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原文摘要

Accurate evaluation of multimodal large language models in dental panoramic radiography is limited by the lack of fine-grained, clinically reliable benchmarks that reflect expert interpretation. This work introduces PanDent, a large-scale benchmark built on expert-validated tooth-level annotations. It comprises 9,554 panoramic radiographs with comprehensive structured findings produced by experienced dentists and further validated by an oral and maxillofacial radiologist. Clinician-guided reports are constructed from these findings using clinician-defined reporting logic, establishing explicit correspondence between structured clinical evidence and free-text descriptions. The dataset supports complementary evaluation of report-level textual agreement and tooth-level clinical consistency, with 9,049 public-source cases for supervised training and an independent 505-case in-house benchmark. Experiments cover proprietary, general-domain open-source, and medical-specific models. Current models generate fluent reports but exhibit substantial errors in fine-grained localization and tooth-level diagnosis. Supervised fine-tuning on PanDent markedly improves report alignment and diagnostic accuracy, bringing predictions closer to expert dental interpretation. These results establish PanDent as a rigorous benchmark and training resource for clinically grounded dental multimodal reasoning. Dataset sample: https://huggingface.co/datasets/Desperado1103/Pandent_Sample; code: https://github.com/HKUDentistry/PanDent. Full data will be released upon publication under source redistribution terms.