Evaluation of Artificial Intelligence Models for Periodontitis Diagnosis and Gingival Inflammation Monitoring at Tooth and Patient Levels: A Diagnostic Accuracy Study

Inclusion Criteria

Inclusion Criteria: 1. Patients aged \> 18 years at the time of their clinical periodontal examination. 2. Availability of complete full-mouth periodontal charting records, which must include Probing Depth (PD) and Bleeding on Probing (BOP) documented at 6 sites per tooth. 3. Availability of a digital panoramic radiograph of acceptable diagnostic quality, taken within one months of the clinical periodontal examination. Exclusion Criteria: 1. Patients who are completely edentulous or those who have undergone full-arch dental implant rehabilitation (not applicable for natural teeth periodontitis staging). 2. Panoramic radiographs with severe image degradation, including major motion artifacts, severe positioning errors, or poor contrast/exposure that obscures the alveolar bone crest. 3. Presence of extensive metal artifacts or massive bilateral multiple fixed crowns/bridges that completely shadow the marginal bone level of interest. 4. Incomplete clinical electronic medical records or missing core diagnostic descriptors required to establish the clinical gold standard for periodontitis staging or gingival inflammation.