Geometry-biased transformer for dental caries detection in panoramic X-ray images

Abstract Panoramic X-ray images are essential for dental caries detection, yet they inherently suffer from geometric distortions that complicate accurate early diagnosis. To address this, we propose a Geometry-Biased transformer that explicitly models spherical geometry. Our approach integrates equirectangular relative position embedding, distance-based attention scoring, and equirectangular-aware attention rearrangement to significantly enhance spatial feature representation. This enables the model to effectively capture both local caries lesions and global dental arch structures despite distortions. We rigorously evaluated our model primarily on a hospital-scale dataset, achieving a high accuracy of 94.90% and an AUC of 0.9603. Furthermore, extensive comparative analyses across diverse publicly available dental image datasets demonstrate the superior generalization and competitive performance of our method. Our findings highlight that geometry-aware transformers offer a robust and automated tool, revolutionizing high-precision dental caries detection and potentially other medical imaging diagnostics.