RESUMEN
INTRODUCTION: This study aimed to evaluate the use of deep convolutional neural network (DCNN) algorithms to detect clinical features and predict the three-year outcome of endodontic treatment on preoperative periapical radiographs. METHODS: A database of single-root premolars that received endodontic treatment or retreatment by endodontists with presence of three-year outcome was prepared (n = 598). We constructed a 17-layered DCNN with a self-attention layer (Periapical Radiograph Explanatory System with Self-Attention Network [PRESSAN-17]), and the model was trained, validated, and tested to 1) detect 7 clinical features, that is, full coverage restoration, presence of proximal teeth, coronal defect, root rest, canal visibility, previous root filling, and periapical radiolucency and 2) predict the three-year endodontic prognosis by analyzing preoperative periapical radiographs as an input. During the prognostication test, a conventional DCNN without a self-attention layer (residual neural network [RESNET]-18) was tested for comparison. Accuracy and area under the receiver-operating-characteristic curve were mainly evaluated for performance comparison. Gradient-weighted class activation mapping was used to visualize weighted heatmaps. RESULTS: PRESSAN-17 detected full coverage restoration (area under the receiver-operating-characteristic curve = 0.975), presence of proximal teeth (0.866), coronal defect (0.672), root rest (0.989), previous root filling (0.879), and periapical radiolucency (0.690) significantly, compared to the no-information rate (P < .05). Comparing the mean accuracy of 5-fold validation of 2 models, PRESSAN-17 (67.0%) showed a significant difference to RESNET-18 (63.4%, P < .05). Also, the area under average receiver-operating-characteristic of PRESSAN-17 was 0.638, which was significantly different compared to the no-information rate. Gradient-weighted class activation mapping demonstrated that PRESSAN-17 correctly identified clinical features. CONCLUSIONS: Deep convolutional neural networks can detect several clinical features in periapical radiographs accurately. Based on our findings, well-developed artificial intelligence can support clinical decisions related to endodontic treatments in dentists.