{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T23:51:55Z","timestamp":1794009115326,"version":"4.8.0"},"reference-count":40,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,7,12]],"date-time":"2025-07-12T00:00:00Z","timestamp":1752278400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Dent Res"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>Late detection of periodontitis has significant health implications. Screening via oral images may serve as an accessible nonclinical method. This study tested the hypothesis that diagnostic information in oral images can aid a deep learning algorithm in detecting periodontitis cases. This cross-sectional diagnostic accuracy study involved consecutive subjects seeking care at Shanghai Ninth People\u2019s Hospital, China, and their oral digital twins. The index test was a global activation pooling-based multi-instance deep learning model (DLM) based on pretrained ResNet50, developed and tested in 2 independent samples to identify stage II to IV periodontitis. The model did not use annotated landmarks on images but labeled cases based on a reference consisting of a periodontal clinical examination. The external testing dataset included oral images of subjects diagnosed based on panoramic radiographs. The performance was assessed by the area under the receiver-operating curve (AUROC), sensitivity, and specificity. A total of 387 subjects participated in the internal development and testing. The external testing dataset consisted of 183 subjects. DLM processing of a single frontal view oral image accurately identified stage II to IV periodontitis in the internal (AUROC\u2009=\u20090.93, 95% confidence interval [CI] 0.85\u20130.98) and external dataset (AUROC\u2009=\u20090.93, 95% CI 0.88\u20130.96). High consistency was observed between the regions of interest identified in the class activation heat maps and a periodontist (internal test: 99.66%; external test: 99.45%). DLM showed better sensitivity and specificity than clinicians with different skill levels. The multimodal combination of images and other nonclinical parameters led to only marginal improvements in accuracy. DLM processing of oral images shows potential for periodontal health screening. Artificial intelligence focuses on the important image areas but seems to capture features that are not apparent to clinicians. More development and validation are needed to introduce this approach as a screening tool to multiple populations worldwide.<\/jats:p>","DOI":"10.1177\/00220345251347508","type":"journal-article","created":{"date-parts":[[2025,7,12]],"date-time":"2025-07-12T08:23:56Z","timestamp":1752308636000},"page":"226-235","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":20,"title":["Deep Learning Photo Processing for Periodontitis Screening"],"prefix":"10.1177","volume":"105","author":[{"given":"L.-R.","family":"Tao","sequence":"first","affiliation":[{"name":"Shanghai Perio-Implant Innovation Center, Institute of Integrated Oral, Craniofacial and Sensory Research, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.","family":"Li","sequence":"additional","affiliation":[{"name":"Shanghai Perio-Implant Innovation Center, Institute of Integrated Oral, Craniofacial and Sensory Research, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"},{"name":"Department of Oral Implantology, Shanghai Ninth People\u2019s Hospital, and College of Stomatology, Shanghai Jiao Tong University, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1310-1452","authenticated-orcid":false,"given":"X.-Y.","family":"Wu","sequence":"additional","affiliation":[{"name":"Shanghai Perio-Implant Innovation Center, Institute of Integrated Oral, Craniofacial and Sensory Research, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"},{"name":"Department of Oral Implantology, Shanghai Ninth People\u2019s Hospital, and College of Stomatology, Shanghai Jiao Tong University, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.","family":"Gu","sequence":"additional","affiliation":[{"name":"Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.","family":"Xie","sequence":"additional","affiliation":[{"name":"Shanghai Perio-Implant Innovation Center, Institute of Integrated Oral, Craniofacial and Sensory Research, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"X.-Y.","family":"Yu","sequence":"additional","affiliation":[{"name":"Shanghai Perio-Implant Innovation Center, Institute of Integrated Oral, Craniofacial and Sensory Research, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.-C.","family":"Lai","sequence":"additional","affiliation":[{"name":"Shanghai Perio-Implant Innovation Center, Institute of Integrated Oral, Craniofacial and Sensory Research, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"},{"name":"Department of Oral Implantology, Shanghai Ninth People\u2019s Hospital, and College of Stomatology, Shanghai Jiao Tong University, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2743-0137","authenticated-orcid":false,"given":"M.S.","family":"Tonetti","sequence":"additional","affiliation":[{"name":"Shanghai Perio-Implant Innovation Center, Institute of Integrated Oral, Craniofacial and Sensory Research, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"},{"name":"Department of Oral Implantology, Shanghai Ninth People\u2019s Hospital, and College of Stomatology, Shanghai Jiao Tong University, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China"},{"name":"European Research Group on Periodontology, Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,7,12]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1975.46.12.748"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1214\/ss\/1009213286"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12899"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12940"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.identj.2023.03.007"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-012799"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-020-0282-y"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13485"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13484"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13856"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0004-3702(96)00034-3"},{"key":"e_1_3_2_13_1","volume-title":"Paper presented at: 9th International Conference on Learning Representations (ICLR)","author":"Dosovitskiy A","year":"2021","unstructured":"Dosovitskiy A, Beyer L, Kolesnikov A, Weissenborn D, Zhai X, Unterthiner T, Dehghani M, Minderer M, Heigold G, Gelly S, et al. 2021. An image is worth 16x16 words: transformers for image recognition at scale. Paper presented at: 9th International Conference on Learning Representations (ICLR); May 3\u20137, 2021; Virtual. Red Hook (NY): Curran Associates, Inc."},{"key":"e_1_3_2_14_1","doi-asserted-by":"crossref","unstructured":"Efron B Tibshirani R. 1993. An introduction to the bootstrap. London: Chapman and Hall.","DOI":"10.1007\/978-1-4899-4541-9"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034513505621"},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13630"},{"key":"e_1_3_2_17_1","doi-asserted-by":"publisher","DOI":"10.1109\/CVPR.2016.90"},{"key":"e_1_3_2_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.14152"},{"key":"e_1_3_2_19_1","doi-asserted-by":"publisher","DOI":"10.1109\/CVPR52688.2022.01819"},{"issue":"8","key":"e_1_3_2_20_1","first-page":"680","article-title":"Detection of tooth numbering, frenulum attachment, gingival overgrowth, and gingival inflammation signs on dental photographs using convolutional neural network algorithms: a retrospective study","volume":"54","author":"Kurt-Bayrakdar S","year":"2023","unstructured":"Kurt-Bayrakdar S, U\u011furlu M, Yavuz MB, Sali N, Bayrakdar \u0130\u015e, \u00c7elik \u00d6, K\u00f6se O, Beklen A, Uzun Saylan BC, Jagtap R, et al. 2023. Detection of tooth numbering, frenulum attachment, gingival overgrowth, and gingival inflammation signs on dental photographs using convolutional neural network algorithms: a retrospective study. Quintessence Int. 54(8):680\u2013693.","journal-title":"Quintessence Int"},{"key":"e_1_3_2_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-96091-3"},{"key":"e_1_3_2_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13987"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034515602879"},{"key":"e_1_3_2_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.media.2017.07.005"},{"key":"e_1_3_2_25_1","doi-asserted-by":"publisher","DOI":"10.1109\/CVPR.2017.713"},{"key":"e_1_3_2_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/jre.13337"},{"key":"e_1_3_2_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.17-0721"},{"key":"e_1_3_2_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdent.2021.103610"},{"key":"e_1_3_2_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13675"},{"key":"e_1_3_2_30_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-bioeng-071516-044442"},{"key":"e_1_3_2_31_1","doi-asserted-by":"publisher","DOI":"10.1177\/00220345241286488"},{"key":"e_1_3_2_32_1","doi-asserted-by":"publisher","DOI":"10.1109\/CVPR.2014.220"},{"key":"e_1_3_2_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.18-0006"},{"key":"e_1_3_2_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12732"},{"key":"e_1_3_2_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12939"},{"key":"e_1_3_2_36_1","doi-asserted-by":"publisher","DOI":"10.2196\/46143"},{"key":"e_1_3_2_37_1","doi-asserted-by":"publisher","DOI":"10.1109\/TCBB.2022.3168189"},{"key":"e_1_3_2_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.patcog.2017.08.026"},{"key":"e_1_3_2_39_1","doi-asserted-by":"publisher","DOI":"10.1109\/JBHI.2019.2939121"},{"key":"e_1_3_2_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.patter.2024.101028"},{"key":"e_1_3_2_41_1","doi-asserted-by":"publisher","DOI":"10.1109\/CVPR.2016.319"}],"container-title":["Journal of Dental Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00220345251347508","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00220345251347508","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00220345251347508","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T21:09:28Z","timestamp":1777496968000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00220345251347508"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,12]]},"references-count":40,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1177\/00220345251347508"],"URL":"https:\/\/doi.org\/10.1177\/00220345251347508","relation":{},"ISSN":["0022-0345","1544-0591"],"issn-type":[{"value":"0022-0345","type":"print"},{"value":"1544-0591","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,12]]}}}