Multimodal Language Model for Jaw Osteonecrosis Diagnosis and Treatment.

Journal: Journal of dental research
Published Date: Jun 24, 2025

Abstract

Owing to the complexity of the clinical manifestations in patients with osteonecrosis of the jaw (ONJ), particularly in settings lacking oral and maxillofacial surgery, timely and accurate treatment remains challenging. Here, we developed an integrated vision-language interactive system (namely, the Osteonecrosis of the Jaw Treatment Supporting [ONJ-TS] system), which is designed to provide clinical support for the diagnosis and treatment of ONJ. We retrospectively collected panoramic radiography (PR) images and medical records of 366 patients with ONJ to develop the ONJ-TS system. In the ONJ-TS system, the core Qwen2-VL was fine-tuned for natural language question answering on ONJ treatment. To support the primary functionality of the Qwen2-VL, we trained the SwinTransformer and the U-Net to identify ONJ cases and segment the ONJ regions in the PR images, respectively. Human evaluation of the output responses indicated that the ONJ-TS system exceeded the accuracy levels of junior oral and maxillofacial surgeons (OMFSs) with accuracy scores of 0.9598 (95% confidence interval [CI], 0.9351-0.9845) and 0.8835 (95% CI, 0.8432-0.9238), respectively ( = 0.003). Notably, in comparative analyses with the senior OMFSs (accuracy, 0.9959 [95% CI, 0.8432-0.9238]), the ONJ-TS system demonstrated comparable efficacy in disease management ( < 0.001). Extensive experiments showed that the ONJ-TS system outperformed baseline models in generating accurate responses to treatment support. Given its multifaceted capabilities, the ONJ-TS system holds promise as a digital solution for supporting clinical decisions in managing ONJ and enhancing clinical efficiency and treatment accuracy.

Authors

  • X Gao
  • L Zhao
  • Q Zhang
    Department of Radiology, People's Hospital of Qinghai Province, Xining 810000, China.
  • Z Guo
    Qingdao Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, China.
  • W Hu
    State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu City, China.
  • W Tang
    Department of Nephrology, Peking University Third Hospital, Beijing 100191, China.
  • C Han
    State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu City, China.
  • X Wang
    3 Laboratory Animal Center, Wenzhou Medical University, Wenzhou, China.
  • P Gong
    State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu City, China.
  • J Long
    Chongqing Municipal Center for Disease Control and Prevention (Chongqing Academy of Preventive Medicine), Chongqing 400707, China.

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