Assessing the Accuracy of AI Models in Orthodontic Knowledge: A Comparative Study Between ChatGPT-4 and Google Bard.

OBJECTIVE: To compare the knowledge accuracy of ChatGPT-4 and Google Bard in response to knowledge-based questions related to orthodontic diagnosis and treatment modalities. STUDY DESIGN: Cross-sectional comparative study. Place and Duration of the Study: Department of Orthodontics, Rawal Institute of Health Sciences, Islamabad, Pakistan, from June 23rd to August 30th 2023. METHODOLOGY: A comprehensive content analysis was designed based on a mini implant-assisted rapid palatal expansion (MARPE), clear aligners (CA), and cone beam computed tomography (CBCT), involving 30 questions for each category (total = 90) derived from recent review articles. Questions were prepared and presented to two large language models (LLMs): Google Bard and ChatGPT-4. Two independent raters evaluated the accuracy of the responses using a scoring system ranging from one to five, by comparing the answers to a standard key. Statistical analyses, including the paired sample t-test, were used to assess the performance of the two language models. RESULTS: GPT-4 demonstrated superior performance, outperforming Google Bard significantly in the MARPE, CBCT, and CA categories, and achieved a higher mean score. A p-value was found to be (p = 0.001) for MARPE and CBCT, while it was (p = 0.013) for CA. Overall, GPT-4 achieved a total score of 92.6%, surpassing Google Bard's which was 72%. CONCLUSION: GPT-4 is more efficient than Google Bard in providing accurate and up-to-date information regarding recent trends in orthodontic treatment modalities. KEY WORDS: Aligners, Cone beam computed tomography, ChatGPT-4, Google Bard, Mini implant-assisted rapid palatal expansion.

[Improvement of the mastication function of orthodontics combined with restoration in the treatment of deep overbite with severe lower anterior teeth attrition].

PURPOSE: To observe the effect of orthodontics combined with restoration on masticatory function in deep overbite patients with severe lower anterior teeth attrition. METHODS: From January 2018 to January 2022, a total of 164 deep overbite patients with severe lower anterior teeth attrition were collected and divided into two groups according to different treatment plans: control group(72 patients, with restoration treatment) and experimental group(92 patients, with orthodontics combined with restoration treatment). The chewing efficiency of the two groups was evaluated, temporomandibular joint dysfunction index (DI), muscle palpation index (PI) and cranio-mandibular index (CMI) were calculated. The satisfaction with facial esthetic, the Chinese version of Oral Health Impact Scale-14(OHIP-14) and the repair satisfaction score were evaluated, the occurrence of adverse events between the two groups was compared. SPSS 23.0 software package was used for statistical analysis. RESULTS: After treatment, the chewing efficiency of the experimental group was significantly improved compared to the control group, while the DI, PI, and CMI were significantly reduced compared to the control group(P＜0.05). Compared with the control group, the satisfaction degree with facial esthetic and restoration in the experimental group was significantly higher, while the OHIP-14 score was significantly lower after treatment(P＜0.05). The incidence of adverse events in the experimental group was significantly decreased compared with the control group (6.52% vs 25.00%, P＜0.05). CONCLUSIONS: Combination of orthodontics and restoration treatment can enhance the effectiveness of restoration treatment for deep overbite with severe lower anterior teeth attrition, improve the mastication function and temporomandibular joint balance,satisfaction and quality of life of patients, as well as reduce the risk of adverse events.

Pain and root resorption due to surgical interventions to accelerate tooth movement in orthodontics: A systematic review and meta-analysis.

BACKGROUND: There are several publications that show the efficacy of surgical interventions in accelerating the rate of tooth movement in orthodontics. Consequently, possible adverse effects must also be evaluated. OBJECTIVES: The aim of the present study was to compare the perception of pain and root resorption between orthodontic treatment with a surgical acceleration intervention vs. conventional orthodontic treatment. MATERIAL AND METHODS: An electronic search was conducted in the MEDLINE, Scopus, Web of Science (WoS), ScienceDirect, Cochrane Library, and Virtual Health Library (VHL) databases up to September 12, 2022. Randomized or non-randomized, controlled, parallel-arm or split-mouth clinical trials were included. Fixed-and random-effects meta-analyses were performed with regard to heterogeneity. The risk of bias (RoB) was assessed using the RoB 2.0 and ROBINS-I tools. RESULTS: A total of 1,395 articles were initially retrieved, 40 studies were finally included in the review and 15 studies were eligible for quantitative analysis. The meta-analysis showed a significant difference in pain perception between acceleration surgery vs. conventional orthodontics at 24 h (p = 0.040); however, this difference was not significant at 7 days (p = 0.080). Overall, the patients who underwent any acceleration procedure presented significantly less resorption as compared to those who were applied conventional treatment (p < 0.001). A similar significant difference was found in retraction movements (p < 0.001) and alignment movements (p = 0.030). CONCLUSIONS: In the first 24 h, surgical interventions for the acceleration of tooth movement produce a greater perception of pain as compared to conventional orthodontic treatment, but the perception is similar after 7 days. Acceleration surgery results in less root resorption - in alignment movements, and especially in retraction movements.

Are protective measures against Covid-19 still active in orthodontic practices? A cross-sectional online survey of French orthodontists three years on from the pandemic.

PURPOSE: The Covid-19 epidemic has imposed profound changes on the practice of orthodontics. It was in this anxiety-inducing context that drastic measures were imposed on orthodontists. The main aim of this online survey is to highlight the measures that are still in place in French orthodontic practices three years after the emergence of the pandemic. METHODS: A cross-sectional online survey was distributed to French orthodontists from march to June 2023. The questionnaire, consisting of 32 questions, was divided into five sections covering habits before and after the pandemic, and the feelings of professionals. RESULTS: In this survey 230 complete answers were recorded. Three years later, the daily pace had returned to its pre-crisis level. Disinfection and aeration times were still present (p < 0.001). Orthodontists maintained and generalized the use of protective glasses (p = 0.17) and visors (p < 0.001). The same was true for the FFP2 mask and its frequency of change, as well as rigorous hand washing. Finally, the dedicated layout of the practices was maintained: protective screen, filtration system, supply of SHA, travel paths, removal of magazines (for all, p < 0.001). CONCLUSION: This study shows that the professional practices imposed by the Covid-19 crisis have been adopted by the majority of French orthodontists, and now appear to be anchored in their routine practice. TRIAL REGISTRATION NUMBER: opinion n°2023-004, dated 01.25.2023.

Still to ARRIVE at adequate reporting of orthodontic studies involving animal models.

BACKGROUND: The ARRIVE 2.0 guidelines were introduced to improve the reporting of animal studies. The aim of this study was to assess the reporting adherence of orthodontic speciality animal studies in relation to ARRIVE 2.0 guidelines. Associations between the reporting and study characteristics were explored. MATERIALS AND METHOD: An electronic database search was undertaken using Medline via PubMed (www.pubmed.ncbi.nlm.nih.gov) to identify studies meeting the eligibility criteria published between 1 January 2018 and 31 December 2023. Data extraction was performed in duplicate and independently. Descriptive statistics and frequency distributions for the responses to each checklist item were calculated. Mean values for adequate reporting per ARRIVE item were calculated. A sum score was calculated by adding the responses (0 = not reported, 1 = inadequate reporting, 2 = adequate reporting) per item and sub-questions. On an exploratory basis, univariable linear regression between summary score and study characteristics (year of publication, continent of authorship, type of centre, and number of authors) was performed. RESULTS: Three hundred and eighty-four studies were analysed. Variability in the adequate reporting of the ARRIVE 2.0 guideline items was evident. In particular, in 32% of studies, there was a lack of reporting of the priori sample size calculation. Overall, the mean reporting score for the sample was 57.9 (SD 6.7 and range 34-74). There were no associations between score and study characteristics except for a weak association for year of publication with a small improvement over time (each additional year). CONCLUSIONS: The reporting of animal studies relevant to the speciality of orthodontics is sub-optimal in relation to the ARRIVE 2.0 guidelines. There was a tendency for the non-reporting of items pertaining to study sample size, eligibility, methods to reduce bias and interpretation/scientific implications. Greater awareness and reporting adherence to the ARRIVE 2.0 guidelines are required to reduce research waste involving animal models.

Soft skills in Orthodontics: an analysis in residents and experienced professionals.

INTRODUCTION: Soft skills represent a range of personal skills, attitudes and characteristics relevant to success and adequate work performance. OBJECTIVE: This study aimed to evaluate the knowledge and usage of soft skills in Orthodontics. METHODS: The participants answered a questionnaire containing 27 objective questions on awareness and frequency of soft skills in their professional activities. Participants were also asked to rank the soft skills in a crescent order of importance. The sample was divided into subgroups: A) residents in Orthodontics; B) orthodontists with less than 5 years of experience and C) orthodontists with more than 5 years of experience. Intergroup comparisons were performed using the Kruskal-Wallis test. Sexual differences were compared using Mann-Whitney test (p< 0.05). RESULTS: The sample of this observational study comprised 129 experienced orthodontists and residents in Orthodontics (92 women, 37 men) with mean age of 35.3 years. From the total sample, 54,6% of respondents reported no previous instructions on soft skills. All respondents reported using the analyzed soft skills with a similar frequency (median 4-5). Residents reported accessing reliable sources in bibliographic research less frequently (46%). Female orthodontists reported to seek help from teachers and other professionals more often than males. Ethics and communication were frequently ranked as the most important soft skills. Information management and leadership were frequently less ranked as important soft skills. CONCLUSION: Poor knowledge of soft skills was demonstrated by residents and orthodontists. Communication skill was highly used and frequently ranked as the most important soft skill.

Obstructive sleep apnea: What is an orthodontist's role?

BACKGROUND: The American Association of Orthodontists white paper on obstructive sleep apnea and orthodontics remains the most authoritative statement on the topic. This was produced in 2019 due to increasing orthodontic interest in obstructive sleep apnea (OSA) and the lack of formal guidelines for orthodontists. Since the white paper's release, advocacy for contrarian ideas and practices remain. Orthodontists are sometimes acting as primary care providers for OSA. Procedures appropriate only for screening are sometimes being used for diagnosis. The side effects of effective treatments such as mandibular advancement devices need further consideration. Also, research has clarified the effectiveness and ineffectiveness of treatments such as palatal expansion. RESULTS: Part of an orthodontist's role is screening for OSA. The correct action when this is suspected remains referral to the appropriate physician specialist for diagnosis and treatment or coordination of treatment. Orthodontists may participate in the treatment of patients with OSA as a member of a multi-disciplinary team. Effective orthodontic treatments may include orthognathic surgery with maxillomandibular advancement and mandibular advancement devices. The negative effects of the latter make this a choice of last resort. Current research indicates that OSA alone is not sufficient indication for palatal expansion. CONCLUSIONS: Orthodontists should appropriately screen for obstructive sleep apnea. This may be done as part of our health histories, our clinical examination, and review of radiographs taken for purposes other than the diagnosis and screening for OSA. Orthodontic treatment for OSA can be helpful and effective. However, this may be done only after referral to the appropriate physician specialist, as part of a multi-disciplinary team, with consideration of the likely effectiveness of treatment, and after all likely and potential negative consequences have been considered and thoroughly discussed with the patient.

Evaluating the Therapeutic Properties of Natural Products in Orthodontic and Surgical Treatment of Dentofacial Deformities: A Systematic Review of Clinical Trials.

The use of natural products as alternatives to traditional pharmacological treatments in orthodontics is gaining interest due to their anti-inflammatory, antibacterial, and antioxidant properties. This systematic review synthesizes evidence from clinical trials to evaluate the efficacy of natural products in reducing inflammation and bacterial presence in orthodontic and orthognathic treatment settings. The database search was conducted across PubMed, Scopus, and Embase up to January 2024. The review focused on randomized controlled trials only. The selected studies centered on the anti-inflammatory, antibacterial, and antioxidant effects of natural products, adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for data extraction. Nine studies, totaling 358 participants, were included. Significant findings demonstrated a reduction in gingival inflammation by over 40% with the use of Aloe vera compared to chlorhexidine. Another study noted a decrease in bleeding on probing by 13.6 points in the treatment group over placebo. Additionally, honey showed a rapid modulation of plaque pH and significantly reduced bacterial counts of Streptococcus mutans. Furthermore, the use of resveratrol emulgel was linked to substantial improvements in gingival health, with a reduction in the gingival index and probing pocket depth. The results indicate that natural products can significantly enhance orthodontic treatment outcomes by reducing inflammation and bacterial levels. These products offer effective alternatives to traditional treatments and show potential for integration into routine orthodontic care protocols. Further research is encouraged to standardize application methods and dosages to maximize clinical benefits and patient satisfaction.

Comparative Evaluation of Digital Cephalometric Tracing Applications on Mobile Devices and Manual Tracing.

BACKGROUND Cephalometric radiography evaluates facial skeleton development and aids in diagnosis and treatment phases (pre and post) in orthodontics. This study aimed to compare digital cephalometric tracing using a smartphone application (App), a tablet-based platform, and manual tracing in 30 orthodontic patients. MATERIAL AND METHODS Thirty orthodontic pretreatment, criteria based, lateral cephalometric radiographs were analyzed/grouped for Steiner analysis parameters (5 skeletal, 3 dentals, 1 soft tissue) by 3 tracing methods [manual - group (Gp M), smartphone (Android - OS9) - Gp S, tablet (Apple - IOS13) - Gp T) after mandatory standardization/calibration. Measurements include 5 angular (SNA, SNB, ANB, SNMPA, SNOP), 3 linear U1NA, L1NB, U1L1, and 1 soft tissue (S line) (millimeters and degrees). Inter-examiner rating was determined using Dahlberg's test. After normality distribution testing (Shapiro-Wilk), data were analyzed using one-way analysis of variance (ANOVA) for group differences. Homogeneity of variance was verified using the Levene test. Differences were determined on probability value of (p≤0.05). RESULTS The results showed that Steiner's analysis parameters were similar in all groups with homogenous variances. Highest differences in mean values were found for L1NB, U1L1, and S line measurement, with higher values being observed in Gp S tracings. However, these differences were not statistically significant (p≤0.05). All parameters, irrespective of being measured in either degrees or millimeters, had means comparable to each other. CONCLUSIONS Smartphone and tablet-based applications produced tracings that were comparable and reliable when compared to conventional manual tracings. Standardization of images, processing, printing, and calibration of devices is important to achieve good results.

The Synergy of Periodontic and Orthodontic Collaboration in Contemporary Oral Health Practice.

Orthodontic treatment (OT) has become a means of improving psychosocial well-being secondarily to enhanced occlusal function and can help patients obtain normal oral physiologic function, coordinated facial profiles, and healthy dentomaxillofacial development. With more adult patients undergoing OT, the need for interdisciplinary treatment and collaboration is vital to ensure periodontal health. This article highlights the importance of combined efforts between periodontics and orthodontics in adult patients with a history of periodontitis who are interested in OT. Furthermore, the article discusses the technological and surgical advances within these specialties, as well as timing of synchronization of treatment. A clinical case demonstrates the results of a collaborative periodontics and orthodontics approach to treat an adult patient with a history of advanced periodontal disease.

A bibliometric analysis of the 100 top-cited systematic review and meta-analysis in Orthodontics.

OBJECTIVE: This bibliometric study aimed to analyze the citation metrics, journal and author characteristics, and subject domains of the 100 top-cited Systematic Reviews (SR) and Meta-Analysis (MA) in orthodontics. MATERIAL AND METHODS: An electronic database search was conducted for SR and MA in the Web of Science on 16th July 2023, without language and time restrictions. Of the 802 hits returned, the 100 top-cited orthodontic articles were shortlisted. They were analyzed for citation metrics, journal characteristics (journal, year of publication, impact factor-IF), author and affiliation characteristics (number, primary and corresponding author's affiliation, and country), study domain, and keywords. RESULTS: These articles were published from 1996 to 2021 in 20 journals, with an impact factor of 1.9 to 10.5, by 351 researchers affiliated with 104 universities. Their citations ranged from 45 to 344, and 34 poised to be classified as classic (≥ 100 citations). The maximum number of articles was published in the American Journal of Orthodontics and Dentofacial Orthopedics (n=38), the European Journal of Orthodontics (n=18), and the Angle Orthodontist (n=8). The authors for individual papers ranged from 1 to 10, with 5 being the most common (n=58). Europe had the highest contribution regarding the number of corresponding authors, institutions, and citations. Bone anchorage and orthodontic tooth movement/Biomechanics were the most frequently researched domains (n=11 each). The most common keyword used was Orthodontics (n=19), followed by Systematic Review (n=16) and Meta-analysis (n=9). CONCLUSION: In general, the top cited SR and MA were published in high-impact orthodontic journals, were multi-authored, and reflected the collaborative work from different universities.

Un "boxing" the reality: Knowledge, attitude, and perception of orthodontists, dental practitioners, and orthodontic patients toward mouthguards' wear during contact sports-A cross-sectional study.

INTRODUCTION: Mouthguards (MGs) have the potential to prevent contact sport-related dental injuries. However, varying perceptions of their effectiveness persist, influencing recommendations by dental professionals. AIM: To assess the attitudes, knowledge, and perceptions of orthodontists, other dental practitioners (general dentists and other dental specialists), and orthodontic patients involved in contact sports regarding the use of MGs. METHODOLOGY: A cross-sectional survey was designed to collect information from dental clinicians (orthodontists and other dental practitioners) and their orthodontic patients about using MGs during sports participation. A convenience sampling technique was used to recruit the participants for an online survey. A total of 107 (32 males/75 females) dental clinicians and 147 (75 males/72 females) orthodontic patients (mean age 17.5 ± 5.84 years) participated in the study. Pre-validated questionnaires, specifically designed for dental clinicians and orthodontic patients, were used. Data were analyzed using SPSS software (version 28.0; SPSS). RESULTS: Nearly 50% of dental clinicians have recently recommended MGs to their patients in their clinical practice out of which 59% preferred the stock type; 33% of dental clinicians enquired their patients about involvement in contact sports during initial visits. The majority of orthodontic patients acquired knowledge about MGs through the Internet. More than half of orthodontic patients expressed unwillingness to pay for MGs, and 89% of orthodontic patients found using MGs during contact sports uncomfortable. CONCLUSION: The findings provide valuable insights into the practices and attitudes of dental clinicians and orthodontic patients regarding MGs, their recommendations, and the comfort levels associated with using them during contact sports.

Patient safety in orthodontic care: a scoping literature review with proposal for terminology and future research agenda.

BACKGROUND: Knowledge about patient safety in orthodontics is scarce. Lack of standardisation and a common terminology hinders research and limits our understanding of the discipline. This study aims to 1) summarise current knowledge about patient safety incidents (PSI) in orthodontic care by conducting a systematic literature search, 2) propose a new standardisation of PSI terminology and 3) propose a future research agenda on patient safety in the field of orthodontics. METHODS: A systematic literature search was performed in the main online sources of PubMed, Web of Science, Scopus and OpenGrey from their inception to 1 July 2023. Inclusion criteria were based on the World Health Organization´s (WHO) research cycle on patient safety. Studies providing information about the cycle's steps related to orthodontics were included. Study selection and data extraction were performed by two of the authors. RESULTS: A total of 3,923 articles were retrieved. After review of titles and abstracts, 41 articles were selected for full-text review and 25 articles were eligible for inclusion. Seven provided information on the WHO's research cycle step 1 ("measuring harm"), twenty-one on "understanding causes" (step 2) and twelve on "identifying solutions" (step 3). No study provided information on Steps 4 and 5 ("evaluating impact" or "translating evidence into safer care"). CONCLUSION: Current evidence on patient safety in orthodontics is scarce due to a lack of standardised reporting and probably also under-reporting of PSIs. Current literature on orthodontic patient safety deals primarily with "measuring harms" and "understanding causes of patient safety", whereas less attention has been devoted to initiatives "identifying solutions", "evaluating impact" and "translating evidence into safer care". The present project holds a proposal for a new categorisation, terminology and future research agenda that may serve as a framework to support future research and clinical initiatives to improve patient safety in orthodontic care. REGISTRATION: PROSPERO (CRD42022371982).

Radiation exposure during orthodontic treatment: risk to children and adolescents.

OBJECTIVES: To estimate radiation risk to children and adolescents during orthodontic treatment by retrieving number and type of radiographs from the patient records. MATERIAL AND METHODS: Radiographs, along with justifications for radiation exposure, were obtained retrospectively from the patient records of 1,790 children and adolescents referred to two Swedish orthodontic clinics. Data were grouped according to treatment stage: treatment planning, treatment, and follow-up. Estimated risk was calculated using the concept of effective dose. RESULTS: Each patient had received around seven radiographs for orthodontic purposes. The most common exposures during treatment planning were one panoramic, one lateral, and three intraoral periapical radiographs. A small number of patients received a tomographic examination (8.2%). Few justifications for treatment planning and follow-up, but more in the actual treatment stage, had been recorded. The most common examinations were to assess root resorption and the positions of unerupted teeth, or simply carry out an unspecified control. The estimated risk of developing fatal cancer was considered low. The radiation risk from orthodontic treatment was equivalent to about 5-10 days of natural background radiation. CONCLUSIONS: Children and adolescents sometimes undergo multiple radiographic examinations, but despite the low radiation burden, accumulated radiation exposure should be considered and justified in young patients.