{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T18:40:55Z","timestamp":1786732855931,"version":"build-2736575974"},"reference-count":23,"publisher":"Oxford University Press (OUP)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the sensitivity of 2 dental artificial intelligence (AI) systems for detecting dentinal caries using longitudinal, outcomes-anchored validation within an integrated healthcare system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this pilot external validation study, 2 commercially available AI systems were tested on full-mouth intraoral radiographic series, including bitewings, from 90 patients in a federal healthcare system. Ground truth was established using baseline clinical examinations and follow-up documentation 6-12\u2009months later. Vendor-specific and pooled sensitivity for dentinal caries detection were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Vendor A achieved a sensitivity of 48.5% (95% CI: 37.0-60.2), Vendor B achieved 57.5% (95% CI: 46.1-68.2), and pooled sensitivity was 53.0% (95% CI: 44.8-61.1).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Outcomes-anchored, longitudinal validation of dental AI systems for dentinal caries detection was feasible within a large integrated healthcare system. This approach provides clinically relevant sensitivity estimates grounded in real treatment outcomes. These findings are most directly applicable to large integrated healthcare systems with standardized longitudinal data capture and may not fully reflect the variability of private-practice dental settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Advances in knowledge<\/jats:title>\n                    <jats:p>This study establishes a reproducible framework for evaluating AI diagnostic performance in real-world healthcare settings using longitudinal clinical outcomes rather than radiographic labels alone, demonstrating that independent validation with clinical follow-up is feasible within a large healthcare system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/dmfr\/twag054","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T05:17:58Z","timestamp":1785129478000},"source":"Crossref","is-referenced-by-count":0,"title":["External validation of 2 artificial intelligence systems for dentinal caries detection: a retrospective pilot clinical outcomes study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2501-1855","authenticated-orcid":false,"given":"Owais A","family":"Farooqi","sequence":"first","affiliation":[{"name":"VA Greater Los Angeles Healthcare System Dental Service, , Los Angeles, CA 90073,","place":["United States"]},{"name":"Section of Public and Population Health, UCLA School of Dentistry , Los Angeles, CA, 90095,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilbert A","family":"Fru","sequence":"additional","affiliation":[{"name":"VA Greater Los Angeles Healthcare System Dental Service, , Los Angeles, CA 90073,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan Ming","family":"Gong","sequence":"additional","affiliation":[{"name":"VA Greater Los Angeles Healthcare System Dental Service, , Los Angeles, CA 90073,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Landon E","family":"Oswald","sequence":"additional","affiliation":[{"name":"VA Greater Los Angeles Healthcare System Dental Service, , Los Angeles, CA 90073,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7496-8040","authenticated-orcid":false,"given":"Donald J","family":"DeNucci","sequence":"additional","affiliation":[{"name":"VA Greater Los Angeles Healthcare System Dental Service, , Los Angeles, CA 90073,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"key":"2026081414170453700_twag054-B1","author":"World Health Organization","year":"2025"},{"key":"2026081414170453700_twag054-B2","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1016\/j.jdsr.2024.02.001","article-title":"Diagnostic performance of artificial intelligence-aided caries detection on bitewing radiographs: a systematic review and meta-analysis","volume":"60","author":"Ammar","year":"2024","journal-title":"Jpn Dent Sci Rev"},{"key":"2026081414170453700_twag054-B3","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1177\/0022034520915714","article-title":"Artificial intelligence in dentistry: chances and challenges","volume":"99","author":"Schwendicke","year":"2020","journal-title":"J Dent Res"},{"key":"2026081414170453700_twag054-B4","doi-asserted-by":"publisher","first-page":"8495","DOI":"10.1038\/s41598-019-44839-3","article-title":"Deep learning for the radiographic detection of periodontal bone loss","volume":"9","author":"Krois","year":"2019","journal-title":"Sci Rep"},{"key":"2026081414170453700_twag054-B5","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1016\/j.joen.2019.03.016","article-title":"Deep learning for the radiographic detection of apical lesions","volume":"45","author":"Ekert","year":"2019","journal-title":"J Endod"},{"key":"2026081414170453700_twag054-B6","doi-asserted-by":"publisher","first-page":"937","DOI":"10.3390\/jcm12030937","article-title":"Machine learning in dentistry: a scoping review","volume":"12","author":"Arsiwala-Scheppach","year":"2023","journal-title":"J Clin Med"},{"key":"2026081414170453700_twag054-B7","doi-asserted-by":"publisher","first-page":"103849","DOI":"10.1016\/j.jdent.2021.103849","article-title":"Artificial intelligence for caries detection: randomized trial","volume":"115","author":"Mertens","year":"2021","journal-title":"J Dent"},{"key":"2026081414170453700_twag054-B8","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1007\/s13755-019-0096-y","article-title":"Dental caries diagnosis in digital radiographs using back-propagation neural network","volume":"8","author":"Geetha","year":"2020","journal-title":"Health Inf Sci Syst"},{"key":"2026081414170453700_twag054-B9","doi-asserted-by":"publisher","first-page":"e18593","DOI":"10.7717\/peerj.18593","article-title":"The application of deep learning in early enamel demineralization detection","volume":"13","author":"He","year":"2025","journal-title":"PeerJ"},{"key":"2026081414170453700_twag054-B10","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1186\/s12903-025-05803-y","article-title":"A novel deep learning-based model for automated tooth detection and numbering in mixed and permanent dentition in occlusal photographs","volume":"25","author":"Ghorbani","year":"2025","journal-title":"BMC Oral Health"},{"key":"2026081414170453700_twag054-B11","doi-asserted-by":"publisher","first-page":"2281","DOI":"10.3390\/diagnostics14202281","article-title":"Caries detection and classification in photographs using an artificial intelligence-based model\u2014an external validation study","volume":"14","author":"Frenkel","year":"2024","journal-title":"Diagnostics (Basel)"},{"key":"2026081414170453700_twag054-B12","doi-asserted-by":"publisher","first-page":"105228","DOI":"10.1016\/j.jdent.2024.105228","article-title":"External validation of an artificial intelligence-based method for the detection and classification of molar incisor hypomineralisation in dental photographs","volume":"148","author":"Neumayr","year":"2024","journal-title":"J Dent"},{"key":"2026081414170453700_twag054-B13","doi-asserted-by":"publisher","first-page":"1970","DOI":"10.1016\/j.identj.2025.01.008","article-title":"External validation of an AI mHealth tool for gingivitis detection among older adults at daycare centers: a pilot study","volume":"75","author":"Chau","year":"2025","journal-title":"Int Dent J"},{"key":"2026081414170453700_twag054-B14","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1002\/j.0022-0337.2001.65.10.tb03470.x","article-title":"Systematic reviews of selected dental caries diagnostic and management methods","volume":"65","author":"Bader","year":"2001","journal-title":"J Dent Educ"},{"key":"2026081414170453700_twag054-B15","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1177\/0022034515586763","article-title":"Visual inspection for caries detection: a systematic review and meta-analysis","volume":"94","author":"Gimenez","year":"2015","journal-title":"J Dent Res"},{"key":"2026081414170453700_twag054-B16","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1016\/j.adaj.2025.11.005","article-title":"Evaluation of artificial intelligence-based clinical decision support systems for caries and periodontal bone loss: An external validation study","volume":"157","author":"Farooqi","year":"2026","journal-title":"J Am Dent Assoc"},{"key":"2026081414170453700_twag054-B17","author":"American Dental Association","year":"2025"},{"key":"2026081414170453700_twag054-B18","doi-asserted-by":"publisher","DOI":"10.3389\/frhs.2023.1187306","volume-title":"Front Health Serv.","author":"Arnaout A, Oseguera-Arasmou M, Mishra N, Liu BM, Bhattacharya A, Rhew DC","year":"2023"},{"key":"2026081414170453700_twag054-B19","author":"American Dental Association","year":"2023"},{"key":"2026081414170453700_twag054-B20","doi-asserted-by":"publisher","first-page":"1474692","DOI":"10.3389\/fdgth.2024.1474692","article-title":"Establishing trust in artificial intelligence-driven autonomous healthcare systems: an expert-guided framework","volume":"6","author":"Alelyani","year":"2024","journal-title":"Front Digit Health"},{"key":"2026081414170453700_twag054-B21","author":"World Health Organization","year":"2025"},{"key":"2026081414170453700_twag054-B22","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1177\/0022034515573272","article-title":"Global burden of untreated caries: a systematic review and metaregression","volume":"94","author":"Kassebaum","year":"2015","journal-title":"J Dent Res"},{"key":"2026081414170453700_twag054-B23","doi-asserted-by":"publisher","first-page":"e10714","DOI":"10.1016\/j.heliyon.2022.e10714","article-title":"Changes in the global burden of untreated dental caries from 1990 to 2019: a systematic analysis for the Global Burden of Disease study","volume":"8","author":"Qin","year":"2022","journal-title":"Heliyon"}],"container-title":["Dentomaxillofacial Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/dmfr\/advance-article-pdf\/doi\/10.1093\/dmfr\/twag054\/70143851\/twag054.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/dmfr\/advance-article-pdf\/doi\/10.1093\/dmfr\/twag054\/70143851\/twag054.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T18:19:51Z","timestamp":1786731591000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/dmfr\/advance-article\/doi\/10.1093\/dmfr\/twag054\/8742149"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,25]]},"references-count":23,"URL":"https:\/\/doi.org\/10.1093\/dmfr\/twag054","relation":{},"ISSN":["0250-832X","1476-542X"],"issn-type":[{"value":"0250-832X","type":"print"},{"value":"1476-542X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,25]]},"article-number":"twag054"}}