CC BY 4.0 · Eur J Dent
DOI: 10.1055/s-0043-1764425
Original Article

Developing an Artificial Intelligence Solution to Autosegment the Edentulous Mandibular Bone for Implant Planning

1   Department of Preventive and Restorative Dentistry, University of Sharjah, United Arab Emirates
Nuha Trabulsi
1   Department of Preventive and Restorative Dentistry, University of Sharjah, United Arab Emirates
Marah Ghousheh
1   Department of Preventive and Restorative Dentistry, University of Sharjah, United Arab Emirates
Tala Fattal
1   Department of Preventive and Restorative Dentistry, University of Sharjah, United Arab Emirates
Ali Ashira
1   Department of Preventive and Restorative Dentistry, University of Sharjah, United Arab Emirates
2   Brunel University London, United Kingdom
› Author Affiliations


Objective Dental implants are considered the optimum solution to replace missing teeth and restore the mouth's function and aesthetics. Surgical planning of the implant position is critical to avoid damage to vital anatomical structures; however, the manual measurement of the edentulous (toothless) bone on cone beam computed tomography (CBCT) images is time-consuming and is subject to human error. An automated process has the potential to reduce human errors and save time and costs. This study developed an artificial intelligence (AI) solution to identify and delineate edentulous alveolar bone on CBCT images before implant placement.

Materials and Methods After obtaining the ethical approval, CBCT images were extracted from the database of the University Dental Hospital Sharjah based on predefined selection criteria. Manual segmentation of the edentulous span was done by three operators using ITK-SNAP software. A supervised machine learning approach was undertaken to develop a segmentation model on a “U-Net” convolutional neural network (CNN) in the Medical Open Network for Artificial Intelligence (MONAI) framework. Out of the 43 labeled cases, 33 were utilized to train the model, and 10 were used for testing the model's performance.

Statistical Analysis The degree of 3D spatial overlap between the segmentation made by human investigators and the model's segmentation was measured by the dice similarity coefficient (DSC).

Results The sample consisted mainly of lower molars and premolars. DSC yielded an average value of 0.89 for training and 0.78 for testing. Unilateral edentulous areas, comprising 75% of the sample, resulted in a better DSC (0.91) than bilateral cases (0.73).

Conclusion Segmentation of the edentulous spans on CBCT images was successfully conducted by machine learning with good accuracy compared to manual segmentation. Unlike traditional AI object detection models that identify objects present in the image, this model identifies missing objects. Finally, challenges in data collection and labeling are discussed, together with an outlook at the prospective stages of a larger project for a complete AI solution for automated implant planning.

Publication History

Article published online:
12 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

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