Performance Validation of ORTHOSEG, a Novel Artificial Intelligence Tool for the Segmentation of Orthopantomographs and Intra-Oral X-Rays

Background: Dental radiographs are essential for diagnosis and treatment planning in modern dentistry. However, their manual interpretation is time-consuming and subject to variability, highlighting the need for automated tools to improve efficiency and consistency. This study aims to validate ORTHOSEG, a deep learning-based system designed to automate the segmentation of anatomical, pathological, and non-pathological elements in radiographs, including orthopantomograms, bitewings, and periapical images. Methods: ORTHOSEG’s performance was evaluated using a rigorously curated dataset of 150 dental radiographs, including 50 orthopantomograms, 50 bitewings, and 50 periapical images, with manual annotations by expert clinicians serving as the ground truth. The system’s segmentation performance was assessed using standard evaluation metrics, including mean Dice Similarity Coefficient (<i>mDSC</i>) and mean Intersection over Union (<i>mIoU</i>), and inference time was also recorded. Results: The system achieved high accuracy, with <i>mDSC</i> and <i>mIoU</i> values of 0.635 ± 0.233 and 0.576 ± 0.214, respectively. In particular for orthopantomograms, it achieved an <i>mDSC</i> of 0.756 ± 0.174 and an <i>mIoU</i> of 0.684 ± 0.172, surpassing existing benchmarks. Its segmentation capabilities extend to approximately 70 distinct elements, underscoring its comprehensive utility. The system demonstrated efficient computational performance, with processing times of 19.745 ± 3.625 s for orthopantomograms, 8.467 ± 0.903 s for bitewings, and 5.653 ± 0.897 s for periapical radiographs on standard clinical hardware. Conclusions: ORTHOSEG demonstrates efficiency suitable for integration into routine workflows. This study confirms ORTHOSEG’s reliability and potential to improve diagnostic workflows, offering clinicians a valuable tool for faster and more detailed radiograph analysis. Future research will focus on extending validation across diverse clinical scenarios to ensure broader applicability. However, this study has limitations, including the use of a dataset derived from a European population and the absence of usability and clinical workflow evaluation, which should be addressed in future studies.