An End-to-end Entangled Segmentation and Classification Convolutional Neural Network for Periodontitis Stage Grading from Periapical Radiographic Images

Periodontitis is a biofilm-related chronic inflammatory disease characterized by gingivitis and bone loss in the teeth area. Approximately 61 million adults over 30 suffer from periodontitis (42.2%), with 7.8% having severe periodontitis in the United States. The measurement of radiographic bone loss (RBL) is necessary to make a correct periodontal diagnosis, especially if the comprehensive and longitudinal periodontal mapping is unavailable. However, doctors can interpret X-rays differently depending on their experience and knowledge. Computerized diagnosis support for doctors sheds light on making the diagnosis with high accuracy and consistency and drawing up an appropriate treatment plan for preventing or controlling periodontitis. We developed an end-to-end deep learning network HYNETS (Hybrid NETwork for pEriodoNTiTiS STagES from radiograpH) by integrating segmentation and classification tasks for grading periodontitis from periapical radiographic images. HYNETS leverages a multi-task learning strategy by combining a set of segmentation networks and a classification network to provide an end-to-end interpretable solution and highly accurate and consistent results. HYNETS achieved the average dice coefficient of 0.96 and 0.94 for the bone area and tooth segmentation and the average AUC of 0.97 for periodontitis stage assignment. Additionally, conventional image processing techniques provide RBL measurements and build transparency and trust in the model's prediction. HYNETS will potentially transform clinical diagnosis from a manual time-consuming, and error-prone task to an efficient and automated periodontitis stage assignment based on periapical radiographic images.

Use of the Deep Learning Approach to Measure Alveolar Bone Level

Abstract: Aim: The goal was to use a Deep Convolutional Neural Network to measure the radiographic alveolar bone level to aid periodontal diagnosis. Material and methods: A Deep Learning (DL) model was developed by integrating three segmentation networks (bone area, tooth, cementoenamel junction) and image analysis to measure the radiographic bone level and assign radiographic bone loss (RBL) stages. The percentage of RBL was calculated to determine the stage of RBL for each tooth. A provisional periodontal diagnosis was assigned using the 2018 periodontitis classification. RBL percentage, staging, and presumptive diagnosis were compared to the measurements and diagnoses made by the independent examiners. Results: The average Dice Similarity Coefficient (DSC) for segmentation was over 0.91. There was no significant difference in RBL percentage measurements determined by DL and examiners (p=0.65). The Area Under the Receiver Operating Characteristics Curve of RBL stage assignment for stage I, II and III was 0.89, 0.90 and 0.90, respectively. The accuracy of the case diagnosis was 0.85. Conclusion: The proposed DL model provides reliable RBL measurements and image-based periodontal diagnosis using periapical radiographic images. However, this model has to be further optimized and validated by a larger number of images to facilitate its application.