Artificial Intelligence-Assisted Detection of Canine Impaction, Localization, and Classification from Panoramic...

Background/Objectives: This study aimed to develop and evaluate deep learning models for the detection, localization, and classification of impacted maxillary canines, and to compare their performance with cone-beam computed tomography (CBCT) as the reference standard. Methods: This cross-sectional diagnostic accuracy study was conducted at King Abdulaziz University Dental Hospital to develop and validate artificial intelligence (AI) models for detecting and localizing maxillary canine impactions using panoramic and cone-beam computed tomography (CBCT) imaging data. A total of 641 panoramic ra and 158 CBCT scans were collected, of which 158 cases had matched panoramic-CBCT pairs for localization analysis. Images were annotated and validated by expert radiologists and orthodontists, with consensus review ensuring labeling reliability. Data augmentation expanded each panoramic and CBCT category to 500 samples for panoramic and 1000 samples for CBCT, resulting in 1935 panoramic and 5703 CBCT images after preprocessing and normalization. The datasets were divided into (training + validation) (80%) and testing (20%) subsets. MobileNetV2 architectures were used for classification, and whdiographsile, a ResNet-50-based Few-Shot Learning framework, enabled spatial localization of impacted canines. Models were trained using the Adam optimizer with a learning rate of 1 × 10^-4 and evaluated using accuracy, precision, recall, F1 score, and area under the receiver operating characteristic curve (AUC). Cohen's kappa and 95% confidence intervals were used to assess agreement between AI predictions and expert annotations. Results: Panoramic classification achieved 94% accuracy, demonstrating the highest performance in normal cases and reduced recall for bilateral impactions. The CBCT classifier achieved 98% accuracy across positional categories. Cross-modality prediction reached 93.5% accuracy, with strong agreement compared to CBCT (Cohen's kappa = 0.91). Expert review confirmed reliable localization of impacted canines on both imaging modalities. Conclusions: Artificial intelligence applied to panoramic radiographs supports the detection, localization, and characterization of impacted maxillary canines with performance comparable to CBCT. This approach may enable lower-radiation decision support for clinical triage.