The performance of artificial intelligence models in generating responses to general orthodontic questions: ChatGPT vs Google Bard.

INTRODUCTION: This study aimed to evaluate and compare the performance of 2 artificial intelligence (AI) models, Chat Generative Pretrained Transformer-3.5 (ChatGPT-3.5; OpenAI, San Francisco, Calif) and Google Bidirectional Encoder Representations from Transformers (Google Bard; Bard Experiment, Google, Mountain View, Calif), in terms of response accuracy, completeness, generation time, and response length when answering general orthodontic questions. METHODS: A team of orthodontic specialists developed a set of 100 questions in 10 orthodontic domains. One author submitted the questions to both ChatGPT and Google Bard. The AI-generated responses from both models were randomly assigned into 2 forms and sent to 5 blinded and independent assessors. The quality of AI-generated responses was evaluated using a newly developed tool for accuracy of information and completeness. In addition, response generation time and length were recorded. RESULTS: The accuracy and completeness of responses were high in both AI models. The median accuracy score was 9 (interquartile range [IQR]: 8-9) for ChatGPT and 8 (IQR: 8-9) for Google Bard (Median difference: 1; P <0.001). The median completeness score was similar in both models, with 8 (IQR: 8-9) for ChatGPT and 8 (IQR: 7-9) for Google Bard. The odds of accuracy and completeness were higher by 31% and 23% in ChatGPT than in Google Bard. Google Bard's response generation time was significantly shorter than that of ChatGPT by 10.4 second/question. However, both models were similar in terms of response length generation. CONCLUSIONS: Both ChatGPT and Google Bard generated responses were rated with a high level of accuracy and completeness to the posed general orthodontic questions. However, acquiring answers was generally faster using the Google Bard model.

Are units of analysis properly considered in orthodontic meta-analyses?

BACKGROUND: Assessment of unit of analysis (UoA) in meta-analysis with cluster, split-mouth, repeated measures designs, and multiple intervention groups is a fundamental step in the analysis. The objective of this study was to evaluate the UoAs in orthodontic meta-analysis and determine the error of the analysis. METHODS: An electronic search was conducted in the Cochrane Library and PubMed to identify orthodontic systematic reviews (SRs) with meta-analyses published in Cochrane and in the highest impact orthodontic journals between 1 January 2013 and 31 December 2022. SRs with meta-analysis assessing at least one of the following UoAs; cluster trials, crossover trials, multiple observations, or multiple intervention groups were included. Screening and data extraction were undertaken by two investigators independently. Descriptive statistics for the study characteristics were provided. The associations between avoiding the unit analysis error (yes, no) and the study characteristics were examined using Fisher's exact test and chi-square test. Logistic regression was undertaken for the significant predictors. RESULTS: Eighty SRs were deemed eligible for inclusion. Only 30 per cent of the included SRs avoided UoA errors. Compared to the split-mouth design, repeated measures designs had higher odds of avoiding UoA error (odds ratio: 9.6, 95% confidence interval: 2.8-32.3, P < 0.001). In contrast, fewer odds of avoiding the UoA error were found in the cluster design (OR: 0.2, 95% CI: 0.4-1.3, P = 0.09). Though multiple intervention groups have higher odds of avoiding UoA error than split-mouth studies, this was not statistically significant (OR: 2.1, 95% CI: 0.5-8, P = 0.28). None of the SRs characteristics have influenced the appropriate handling of the unit analysis except the type of the journal; the odds of avoiding the UoA error were higher in Cochrane reviews than the non-Cochrane reviews (OR: 3.3, 95% CI: 1.2-8.7, P = 0.02), and the number of authors (P < 0.05). CONCLUSIONS: UoA errors are common in orthodontic meta-analyses and were only partially avoided in split-mouth design, repeated measures design, and multiple intervention groups.

Compliance with retainer wear using audiovisual integration and reminder: a randomized clinical trial.

Active audiovisual representation of instructions ensures vibrant knowledge acquisition and improves acquaintance needed for self-care with retainer wear. The aim of this trial is to assess the impact of audiovisual instructions with additional weekly electronic reminder messages on improving adherence to instructed wear time of Hawley retainer, periodontal outcomes, and participants' experiences. Fifty-two participants (mean age 26.1 y) planned for removable retention, were randomly assigned to two parallel groups to receive either (1) audiovisual instructions with an additional weekly reminder, or (2) verbal instructions alone. Each participant received a Hawley retainer equipped with a TheraMon microsensor and was instructed to wear it for 22 h daily. Participants were monitored for adherence to the wear time after 3 (T1) and 6 months (T2), and had their periodontal health and experiences assessed at T2. Overall, the mean objectively measured daily wear time at T1 was 14.9 (± 4.9 h), and 14.3 (± 5.4 h) at T2. After 3 months, no significant differences were found between the groups (p = 0.065), however, a significant difference favoring better compliance with wear instructions was observed in the audiovisual group after 6 months (p = 0.033). A non-significant difference was observed between both groups regarding the gingival (p = 0.165) and plaque index scores (p = 0.173). Participants' experiences were similar in both groups, except for satisfaction with the way of delivering instructions, being favorably reported in the audiovisual group. Audiovisual instructions with weekly reminders seem to have a significant effect on patient compliance in the longer term.Trial registration: TCTR20230220002.

Tele-orthodontics and sensor-based technologies: a systematic review of interventions that monitor and improve compliance of orthodontic patients.

BACKGROUND: Recent advances in orthodontics offer appealing tools to monitor compliance and designate protocols to enhance it. OBJECTIVE: This systematic review of systematic reviews (SRs) aimed to assess the effectiveness of digitized communication methods and sensor-based devices that track compliance in orthodontic patients. SEARCH METHODS: Five electronic databases (PubMed, Web of Science, MEDLINE, PsycINFO, and EMBASE) were searched from database inception up to 4 December 2022. SELECTION CRITERIA: SRs using digitized systems and sensor-based technologies to monitor and/or improve compliance with orthodontic treatment or during an active retention phase were included. DATA COLLECTION AND ANALYSIS: Study selection, data extraction, and risk of bias assessment using the AMSTAR 2 tool were performed independently by two review authors. A qualitative synthesis of outcomes from moderate- and high-quality SRs was provided, and evidence was graded in accordance with a scale of statements. RESULTS: A total of 846 unique citations were retrieved. After study selection, 18 SRs met the inclusion criteria, and 9 moderate- and high-quality reviews were further integrated into the qualitative synthesis. Digitized communication methods were found to be effective in improving compliance with oral hygiene practices and adherence to orthodontic appointments. Monitoring removable appliance wear with microsensors revealed sub-optimal levels of compliance with wear instructions of intra-oral and extra-oral appliances. One review discussed the informational value of social media platforms and their importance in guiding the decision-making process to seek orthodontic treatment and compliance-related experiences. LIMITATIONS: The variability in the quality of included SRs and the limited number of primary studies on certain outcomes present as limitations within this overview. CONCLUSIONS: The integration of tele-orthodontics and sensor-based technologies to improve and monitor compliance within orthodontic practices is promising. There is sufficient evidence that establishing communication channels with orthodontic patients through reminders and audiovisual systems positively impact their oral hygiene practices throughout orthodontic treatment. However, understanding the informational value of social media as communication channels between clinicians and their patients, and their overall effect on modulating compliance is still insufficient. REGISTRATION: CRD42022331346.

A quantitative three-dimensional comparative study of alveolar bone changes and apical root resorption between clear aligners and fixed orthodontic appliances.

BACKGROUND: This study aimed to evaluate and compare the alveolar bone changes and to investigate the prevalence and severity of orthodontically induced inflammatory root resorption (OIIRR) of maxillary incisors in patients who received treatment with clear aligners (CA) versus conventional fixed appliances (FA), using cone-beam computed tomography (CBCT). METHODS: One hundred sixty maxillary incisors from 40 patients with similar baseline characteristics based on the American Board of Orthodontics discrepancy index scores were divided into the CA and FA groups. The dentoalveolar quantitative changes were analyzed using pre- (T0) and post-treatment (T1) CBCT. The measured parameters included alveolar bone thickness (ABT), alveolar bone height (ABH), root length (OIIRR), and maxillary incisor inclinations. RESULTS: Post-treatment, the average palatal and total ABT significantly decreased in central and lateral incisors in the FA group. In contrast, the CA group's average labial ABT of the lateral incisors decreased considerably. Regarding the ABH, both groups showed significant labial and palatal marginal bone resorption. In both groups, root lengths significantly decreased after treatment (p < 0.005). The inter-group comparison revealed that ABT and root length had significantly decreased in the FA group compared to the CA group, while the ABH showed no significant difference between the two groups. The mean absolute reductions of ABT and OIIRR in the CA group were significantly less (- 0.01 ± 0.89 and 0.31 ± 0.42) than those in the FA group (0.20 ± 0.82 and 0.68 ± 0.97), respectively. CONCLUSIONS: CA and FA treatments appear to cause a significant ABT reduction and a statistically significant increased OIIRR in the maxillary incisor region, with a greater extent expected with FA treatment. However, the increased OIIRR values in the majority of both groups' cases were not clinically significant. Both treatment modalities resulted in a significant ABH reduction, with the highest found in the labial side of lateral incisors in the CA group.

Effect of chlorhexidine mouthwash on gingival health around orthodontic miniscrew implants: A pilot placebo-controlled randomized trial.

OBJECTIVE: This randomized controlled trial (RCT) aims to investigate the short-term effects of chlorhexidine mouthwash (MW) on gingival health surrounding orthodontic miniscrew implants (OMIs) and their overall survivability. MATERIALS AND METHODS: Thirty-two participants (mean age, 22.8 years) undergoing fixed orthodontic appliance treatment after maxillary premolar extraction were randomly allocated in a parallel fashion to either receive (1) MW with an active component of chlorhexidine or (2) a placebo. Each participant received two maxillary buccal OMIs for anchorage reinforcement purposes. Participants were assessed for their gingival oral health status around all inserted OMIs and had their OMI survivability recorded at three time points; T1 = 1 month, T2 = 3 months, and T3 = 6 months after OMI placement. A Kaplan-Meier plot was used to estimate the survival function of OMIs. RESULTS: All randomized participants completed the follow-up period. In terms of gingival oral health, there were no statistically significant differences at any time point between the chlorhexidine MW group and the placebo-controlled group (P > .05). One OMI was lost in the chlorhexidine MW group and another two OMIs in the control group. There was no significant difference between both groups in terms of survivability (P = .585). CONCLUSION: The use of chlorhexidine MW does not seem to have a significant clinical impact on gingival health around OMIs or their survivability in this pilot study.

A qualitative study of orthodontic patients' experiences in quarantine during the COVID-19 pandemic outbreak.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is one of the most formidable challenges that influenced all domains of health care delivery. This research explored the experiences and challenges orthodontic patients faced in quarantine during the COVID-19 outbreak. The goal was to learn from patients about their oral health and general practices during this time to provide optimal delivery of orthodontic treatment care. METHODS: A phenomenographic qualitative design involving semistructured face-to-face interviews. A purposive sampling strategy was deployed to collect qualitative data from 24 orthodontic patients who quarantined during the COVID-19 pandemic. All interviews were digitally recorded, and afterwards, they were transcribed verbatim. RESULTS: Four main themes and associated subthemes were identified. The themes were (1) oral-health-related behavioral changes, (2) impact on treatment progression, (3) psychosocial impact and attitude changes, and (4) areas for future enhancements in health care delivery. Overall findings revealed both positive and negative behavioral changes in orthodontic patients regarding their adjustment during the quarantine and its implications to general health and well-being. CONCLUSIONS: Findings from this study suggest that COVID-19 impacted dental health care delivery to orthodontic patients during the quarantine. Patients reported psychosocial and behavioral changes as a consequence of treatment disruption and pandemic lockdown. The implications of these findings to the clinical dental environment and patient education are pivotal to further target areas in dental health care delivery that require strengthening. As such, clinicians could expect behavioral changes from orthodontic patients and identify better strategies to mitigate clinical challenges resulting from such changes.

Reminders improve oral hygiene and adherence to appointments in orthodontic patients: a systematic review and meta-analysis.

BACKGROUND: Reminders are implemented in healthcare services to increase compliance with treatment and to decrease the rate of failed appointments. Their effects in the provision of orthodontic care are not yet fully understood. OBJECTIVES: The main objectives of this review were to assess the effectiveness of reminder systems in improving oral hygiene (OH) and adherence to appointments in orthodontic patients. SEARCH METHODS: An unrestricted search was conducted in six electronic databases and was supplemented by an extensive manual search up to January 2018. SELECTION CRITERIA: Only randomized controlled trials (RCTs) evaluating the effectiveness of reminders in orthodontics were included. DATA COLLECTION AND ANALYSIS: Two authors were independently involved in study selection, data extraction, and bias assessment. A random-effects model with its corresponding 95% confidence interval (CI) was generated for comparable outcomes. Periodontal parameters were evaluated in the short term (1-3 months) and in the long term (>3 months). Cochrane risk of bias tool was utilized for bias assessment and the quality of the resultant evidence was graded. Additional subgroup and sensitivity analyses were implemented. RESULTS: Fourteen RCTs involving 2078 participants met the inclusion criteria; five studies were excluded from the quantitative synthesis due to high risk of bias. Small but statistically significant standardized mean differences in the plaque index scores were recorded favoring patients receiving reminders in the short-term (-0.38; 95% CI: -0.65 to -0.10) and in the long-term (-1.51; 95% CI: -2.72 to -0.30). Patients receiving reminders were less likely to miss their appointments with a relative risk of (0.39; 95% CI: 0.22 to 0.70) and less likely to develop white spot lesions (0.45; 95% CI: 0.31 to 0.65). CONCLUSIONS: There is moderate-to-high quality of evidence that reminders have a positive effect on OH and adherence to appointments in orthodontic patients. These effects were demonstrated in the short- and long-term. Future high-quality RCTs should be designed with longer follow-up periods. REGISTRATION: PROSPERO (CRD42017084479). CONFLICT OF INTEREST: None.

Role of anatomical sites and correlated risk factors on the survival of orthodontic miniscrew implants: a systematic review and meta-analysis.

OBJECTIVES: The aim of this review was to systematically evaluate the failure rates of miniscrews related to their specific insertion site and explore the insertion site dependent risk factors contributing to their failure. SEARCH METHODS: An electronic search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Knowledge, Scopus, MEDLINE and PubMed up to October 2017. A comprehensive manual search was also performed. ELIGIBILITY CRITERIA: Randomised clinical trials and prospective non-randomised studies, reporting a minimum of 20 inserted miniscrews in a specific insertion site and reporting the miniscrews' failure rate in that insertion site, were included. DATA COLLECTION AND ANALYSIS: Study selection, data extraction and quality assessment were performed independently by two reviewers. Studies were sub-grouped according to the insertion site, and the failure rates for every individual insertion site were analysed using a random-effects model with corresponding 95% confidence interval. Sensitivity analyses were performed in order to test the robustness of the reported results. RESULTS: Overall, 61 studies were included in the quantitative synthesis. Palatal sites had failure rates of 1.3% (95% CI 0.3-6), 4.8% (95% CI 1.6-13.4) and 5.5% (95% CI 2.8-10.7) for the midpalatal, paramedian and parapalatal insertion sites, respectively. The failure rates for the maxillary buccal sites were 9.2% (95% CI 7.4-11.4), 9.7% (95% CI 5.1-17.6) and 16.4% (95% CI 4.9-42.5) for the interradicular miniscrews inserted between maxillary first molars and second premolars and between maxillary canines and lateral incisors, and those inserted in the zygomatic buttress respectively. The failure rates for the mandibular buccal insertion sites were 13.5% (95% CI 7.3-23.6) and 9.9% (95% CI 4.9-19.1) for the interradicular miniscrews inserted between mandibular first molars and second premolars and between mandibular canines and first premolars, respectively. The risk of failure increased when the miniscrews contacted the roots, with a risk ratio of 8.7 (95% CI 5.1-14.7). CONCLUSIONS: Orthodontic miniscrew implants provide acceptable success rates that vary among the explored insertion sites. Very low to low quality of evidence suggests that miniscrews inserted in midpalatal locations have a failure rate of 1.3% and those inserted in the zygomatic buttress have a failure rate of 16.4%. Moderate quality of evidence indicates that root contact significantly contributes to the failure of interradicular miniscrews placed between the first molars and second premolars. Results should be interpreted with caution due to methodological drawbacks in some of the included studies.