ToothSeg: Robust Tooth Instance Segmentation and Numbering in CBCT using Deep Learning and Self-Correction

Accurate interpretation of cone-beam computed tomography (CBCT) scans is critical for oral diagnosis and treatment planning. Existing methods for automated tooth segmentation in CBCT face challenges, such as difficulties in generalizing across imaging artifacts and anatomical variations, as well as requiring manual revisions in many cases. To address these limitations, this study introduces ToothSeg, a fully automated approach for tooth instance segmentation and numbering in CBCT using deep learning and self-correction. ToothSeg combines semantic and instance segmentation into a unified method where their respective strengths are complemented. In particular, self-correction is employed when combining the segmentations, resolving merged or split teeth and determining the optimal sequence of tooth numbers for each dental arch. We conducted a comprehensive evaluation using a diverse in-house dataset (n = 1282, 25+ devices) and the publicly available ToothFairy2 challenge dataset (n = 480, 1 device), including an ablation study, a comparison to state-of-the-art methods, and an analysis of challenging cases. Compared to an optimized semantic segmentation model, including instance segmentation and self-correction consistently improved tooth segmentation (True Positive Dice: 93.6% to 94.3%) and tooth detection and numbering (multiclass instance F1: 94.2% to 95.5%). Furthermore, ToothSeg outperformed the other methods on both datasets (True Positive Dice: $\boldsymbol{\ge }$ +0.4%, multiclass instance F1: $\boldsymbol{\ge }$ +1.8%), particularly for challenging cases. This study provides a promising approach for automated tooth segmentation and numbering in CBCT, which is significant for reducing manual workload and supporting scalable, data-driven research in oral and craniofacial health. Code and models are publicly available at https://github.com/MIC-DKFZ/ToothSeg.