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Comparative Study
. 2025 May:156:105668.
doi: 10.1016/j.jdent.2025.105668. Epub 2025 Mar 8.

Assessment of CNNs, transformers, and hybrid architectures in dental image segmentation

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Free article
Comparative Study

Assessment of CNNs, transformers, and hybrid architectures in dental image segmentation

Lisa Schneider et al. J Dent. 2025 May.
Free article

Abstract

Objectives: Convolutional Neural Networks (CNNs) have long dominated image analysis in dentistry, reaching remarkable results in a range of different tasks. However, Transformer-based architectures, originally proposed for Natural Language Processing, are also promising for dental image analysis. The present study aimed to compare CNNs with Transformers for different image analysis tasks in dentistry.

Methods: Two CNNs (U-Net, DeepLabV3+), two Hybrids (SwinUNETR, UNETR) and two Transformer-based architectures (TransDeepLab, SwinUnet) were compared on three dental segmentation tasks on different image modalities. Datasets consisted of (1) 1881 panoramic radiographs used for tooth segmentation, (2) 1625 bitewings used for tooth structure segmentation, and (3) 2689 bitewings for caries lesions segmentation. All models were trained and evaluated using 5-fold cross-validation.

Results: CNNs were found to be significantly superior over Hybrids and Transformer-based architectures for all three tasks. (1) Tooth segmentation showed mean±SD F1-Score of 0.89±0.009 for CNNs, 0.86±0.015 for Hybrids and 0.83±0.22 for Transformer-based architectures. (2) In tooth structure segmentation CNNs also outperformed with 0.85±0.008 compared to Hybrids 0.84±0.005 and Transformers 0.83±0.011. (3) Even more pronounced results were found for caries lesions segmentation; 0.49±0.031 for CNNs, 0.39±0.072 for Hybrids and 0.32±0.039 for Transformer-based architectures.

Conclusion: CNNs significantly outperformed Transformer-based architectures and their Hybrids on three segmentation tasks (teeth, tooth structures, caries lesions) on varying dental data modalities (panoramic and bitewing radiographs).

Clinical significance: As deep-learning-based image analysis is part of modern dentistry, practitioners and dental researchers should be aware of strength and limitations of modern model architectures for dental-image analysis. Models that demonstrate optimal performance in other domains do not necessarily constitute the optimal selection for the purpose of dental imaging.

Keywords: Artificial intelligence; Computer vision; Deep learning.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Falk Schwendicke is co-founder of the startup dentalXrai GmbH. dentalXrai GmbH did not have any role in conceiving, conducting or reporting this study. The authors are solely responsible for the contents of this paper. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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