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Professor Axel Spahr believes artificial intelligence (AI) could transform periodontal screening and diagnostics by helping dentists detect disease earlier, more accurately, and more consistently to address one of dentistry’s most widespread epidemics. By Shane Conroy
According to the World Health Organization (WHO), periodontal disease affects more than one billion people worldwide. In Australia, it is estimated around one in three adults has moderate to severe periodontitis.
It is common, progressive, and often invisible to patients until the damage is already done. By the time symptoms such as tooth mobility, pain, tooth loss, or significant bone destruction become obvious, the disease may have moved well beyond the stage where simple, non-surgical intervention is enough.
Professor Axel Spahr, head of periodontics at the University of Sydney Dental School, thinks the solution may lie in an innovative tool that uses artificial intelligence (AI) to diagnose periodontal disease.
He is working with Eyes of AITM on Perio-Detect, an AI-powered screening platform designed to support earlier and more consistent detection of periodontal disease. Eyes of AITM is an Australian health technology company focused on developing AI tools to enhance clinical decision-making and improve patient outcomes.
“The Perio-Detect platform has the potential to fundamentally change how we approach periodontal disease,” Professor Spahr says. “At the moment, we often diagnose it too late, when significant damage has already occurred.”
Perio-Detect is still in development with preclinical and clinical validation required before a wider rollout, expected to commence in two to three years. But Professor Spahr believes the direction is clear. Dentistry has accepted new diagnostic technologies before, from 2D radiographs to 3D imaging. AI, he argues, should be understood in the same practical way: as a tool that expands what clinicians can see and how confidently they can act.
“Perio-Detect does not replace the clinician,” Professor Spahr says. “It’s a support tool. If we can detect disease earlier, more precisely, more consistently, and for more patients, then we have a real chance to improve outcomes before significant damage is done.”
Professor Spahr says Perio-Detect could also help with triage by identifying whether a patient can be managed by a general dentist or whether specialist referral is needed. It may also help monitor patients over time to show whether disease is stable or whether specific areas are deteriorating.
“That could matter greatly in rural, remote, and public dental settings, where access to periodontists is limited,” he explains. “If you have something like this, you could screen patients who otherwise wouldn’t be screened, particularly those who don’t have access to or might have to travel long distances for specialist care.”
The diagnostic gap
Perio-Detect is being developed as an AI-assisted periodontal screening platform that integrates CBCT imaging and intraoral scanning to generate a more objective and accurate periodontal profile.
Perio-Detect does not replace the clinician. It’s a support tool. If we can detect disease earlier, more precisely, more consistently, and for more patients, then we have a real chance to improve outcomes before significant damage is done.
Professor Axel Spahr, head of periodontics, University of Sydney Dental School
By combining hard-tissue and soft-tissue data, the system aims to support assessment of key indicators including bone loss, attachment loss, probing depth estimation, gingival recession, and furcation involvement.
Professor Spahr became involved after being introduced to the Eyes of AITM team through his role at the University of Sydney. He was already familiar with the power of digital workflows through implant planning, where CBCT and intraoral scans can be combined to guide precise surgical treatment. The Perio-Detect concept raised an interesting question that captured his attention—whether the digital data he was already familiar with could be combined with AI analysis to improve periodontal screening.
He says the limitations of periodontal screening and diagnostics are felt by clinicians and patients every day. Current periodontal diagnosis relies heavily on manual probing and comprehensive periodontal charting. It is time-consuming, operator-dependent, and often uncomfortable for patients.
“You must stick the probe underneath the gum margin down to the bottom of the pocket, which can hurt a lot,” Professor Spahr says. “It’s also very dependent on the clinician—how much pressure they apply, the angle they use, even how the patient reacts in the chair. So manual diagnosis is not always as consistent or as comfortable as we would like.”
That creates a diagnostic gap. Early disease may be missed or the severity and complexity of the disease may be underestimated, and by the time disease is accurately diagnosed, it may require more complex, invasive, and costly treatment.
“One advantage of AI diagnosis is that it’s reproducible,” Professor Spahr says. “If you train the AI properly and validate it properly, it will always give you the same result. It doesn’t have good days and bad days, and it is not influenced by whether the patient is anxious or inflamed. And because Perio-Detect doesn’t require manual probing it’s pain free.
“It can also assess the tooth in a more comprehensive way than conventional probing. In manual charting, clinicians measure six selected sites around the tooth. With AI, you can measure in 0.5mm increments around the tooth, which reduces the risk that localised disease is missed.”
From action films to academia
Professor Spahr was born in Germany in Heidenheim an der Brenz. He spent much of his childhood outdoors and developed a strong love of sport and physical activity, influenced in part by his parents, who worked as ski instructors. As a young adult, he became involved in weight training and even took on roles in action films to help fund his university studies.
“It wasn’t anything glamorous, but it helped pay the bills and suited me at the time because I was already training a lot and enjoyed that kind of physical challenge,” he says. “It was a very different environment from academia, but in a way it taught me discipline and resilience, which are qualities that ended up being just as important later in my career.”
His early career began in restorative dentistry, where he developed a strong foundation in clinical practice and research. Over time, however, he found himself increasingly drawn to periodontics, which offered a different set of clinical and biological challenges.
“In periodontics you’re dealing with the periodontal ligament, the gum, the bone, and all of it is dynamic living tissue,” he explains. “It responds to treatment, it can heal, and in some cases you can actually regenerate what’s been lost. That biological aspect, and the connection to the rest of the body, makes periodontics very different from other areas of dentistry.”
That interest led him into international research, including work in Scandinavia, South Africa, and Germany on periodontal regeneration, microbiology, and tissue biology. He became head of periodontics at the University of Ulm in Germany before moving to Sydney in 2010, where he now combines research, specialist education, and clinical practice.
Despite the heavy demands of his academic role at the University of Sydney, Professor Spahr has deliberately remained in practice. He works part-time at Park Street Perio in Sydney and travels regularly to Dubbo, where access to specialist periodontal care is more limited.
For him, his clinical work is not separate from research. It is what keeps his research connected.
“I think it’s important for an academic to stay connected to the real world,” he says. “The real world is what happens in a practice when you see real patients.”
That real-world perspective is central to how Professor Spahr believes AI will be applied to shape the future of dentistry. He states the long-term promise of AI extends beyond diagnosis and will ultimately be used as a key tool to improve treatment outcomes across the board.
“The future of AI is not only about earlier diagnosis,” he says. “If AI can give us more detailed information about the disease, it can also help guide the right treatment for the right patient. That’s where this becomes much more than a diagnostic tool.”
