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AI-generated diagnoses at the tooth-pair level were compared with a reference standard based on a modified Little\u2019s Irregularity Index (mLII) that incorporates signed contact-point displacement. Diagnostic performance \u2014 sensitivity, specificity, positive and negative predictive values, and Cohen\u2019s \u03ba \u2014 was assessed at the tooth-pair level (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009875) across five thresholds (\u00b1\u20090.5 to \u00b1\u20092.5\u00a0mm). Arch-level performance was assessed using the conventional Little\u2019s Irregularity Index (LII). Statistical significance was set at \u03b1\u2009=\u20090.05, and all estimates are reported with 95% confidence intervals.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At the tooth-pair level, sensitivity for crowding ranged from 28.8% to 42.0%, whereas specificity remained high (81.9\u201388.9%). Agreement with the reference standard was fair (maximum \u03ba\u2009=\u20090.247). A consistent blind spot was identified at the maxillary central-incisor pair (11\u201321), where no crowded cases were detected despite confirmed irregularities. Spacing detection was poor (sensitivity 10\u201325%). At the arch level, detection improved with increasing severity of irregularity (38.8\u201375.0%) but remained incomplete and was accompanied by a high false-positive rate (41.2% in perfectly aligned arches).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The AI system showed limited sensitivity and only fair agreement for detecting anterior crowding and spacing on CBCT. Clinically relevant irregularities, including those at the anterior midline, may be missed. Because crowding and spacing are most reliably assessed from clinical examination and intraoral records rather than from CBCT, AI-based CBCT assessments should be interpreted with caution and cannot replace clinician evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12903-026-09405-0","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T11:57:12Z","timestamp":1784980632000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Accuracy of artificial intelligence-based detection of dental crowding and spacing on cone-beam computed tomography"],"prefix":"10.1186","volume":"26","author":[{"given":"Natalia","family":"Kazimierczak","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0141ukasz","family":"Wanczura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Kulczyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Jankowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnieszka","family":"Jankowska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Zieli\u0144ska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Czarnecka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ma\u0142gorzata","family":"Dittrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiktoria","family":"Biega\u0142a","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zbigniew","family":"Serafin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Kazimierczak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"issue":"4","key":"9405_CR1","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1016\/j.ajodo.2012.04.018","volume":"142","author":"HS Hafez","year":"2012","unstructured":"Hafez HS, Shaarawy SM, Al-Sakiti AA, Mostafa YA. 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The requirement for written informed consent was waived by the Bioethics Committee, given the retrospective design and the full anonymisation of all imaging data. All DICOM datasets were de-identified using a standardised anonymisation protocol before analysis. The patients had undergone the CBCT examinations as part of routine clinical care, before this research was conceived.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"2074"}}