## 4 Discussion  
An automated method for assessing and quantifying radiographic bone loss in the upper molar area was presented in this study. The evaluation of the boundary box metrics showed a moderate overlap with the ground truth, revealing an average precision of up to 0.758. The average precision and recall over all five folds were 0.694 and 0.611, respectively. The mean average precision and recall for the keypoint detection were 0.632 and 0.579, respectively. Despite only using a small and heterogeneous set of images for training, our results indicate that the algorithm was able to learn the objects of interest, although without sufficient accuracy due to the limited number of images and a large amount of information available in the panoramic radiographs. Considering the widespread availability of panoramic radiographs as well as the increasing use of online databases, the presented model can be further improved in the future to facilitate its implementation in clinics. Panoramic radiographs are the most commonly used dental imaging technique. As a diagnostic tool, it is used to evaluate dental hard tissues, bones, and soft tissues in the maxillofacial region. [PERSON] et al. showed that periapical radiographic imaging with the aid of an AI could detect landmarks well and diagnose periodontal bone loss on the basis of these [45]. The amount of bone loss in the alveolar region was underestimated by all radiographic methods. In bitewing radiographs, the underestimation ranged from 11 to 23% [46]. There were some advantages to intraoral and panoramic radiographs over bitewing radiographs when diagnosing bone loss; however, the differences were minimal in the premolar and molar regions [46]. Panoramic imaging, bitewing, and periapical radiographs have fairly similar sensitivities but significant differences in specificities [47]. In comparison with the periapical and bitewing radiographs, panoramic imaging resulted \begin{table}
\begin{tabular}{c c c c} \hline \hline \multicolumn{2}{c}{**Boxes**} & \multicolumn{2}{c}{**Keypoints**} \\ \hline \multicolumn{2}{c}{IoU = 0.500.95} & \multicolumn{2}{c}{IoU = 0.50:0.95} \\ \hline Fold 1 AP & 0.621 & Fold 1 AP & 0.544 \\ Fold 2 AP & 0.465 & Fold 2 AP & 0.358 \\ Fold 3 AP & 0.815 & Fold 3 AP & 0.671 \\ Fold 4 AP & 0.691 & Fold 4 AP & 0.604 \\ Fold 5 AP & 0.795 & Fold 5 AP & 0.599 \\ \hline \multicolumn{2}{c}{IoU = 0.500.95} & \multicolumn{2}{c}{IoU = 0.50:0.95} \\ \hline Fold 1 AR & 0.651 & Fold 1 AR & 0.512 \\ Fold 2 AR & 0.784 & Fold 2 AR & 0.655 \\ Fold 3 AR & 0.719 & Fold 3 AR & 0.498 \\ Fold 4 AR & 0.604 & Fold 4 AR & 0.577 \\ Fold 5 AR & 0.455 & Fold 5 AR & 0.681 \\ \hline mAP & 0.6774 & mAP & 0.5552 \\ mAR & 0.6426 & mAR & 0.5846 \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Evaluation of the testing dataset. in the lowest specificity values. The use of vertical bitewings rather than horizontal bitewings was recommended in periodontal treatment planning [13]. A major advantage of panoramic and bitewing radiographs is their precise resolution in the region to be examined. While this method is effective, it does have the disadvantage of being able to image only a small area, which may result in lower reproducibility between different time points. A panoramic radiograph, which is also commonly used as a diagnostic tool in clinics, provides a more comprehensive view, can also reduce the probability of missing potentially significant areas. In addition to providing information regarding the periodontal bone situation, periapical lesions, and continuity breaks in the bone, it is widely used among clinics [11; 12; 25]. According to [PERSON] et al., a high degree of agreement was found between intraoral dental films and panoramic radiographs in determining the cemento-enamel junction (CEJ) plane distances and periodontal bone loss [46]. In light of the shorter time required for panoramic radiographs, it can be concluded that it can serve as a partial substitute for a full-mouth dental film evaluation to assess periodontal health [46].