Automated Detection of Periodontal Bone Loss in Two-Dimensional (2D) Radiographs Using Artificial Intelligence: A Systematic Review.

Artificial intelligence is an emerging tool that is being used in multiple fields, including dentistry. An example of this is the diagnosis of periodontal bone loss by analyzing two-dimensional (2D) radiographs (periapical, bitewing, and panoramic). Objectives: The objectives of this systematic review are to bring together the existing evidence and evaluate the effectiveness of the different artificial intelligence architectures that have been used in recent studies. Materials and Methods: This work has been carried out following the PRISMA criteria and has been recorded in PROSPERO (ID = CRD 42025640049). We searched six different databases, and the results were filtered according to previously established inclusion and exclusion criteria. We extracted data independently by three review authors and analyzed the risk of bias of the studies using the QUADAS-2 test, calculating Cohen's kappa index (κ) to measure the agreement between assessors. Results: We included 20 diagnostic accuracy studies according to the inclusion and exclusion criteria, published between 2019 and 2024. All included studies described the detection of periodontal bone loss on radiographs. Limitations: One of the main limitations identified was heterogeneity in the indices used to assess the accuracy of models, which made it difficult to compare results between studies. In addition, many works use different imaging protocols and X-ray equipment, introducing variability into the data and limiting reproducibility. Conclusions: Artificial intelligence is a promising technique for the automated detection of periodontal bone loss, allowing the accurate measurement of bone loss, identifying lesions such as apical periodontitis and stage periodontitis, in addition to reducing diagnostic errors associated with fatigue or inexperience. However, improvements are still required to optimize its accuracy and clinical applicability.