{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T14:19:59Z","timestamp":1788185999214,"version":"build-2803163510"},"reference-count":45,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T00:00:00Z","timestamp":1778371200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T00:00:00Z","timestamp":1778371200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT, South Korea","doi-asserted-by":"publisher","award":["RS\u20102023\u201000251473"],"award-info":[{"award-number":["RS\u20102023\u201000251473"]}],"id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT, South Korea","doi-asserted-by":"publisher","award":["RS\u20102024\u201000455720"],"award-info":[{"award-number":["RS\u20102024\u201000455720"]}],"id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003653","name":"Korea National Institute of Health","doi-asserted-by":"publisher","award":["2024ER040700"],"award-info":[{"award-number":["2024ER040700"]}],"id":[{"id":"10.13039\/501100003653","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003653","name":"Korea National Institute of Health","doi-asserted-by":"publisher","award":["2025ER040300"],"award-info":[{"award-number":["2025ER040300"]}],"id":[{"id":"10.13039\/501100003653","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003653","name":"Korea National Institute of Health","doi-asserted-by":"publisher","award":["2026ER090400"],"award-info":[{"award-number":["2026ER090400"]}],"id":[{"id":"10.13039\/501100003653","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100021520","name":"National Supercomputing Center, Korea Institute of Science and Technology Information","doi-asserted-by":"publisher","award":["KSC\u20102024\u2010CRE\u20100021"],"award-info":[{"award-number":["KSC\u20102024\u2010CRE\u20100021"]}],"id":[{"id":"10.13039\/501100021520","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100021520","name":"National Supercomputing Center, Korea Institute of Science and Technology Information","doi-asserted-by":"publisher","award":["KSC\u20102025\u2010CRE\u20100065"],"award-info":[{"award-number":["KSC\u20102025\u2010CRE\u20100065"]}],"id":[{"id":"10.13039\/501100021520","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002486","name":"Hankuk University of Foreign Studies","doi-asserted-by":"publisher","award":["2025"],"award-info":[{"award-number":["2025"]}],"id":[{"id":"10.13039\/501100002486","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Endodontic J"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Apical periodontitis (AP) diagnosis primarily relies on periapical radiographs (PRs) and the Periapical Index (PAI) scoring system. However, existing automated approaches often simplify PAI into binary categories or ignore essential clinical metadata, limiting diagnostic performance and applicability. Such limitations hinder timely and accurate diagnosis of AP, which may complicate treatment planning by creating uncertainty about the appropriate timing and type of intervention, and ultimately challenge clinicians' ability to make consistent and informed decisions. This study aimed to develop and validate a novel Mamba\u2010based classification model that integrates PR with structured clinical metadata to predict detailed PAI scores across the full 5\u2010class.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>In this retrospective diagnostic accuracy study, PRs and corresponding metadata\u2014including patient age, tooth location, tooth number and arch type\u2014were collected from a single institution. Two expert endodontists independently assigned PAI scores (1\u20135) based on \u00d8rstavik's criteria, with the final reference standard set by consensus. The proposed artificial intelligence (AI) model utilized a Mamba\u2010based state\u2010space architecture to capture spatial dependencies and incorporate structured clinical metadata features. Training and evaluation were conducted using stratified 5\u2010fold cross\u2010validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The model achieved 54.72% accuracy and a quadratic\u2010weighted kappa (QWK) of 0.713 in 5\u2010class classification, outperforming the latest models based on convolutional neural networks (CNNs) and object detection networks. Ablation analysis further supported the value of integrating patient information, showing that age was the largest impact on model performance. Gradient\u2010weighted Class Activation Mapping (Grad\u2010CAM) analysis for model explainability demonstrated that the model's highlighted areas were aligned with clinically meaningful periapical regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The proposed model addresses limitations of prior methods by leveraging the full range of the PAI scores and incorporating structured clinical information. It has the potential to support more consistent radiographic interpretation, reduce inter\u2010examiner variability and serve as an interpretable tool in educational and clinical decision\u2010support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iej.70170","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T05:19:01Z","timestamp":1778476741000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Mamba\u2010Based Deep Learning Model for Automated Periapical Index Classification Using Periapical Radiographs and Clinical Metadata"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4297-3297","authenticated-orcid":false,"given":"Jiyun","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Computer Science and Engineering Hankuk University of Foreign Studies  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7748-2057","authenticated-orcid":false,"given":"Yudam","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry and Oral Science Research Center Microscope Center, Yonsei University College of Dentistry  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8889-9844","authenticated-orcid":false,"given":"Sunil","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry and Oral Science Research Center Microscope Center, Yonsei University College of Dentistry  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6901-983X","authenticated-orcid":false,"given":"Ikbeom","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Computer Science and Engineering Hankuk University of Foreign Studies  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,10]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1601-1546.2004.00098.x"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2021.06.003"},{"key":"e_1_2_12_4_1","article-title":"Two\u2010Dimensional Periapical, Panoramic Radiography Versus Three Dimensional Conebeam Computed Tomography in the Detection of Periapical Lesion After Endodontic Treatment: A Systematic Review","volume":"12","author":"Antony D. 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B.Liao Q.Zhang X.Wang W.Liu andX.Wang.2024.\u201cVision Mamba: Efficient Visual Representation Learning With Bidirectional State Space Model.\u201darXiv Preprint arXiv:2401.09417.https:\/\/arxiv.org\/abs\/2401.09417."}],"container-title":["International Endodontic Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iej.70170","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/iej.70170","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iej.70170","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T05:19:14Z","timestamp":1778908754000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/iej.70170"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,10]]},"references-count":45,"alternative-id":["10.1111\/iej.70170"],"URL":"https:\/\/doi.org\/10.1111\/iej.70170","archive":["Portico"],"relation":{},"ISSN":["0143-2885","1365-2591"],"issn-type":[{"value":"0143-2885","type":"print"},{"value":"1365-2591","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,10]]},"assertion":[{"value":"2025-09-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"iej.70170"}}