The AI play quietly fixing dentistry’s biggest bottleneck

Cone beam CT scans are everywhere—but who’s actually looking at them?

Here’s a stat that should give anyone in dental care pause: there are about 200 board-certified oral and maxillofacial radiologists in the entire United States, according to the ADA. Meanwhile, cone beam computed tomography (CBCT) machines are generating millions of scans each year—mostly in general practices that don’t employ in-house radiologists. These clinicians face a steep learning curve with a new technology that they haven’t been trained to use.

And when general dentists send scans elsewhere for interpretation, they’re waiting for radiologic expertise. When it comes to patient outcomes, that wait time isn’t just inconvenient, it’s clinically significant.

When “good enough” isn’t

CBCT imaging is one of the most powerful diagnostic tools in dentistry. But it’s also one of the most underutilized. Dentists routinely use it for surgical planning, endodontic troubleshooting, and complex extractions—but many will admit they don’t always feel confident interpreting every structure or anomaly in the volume.

And that makes sense. CBCT data is dense. Hundreds of cross-sectional slices packed with detail—and no obvious roadmap for what’s routine and what’s reason to worry. For many generalists, the result is a kind of quiet diagnostic inertia: either over-referring out of caution or under-referring out of uncertainty.

Radiology for the 99%

That’s where new tools are starting to help—not by replacing radiologists, but by making initial interpretation more accessible.

Emerging AI software, like Pearl’s FDA-cleared Second Opinion^® 3D, now enables automatic segmentation of key anatomical structures in CBCT scans. It doesn’t diagnose—it delineates. It highlights what’s there: the dentition, maxillary sinuses, airway anatomy, IA canal, and more. The kind of labeled, interactive visualization that makes a general dentist’s review not only faster, but also more informed.

Think of it as a kind of clinical triage layer. As it stands, many dentists over-refer—sending out all scans for radiologic review. This worsens the radiologic bottleneck by swamping available radiologists with unnecessary work. Meanwhile, other dentists refer out few or no scans, opening the possibility that an overlooked condition could worsen. 

These tools make it easier for dentists to understand which cases should be referred—and which shouldn’t. When something looks asymmetrical, unexpected, or just plain off, having a system that can surface that signal early helps clinicians know when it’s time to bring in a specialist.

Why this matters now

There’s a growing tension in dentistry between technology adoption and workflow reality. CBCT hardware is in the hands of more providers than ever, but interpretation practices haven’t kept pace. Most CBCT scans, even those capturing subtle or high-risk pathology, are never reviewed by someone formally trained to read them.

This imbalance isn’t going away. The number of trained radiologists isn’t growing fast enough to meet demand—and dental practices can’t always absorb the cost or complexity of outsourcing reviews for every scan. But they still need a way to make smarter decisions based on the imaging they already rely on.

That’s what AI segmentation tools can offer: a scalable assist that helps prioritize, clarify, and flag what matters.

A bridge, not a bypass

For specialists concerned about being cut out of the loop, the bigger picture offers reassurance. AI detection tools for 3D radiography won’t reduce demand for expert review—they will help generalists recognize when that review is warranted. Think atypical radiolucencies, suspected pathology outside the scope of general practice, unexpected anatomical asymmetries, or findings suggestive of systemic disease. These are the gray zones where even the most seasoned GP knows a second set of eyes can make all the difference.

Rather than letting subtle abnormalities go unnoticed—or relying on a hunch—AI segmentation provides the visual context that prompts a timely referral. 

The road ahead

For now, adoption will be the question. Dental professionals are rightfully cautious about workflow changes, especially when it involves new technology. But with regulatory backing, increasingly intuitive interfaces, and a very real shortage of radiologic support, these kinds of tools are likely to gain traction—quietly, perhaps, but meaningfully.

In a profession defined by detail, clarity matters. And when it comes to CBCT, clarity starts with segmentation.