Synthetic Orthopantomography Image Generation Using Generative Adversarial Networks for Data Augmentation

Objective: To overcome the scarcity of annotated dental X-ray datasets, this study presents a novel pipeline for generating high-resolution synthetic orthopantomography (OPG) images using customized generative adversarial networks (GANs). Methods: A total of 4777 real OPG images were collected from clinical centres in Pakistan, Thailand, and the U.S., covering diverse anatomical features. Twelve GAN models were initially trained, with four top-performing variants selected for further training on both combined and region-specific datasets. Synthetic images were generated at 2048 × 1024 pixels, maintaining fine anatomical detail. The evaluation was conducted using (1) a YOLO-based object detection model trained on real OPGs to assess feature representation via mean average precision, and (2) expert dentist scoring for anatomical and diagnostic realism. Results: All selected models produced realistic synthetic OPGs. The YOLO detector achieved strong performance on these images, indicating accurate structural representation. Expert evaluations confirmed high anatomical plausibility, with models M1 and M3 achieving over 50% of the reference scores assigned to real OPGs. Conclusion: The developed GAN-based pipeline enables the ethical and scalable creation of synthetic OPG images, suitable for augmenting datasets used in artificial intelligence-driven dental diagnostics. Clinical Significance: This method provides a practical solution to data limitations in dental artificial intelligence, supporting model development in privacy-sensitive or low-resource environments.