Patient-Level, Leakage-Aware Deep Learning for Cross-Center Periapical Radiograph Classification

RESUMO

Dental caries and endodontic disease are among the most common health conditions worldwide, and intraoral periapical radiographs are central to their detection, treatment planning, and follow-up. Automated tooth-level classification of these images, however, lacks reproducible benchmarks, is often evaluated with image-level splits that leak patients between training and test, and is rarely validated across clinics. This paper presents the first patient-level, leakage-aware classification benchmark for single-tooth intraoral periapical radiographs on the DentIRO dataset, which comprises 5,300 images from 3,243 patients across two clinics and four classes: Healthy, Caries, Crowned, and Root Canal. Five transfer-learning models are compared with patient-grouped stratified cross-validation, so that every patient remains within a single fold. DenseNet121 gave the strongest and most stable result at a mean macro-F1 of 0.9787, while the four ImageNet-initialized backbones performed comparably. A controlled comparison on a fixed architecture showed that chest-radiograph pretraining transferred less effectively than ImageNet initialization. Bidirectional cross-center validation produced a small average generalization gap of 0.0077, and Grad-CAM confirmed that predictions rely on clinically meaningful tooth regions rather than acquisition artifacts. The benchmark offers a rigorous and reproducible baseline for intraoral radiograph classification.