Artificial intelligence for binary dental caries diagnosis using intraoral images and dental radiographs: a...

Artificial intelligence (AI) has shown increasing potential in dental diagnostics, yet its accuracy for binary classification of dental caries across different imaging modalities remains unclear. This study aimed to systematically evaluate the diagnostic performance of AI models using clinical intraoral images and dental radiographs.

Following the PRISMA-DTA guidelines, PubMed, Embase, Scopus, Web of Science, and IEEE Xplore were systematically searched for studies published between January 2015 and June 2025. Eligible studies applied AI models for caries diagnosis with extractable sensitivity and specificity. Data on dentition, dataset, analysis unit, caries prevalence in test dataset, and preprocessing methods were extracted. Reporting quality and risk of bias were assessed using CLAIM and QUADAS-2. Pooled estimates were calculated with a bivariate random-effects model, with subgroup analyses by image type and analytical unit.

25 studies met the criteria, and 13 were included in the meta-analysis. Pooled sensitivity, specificity, and the area under the curve (AUC) were 0.86, 0.91 and 0.94, respectively. Intraoral image-based models achieved higher sensitivity (0.88) and AUC (0.95), while radiograph-based models showed higher specificity (0.92). Tooth-level analyses yielded stable, clinically relevant performance (0.87/0.91). High heterogeneity (I² > 90%) was partly explained by image type, model architecture, reference standard variation, and test set caries prevalence.

AI models showed good diagnostic accuracy for caries detection across imaging modalities and analytical units. However, given the substantial heterogeneity and limitations in study quality and reference standards, these summary estimates should be interpreted with caution. AI-based systems may serve as complementary decision-support tools in clinical practice, but further standardization, external validation, and high-quality multicenter studies are required before broad clinical implementation.