Pearl Second Opinion

Chairside X-ray AI with FDA clearances for caries and periapical findings and 40+ imaging integrations. The most accessible option for a single practice.

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Review

Pearl Second Opinion review: our verdict

By the Denture-ID Research Desk · updated Sep 30, 2026 · based on vendor documentation, published pricing and public user reviews; not hands-on tested

Reviewed by Francis Brero, VP of AI Strategy & Data Science Expert · Editorial Board

Pearl Second Opinion is the radiograph AI most practical for an individual practice to adopt. It plugs into a long list of imaging systems, its clearances are easy to verify, and unlike its main rivals there is a price in the public domain.

Users who have reviewed it are positive about patient communication and consistent about the limitation: it flags things that are not there, so every finding needs a dentist's confirmation. That is what a second reader is for.

Strengths

FDA 510(k) clearances we verified for caries detection and periapical radiolucency
Integrates with more than 40 imaging and practice management systems, by the vendor's count
Detects up to 18 types of finding, including measured bone loss
A price is listed on Capterra: $299 per month, with a free trial

Watch-outs

Reviewers report false positives, especially interproximal decay and cervical burnout
Clearances are limited by image type and patient age
Only a handful of public user reviews
Pricing is not shown on the vendor's own site

What Pearl Second Opinion is

Second Opinion is software from Pearl that analyses dental radiographs and marks suspected findings on the image in real time. Pearl says it identifies up to 18 findings, among them early and advanced caries, bone loss measured in millimeters, calculus, periapical radiolucencies, defective restoration margins, widened periodontal ligament and impactions. A separate product, Second Opinion 3D, covers CBCT.

It runs alongside your imaging software rather than replacing it. Pearl lists more than 40 integrations, including DEXIS, Carestream, Romexis, Sidexis, Apteryx XVWeb, SOTA Cloud, tab32, Open Dental, Eaglesoft, Curve and Dentally.

FDA clearances: what they cover

Clearance	Date	Indication
Second Opinion CC (K242522)	Jan 16, 2025	Caries on bitewing and periapical radiographs, permanent teeth, patients 19 and older
Second Opinion PC (K242600)	Apr 11, 2025	Periapical radiolucencies on periapical radiographs, permanent teeth, patients 12 and older
Second Opinion CS (K243234)	Jun 12, 2025	Caries detection and segmentation on periapical radiographs, permanent teeth, patients 12 and older

Each letter describes the software as an aid for dental professionals acting as a second reader. Pearl states it also holds clearances for panoramic radiographs. If you treat many children, note the age limits and the restriction to permanent teeth in the clearances above.

Pricing

Pearl's product page has no price. Its Capterra listing shows $299 per month as a flat rate with a free trial available. Treat that as a reference point and confirm with the vendor whether it is per location, which products it includes and whether Second Opinion 3D is extra.

Where Pearl is strong

Fits existing workflows. The integration list covers the imaging software most practices already have.
Patient communication. Highlighted findings on the screen make conditions easier to explain, which reviewers confirm.
Consistency. Useful where several providers read radiographs to different standards.
Verifiable clearances. The letters are public and specific.

Where it falls short

False positives. Reviewers mention interproximal areas and cervical burnout being flagged as decay.
Age and image limits. See the clearance table.
Vendor claims. Figures such as a 30% lift in case acceptance come from Pearl; measure your own.
Support. Described as inconsistent in some reviews.
Small review base. Four reviews on Capterra when we read it.

Pearl alternatives to compare

Overjet, stronger for groups and insurers: Overjet vs Pearl.
VideaAI, cleared for patients from age 3.

All tools: AI dental X-ray analysis ranking.

Bottom line

For a single practice that wants to try radiograph AI without changing its imaging software, Pearl is the easiest place to start. Use the free trial on your own images, watch the false-positive rate and keep the dentist's judgment final.

What users say about Pearl Second Opinion

Praised most often

Intuitive and easy to navigate
Effective for showing patients what the dentist sees
Integrates smoothly with existing systems
Helpful second check for practices with associates

Criticized most often

False positives for decay, particularly between teeth
Artifacts such as cervical burnout misread
Inconsistent customer support
Cannot be relied on as the sole means of detection

Summarized by us from four public reviews on Capterra (overall 4.3 out of 5; ease of use 4.5, features 4.0, customer service 4.3, value 4.5), read on September 30, 2026. This is a very small sample. Themes are paraphrased, not quoted.

Sources for this review (5)

Pearl: Second Opinion — findings, integrations and vendor claims
FDA 510(k) K242522: Second Opinion CC — clearance letter and indications
FDA 510(k) K242600: Second Opinion PC — clearance letter and indications
FDA 510(k) K243234: Second Opinion CS — clearance letter and indications
Capterra: Pearl — listed price, rating and review themes

Data Index profile

Table view

Axis	Pearl Second Opinion	Basis
Features	8.5	11 of 13 tracked capabilities confirmed (0 unverified)
Integrations	7.6	9 verified integrations
Pricing clarity	2.0	quote only
Support	4.0	2 channels
Vendor stability	8.0	501-1000 staff
User rating	8.8	4.4/5 from 13 public reviews

Of the 6 axes we could measure, Pearl Second Opinion is strongest on user rating (8.8/10) and weakest on pricing clarity (2.0/10). It ranks #1 of 14 in AI radiograph analysis, 2.5 points above the category median of 4.4.

Features8.5

11 of 13 tracked capabilities confirmed (0 unverified). What this measures ⓘ
Integrations7.6

9 verified integrations. What this measures ⓘ
Pricing clarity2.0

quote only. What this measures ⓘ
Support4.0

2 channels. What this measures ⓘ
Vendor stability8.0

501-1000 staff. What this measures ⓘ
User rating8.8

4.4/5 from 13 public reviews. What this measures ⓘ

AI transparency

✓Uses AIConfirmed

?Human in the loopNot disclosed

✓FDA-cleared AIConfirmed

?LLM provider disclosedNot disclosed

1 of 3 AI transparency signals disclosed. Across all AI tools we track, most vendors disclose none of them — which is why we show this panel on every AI product.

Compliance & security

✓HIPAAClaimed by vendor

?BAA availableNot verified

?SOC 2 Type IINot verified

?HITRUSTNot verified

?GDPRNot verified

?PIPEDA (Canada)Not verified

Market	Status	Number	Date	Source
United States	FDA 510(k) cleared	K242522 ↗	Jan 16, 2025	regulatory db ↗
United States	FDA 510(k) cleared	K242600 ↗	Apr 11, 2025	regulatory db ↗
United States	FDA 510(k) cleared	K243234 ↗	Jun 12, 2025	regulatory db ↗

“Claimed by vendor” means a public statement we could cite; it is not an audit. Ask for the SOC 2 report or signed BAA before you share patient data.

AI imaging coverage

Pearl Second Opinion confirms 11 of 13 capabilities we track for this category. Relatively rare among its 13 peers: calculus, chairside patient view, and claim support.

✓ Bitewing
✓ Periapical
✓ Panoramic
✓ CBCT
✕ Intraoral photo
✓ Caries
✓ Calculus
✓ Bone loss
✓ Periapical lesion
✓ Restorations
✕ Segmentation
✓ Chairside patient view
✓ Claim support

Imaging integrations: DEXIS IS 3800, Planmeca Romexis, Sidexis 4, SOTA Cloud, tab32, Open Dental, Eaglesoft, Curve Dental, Dentally

See how every AI radiograph analysis product compares on these features →

Integration web

Pearl Second Opinion lists 9 verified integrations, all native. It covers 3 of the 6 most-connected systems in our database (Open Dental, Eaglesoft, and Curve Dental).

Native listed by this product · lists this product

Pricing & 3-year cost

License model: Quote only
Price transparency: Quote only
Starting price: Not published
Free trial: Not verified
Price last checked: Sep 30, 2026

Minimum term: Not verified
Auto-renew: Not verified
Cancellation notice: Not verified
Early termination fee: Not verified
Data export on exit: Not verified

Pearl Second Opinion is quote-only — like 7 of 13 other products in this category. 6 competitors publish at least partial pricing.

User ratings

4.4/5 averaged across Capterra from 13 reviews.

Capterra

4.4/5 · 13 ↗

Ratings are snapshots from third-party platforms, shown with their date and link. We do not publish them as our own review stars.

Who it’s for

Best for

Independent practices that want radiograph AI working inside the imaging software they already use
Offices that want a visual aid for explaining findings to patients
Practices with associates, where a consistent second read is useful

Not ideal for

Anyone expecting the software to diagnose on its own
Pediatric-focused practices: the clearances we read cover permanent teeth from age 12 or 19
Buyers who want a large body of public user reviews

Practice size

Solo2–5 operatories6–15 operatories16+ operatories✓ Multi-location✓ DSO

Specialties: General, Pediatric, Orthodontics, Oral surgery, Periodontics, Endodontics, Prosthodontics, Cosmetic
Deployment: Cloud
Open API: ?
Support: phone, email

Company

Vendor: Pearl
Employees: 501-1000
Customers (vendor claim): 10,000

Markets

MENA

APAC

LATAM

Vendor also markets the product globally.

Markets the vendor actively sells into: Global.

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FAQ

Is Pearl Second Opinion FDA cleared?

Yes. We read three FDA clearance letters issued to Pearl in 2025: Second Opinion CC (K242522) for caries on bitewing and periapical radiographs in patients 19 and older, Second Opinion PC (K242600) for periapical radiolucencies in patients 12 and older, and Second Opinion CS (K243234) for caries detection and segmentation on periapical radiographs in patients 12 and older. Pearl also states it has clearances covering panoramic images.

How much does Pearl Second Opinion cost?

Pearl does not show pricing on its product page. Its Capterra listing gives $299 per month as a flat rate and mentions a free trial. Confirm the current price, what it covers and the contract term with the vendor.

How accurate is Pearl AI?

Pearl publishes accuracy claims above 90%, which are the vendor's own figures. User reviews describe it as helpful but mention false positives, so it should be used as a second reader alongside the dentist's judgment, which is also how its FDA indications describe it.

How much does Pearl Second Opinion cost?

Pearl Second Opinion does not publish pricing; it is sold on a quote basis. 5 competitors in AI radiograph analysis publish a starting price.

Is Pearl Second Opinion HIPAA compliant?

Yes — Pearl Second Opinion's vendor states HIPAA compliance. Always request a signed BAA before sharing PHI.

What does Pearl Second Opinion integrate with?

We verified 9 integrations: DEXIS IS 3800, Planmeca Romexis, Sidexis 4, SOTA Cloud, tab32, Open Dental, Eaglesoft, and Curve Dental and others.

What are the best alternatives to Pearl Second Opinion?

By our Data Index, the strongest alternatives in AI radiograph analysis are Overjet (6.2), Denti.AI (5.9), and CranioCatch (5.2).

Where is the Pearl Second Opinion login?

Pearl Second Opinion accounts are accessed through the vendor's official site, hellopearl.com. Denture-ID is an independent review site and cannot access or reset Pearl Second Opinion accounts — use the vendor's own login and password-reset pages.