Artificial Intelligence-Assisted Detection of the Elongated Styloid Process on Dental Radiographic Images: A Systematic Review and Literature Update

Background: Elongated styloid processes and ossifications of the stylohyoid chain can be observed on dental imaging modalities. In this study, we assessed the performance of artificial intelligence (AI) in identifying elongated styloid processes and ossifications of the stylohyoid chain. Methods: We performed a systematic review of relevant studies published between April 2020 and April 2026 on PubMed, Scopus, and Web of Science. Relevant data were extracted using predefined criteria. We assessed the risk of bias using categories derived from QUADAS-2, CLAIM and STARD-AI. Results: Four original studies met the inclusion criteria. Of these, only two specifically addressed elongated styloid processes on panoramic images (OPGs). For one study that utilized ML algorithms, both logistic regression and neural networks achieved 100% performance, while naive Bayes demonstrated substantially lower performance than either model. Another study using deep learning algorithms observed accuracy rates of 97.49% and 84.11%, and area under the curve values of 0.9825 and 0.8943 for EfficientNetB5 and InceptionV3 models. A broader study using OPG anomaly detection reported target-level data for stylohyoid ligament ossification. The fourth study used cone-beam computed tomography images, including stylohyoid ligament ossification as part of a multi-class soft tissue calcification/ossification detection task. Due to significant variability in target definitions, imaging modalities, validation methods, and performance metrics across studies, a meta-analysis was not feasible. Conclusions: The use of AI-based systems for detecting elongated styloid processes and stylohyoid chain ossification shows potential for future clinical utility; however, current evidence is insufficient to support independent clinical practice. Future research should incorporate larger-scale prospective multicenter validations as well as external validation on a patient-by-patient basis when possible. Additional research into the clinical implications associated with both false-positive and false-negative results is warranted.