Background: Artificial intelligence (AI) is transforming medical imaging, yet its economic impact in dentistry remains largely unexplored.<br>Aim: This study evaluated the cost-effectiveness of AI-assisted detection of apical periodontitis on panoramic radiographs, including downstream clinical decision-making.<br>Material and Methods: Using data from a randomised study on AI-assisted detection of apical lesions, a decision-analytic model was established to analyse costs and effectiveness from a German mixed-payer perspective.<br>Results: AI support reduced average costs per case and increased treatment effectiveness, outperforming unaided examiner performance. These gains were primarily driven by improved specificity, reducing false-positive detection. However, effects varied by examiner experience; junior clinicians achieved the greatest cost savings and effectiveness gains, whereas senior examiners showed reduced sensitivity and slightly lower effectiveness at similar costs.<br>Conclusion: AI-assisted diagnostics offer significant potential to improve cost-effectiveness by reducing overtreatment, with benefits being most pronounced among less experienced practitioners. Adapting AI systems to individual examiners or experience levels might further enhance clinical and economic impact.
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