title":"Medical Image Analysis"},{"key":"45487_CR16","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.1109\/TMI.2016.2528162","volume":"35","author":"HC Shin","year":"2016","unstructured":"Shin, H. C. et al. Deep Convolutional Neural Networks for Computer-Aided Detection: CNN Architectures, Dataset Characteristics and Transfer Learning. IEEE Transactions on Medical Imaging 35, 1285\u20131298 (2016).","journal-title":"IEEE Transactions on Medical Imaging"},{"key":"45487_CR17","doi-asserted-by":"crossref","unstructured":"Men, K. et al. Deep Deconvolutional Neural Network for Target Segmentation of Nasopharyngeal Cancer in Planning Computed Tomography Images. Frontiers in Oncology 7 (2017).","DOI":"10.3389\/fonc.2017.00315"},{"key":"45487_CR18","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1109\/TBME.2013.2288258","volume":"61","author":"B Foster","year":"2014","unstructured":"Foster, B. et al. Segmentation of PET images for computer-aided functional quantification of tuberculosis in small animal models. IEEE Transactions on Biomedical Engineering 61, 711\u2013724 (2014).","journal-title":"IEEE Transactions on Biomedical Engineering"},{"key":"45487_CR19","doi-asserted-by":"crossref","unstructured":"Khalid, S. et al. Segmentation of skin lesion using Cohen\u2013Daubechies\u2013Feauveau biorthogonal wavelet. SpringerPlus 5 (2016).","DOI":"10.1186\/s40064-016-3211-4"},{"key":"45487_CR20","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.media.2016.02.004","volume":"31","author":"Ching-Wei Wang","year":"2016","unstructured":"Wang, C. W. et al. A benchmark for comparison of dental radiography analysis algorithms. Medical Image Analysis, https:\/\/doi.org\/10.1016\/j.media.2016.02.004 (2016).","journal-title":"Medical Image Analysis"},{"key":"45487_CR21","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1007\/978-3-319-24574-4_28","volume-title":"Lecture Notes in Computer Science","author":"Olaf Ronneberger","year":"2015","unstructured":"Ronneberger, O., Fischer, P. & Brox, T. U-Net: Convolutional Networks for Biomedical Image Segmentation. Miccai 234\u2013241 https:\/\/doi.org\/10.1007\/978-3-319-24574-4_28 (2015)."},{"key":"45487_CR22","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1007\/978-3-319-46723-8_49","volume-title":"Medical Image Computing and Computer-Assisted Intervention \u2013 MICCAI 2016","author":"\u00d6zg\u00fcn \u00c7i\u00e7ek","year":"2016","unstructured":"\u00c7i\u00e7ek, \u00d6., Abdulkadir, A., Lienkamp, S. S., Brox, T. & Ronneberger, O. 3D U-net: Learning dense volumetric segmentation from sparse annotation. In Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), https:\/\/doi.org\/10.1007\/978-3-319-46723-8_49 (2016)."},{"key":"45487_CR23","doi-asserted-by":"publisher","unstructured":"Li, H., Sun, G., Sun, H. & Liu, W. Watershed algorithm based on morphology for dental X-ray images segmentation. In International Conference on Signal Processing Proceedings, ICSP, https:\/\/doi.org\/10.1109\/ICoSP.2012.6491720 (2012).","DOI":"10.1109\/ICoSP.2012.6491720"},{"issue":"1","key":"45487_CR24","doi-asserted-by":"publisher","first-page":"307","DOI":"10.13005\/bpj\/613","volume":"8","author":"T. Karthikeyan","year":"2015","unstructured":"Karthikeyan, T. & Manikandaprabhu, P. A novel approach for inferior alveolar nerve (IAN) injury identification using panoramic radiographic image. Biomedical and Pharmacology Journal, https:\/\/doi.org\/10.13005\/bpj\/613 (2015).","journal-title":"Biomedical and Pharmacology Journal"},{"key":"45487_CR25","doi-asserted-by":"crossref","unstructured":"Vila Blanco, N., Tom\u00e1s Carmona, I. & Carreira, M. Fully Automatic Teeth Segmentation in Adult OPG Images. Proceedings 2 (2018).","DOI":"10.3390\/proceedings2181199"},{"key":"45487_CR26","doi-asserted-by":"crossref","unstructured":"Lira, P., Giraldi, G. & Neves, L. A. Segmentation and Feature Extraction of Panoramic Dental X-Ray Images. IJNCR 1 (2010).","DOI":"10.4018\/jncr.2010100101"},{"issue":"6","key":"45487_CR27","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.18517\/ijaseit.6.6.1480","volume":"6","author":"Jufriadif Na`am","year":"2016","unstructured":"Na\u2019am, J., Harlan, J., Madenda, S. & Wibowo, E. P. The Algorithm of Image Edge Detection on Panoramic Dental X-Ray using Multiple Morphological Gradient (mMG) Method. International Journal on Advanced Science, Engineering and Information Technology, https:\/\/doi.org\/10.18517\/ijaseit.6.6.1480 (2016).","journal-title":"International Journal on Advanced Science, Engineering and Information Technology"},{"key":"45487_CR28","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1016\/j.procs.2015.09.016","volume":"65","author":"Yusra Y. Amer","year":"2015","unstructured":"Amer, Y. Y. & Aqel, M. J. An Efficient Segmentation Algorithm for Panoramic Dental Images. In Procedia Computer Science, https:\/\/doi.org\/10.1016\/j.procs.2015.09.016 (2015).","journal-title":"Procedia Computer Science"},{"key":"45487_CR29","doi-asserted-by":"publisher","unstructured":"Arbelaez, P. et al. Semantic segmentation using regions and parts. In Proceedings of the IEEE Computer Society Conference on Computer Vision and Pattern Recognition, https:\/\/doi.org\/10.1109\/CVPR.2012.6248077 (2012).","DOI":"10.1109\/CVPR.2012.6248077"},{"issue":"2","key":"45487_CR30","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1023\/B:VISI.0000029664.99615.94","volume":"60","author":"David G. Lowe","year":"2004","unstructured":"D. G., L. Distinctive Image Features from. International Journal of Computer Vision, https:\/\/doi.org\/10.1023\/B:VISI.0000029664.99615.94 (2004).","journal-title":"International Journal of Computer Vision"},{"issue":"3","key":"45487_CR31","doi-asserted-by":"publisher","first-page":"297","DOI":"10.2307\/1932409","volume":"26","author":"Lee R. Dice","year":"1945","unstructured":"Dice, L. R. Measures of the Amount of Ecologic Association Between Species. Ecology, https:\/\/doi.org\/10.2307\/1932409 (1945).","journal-title":"Ecology"},{"key":"45487_CR32","doi-asserted-by":"publisher","unstructured":"Taha, A. A. & Hanbury, A. Metrics for evaluating 3D medical image segmentation: Analysis, selection, and tool. BMC Medical Imaging, https:\/\/doi.org\/10.1186\/s12880-015-0068-x (2015).","DOI":"10.1186\/s12880-015-0068-x"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-019-45487-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-019-45487-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-019-45487-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,17]],"date-time":"2022-12-17T10:44:38Z","timestamp":1671273878000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-019-45487-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,21]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,12]]}},"alternative-id":["45487"],"URL":"https:\/\/doi.org\/10.1038\/s41598-019-45487-3","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,21]]},"assertion":[{"value":"11 December 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 May 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 June 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}],"article-number":"9007"}}