Vol. 15 No. 3 (2025): International Dental Research

Aim: The aim of this study is to compare three large language models (LLMs) (ChatGPT-5, Gemini 2.5 Flash, and DeepSeek-V3.1) in terms of accuracy, understandability, and readability, based on the answers provided to frequently asked endodontic questions. Methodology: Thirty open-ended frequently asked questions were generated using the AlsoAsked and AnswerThePublic websites. Two experienced endodontists scored the accuracy of the responses using a 5-point Likert scale. The understandability of the responses was analyzed using the Patient Education Materials Assessment Tool for Printed Materials (PEMAT-P) tool. Readability was assessed using the Flesch-Kincaid Readability Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), and Coleman-Liau Index (CLI). Group comparisons were performed using the ANOVA/Kruskal-Wallis test, followed by post-hoc Dunn-Bonferroni tests. Results: Inter-rater agreement was excellent (accuracy ICC: 0.908–0.917; reliability ICC: 0.992–0.995; all p < 0.001). A significant difference was found between the models in terms of accuracy (p < 0.001): DeepSeek-V3.1 (4.63 ± 0.81) scored the highest and performed significantly better than ChatGPT-5 (3.93 ± 0.79) and Gemini 2.5 Flash (3.67 ± 0.76). No significant difference between ChatGPT-5 and Gemini 2.5 Flash (p > 0.05). The understandability (PEMAT-P) scores were similar (p = 0.683), and all models scored above 70% (ChatGPT-5, 77.46%; Gemini, 76.04%; DeepSeek-V3.1, 77.57%). Differences were found in readability metrics: DeepSeek-V3.1 scored higher than ChatGPT-5 in FRES (p = 0.044); Gemini scored higher than DeepSeek-V3.1 in FKGL (p = 0.001); in GFI, Gemini 2.5 Flash scored higher than both ChatGPT-5 (p = 0.036) and DeepSeek-V3.1 (p < 0.001); in SMOG, Gemini outperformed DeepSeek-V3.1 (p = 0.003); and in CLI, ChatGPT-5 was higher than DeepSeek-V3.1 (p = 0.004). No significant correlation was found between readability and understandability (p > 0.05). Conclusion: DeepSeek-V3.1 outperformed ChatGPT-5 and Gemini 2.5 Flash in terms of accuracy. While all models produced similar scores above the PEMAT-P understandability threshold (70%), there were significant differences in readability metrics; furthermore, no model consistently reached the recommended 6 th –8 th grade level.

Aim: This study proposes a support vector machine (SVM)-based classification model for detecting dental caries in panoramic dental orthopantomography (OPG) images. The primary objective is to develop a computationally efficient, reproducible, and clinically adaptable method that enables the automatic differentiation between carious and healthy tooth structures. Methodology: The images used in the study were first subjected to standard resizing and normalization steps. The extracted features were then prepared for classification through feature scaling, feature selection, and dimensionality reduction processes. Hyperparameter grid search, stratified k-fold cross-validation, and decision threshold optimization were applied during the model development process. Medically meaningful metrics, including accuracy, precision, sensitivity, F1 score, area under the receiver operating characteristic (ROC) curve (AUC), and the confusion matrix, were used in the performance evaluation. Results: The SVM model demonstrated balanced and stable performance throughout cross-validation. ROC and Precision–Recall analyses showed that the model has a high capacity to distinguish between decayed and healthy classes. Decision threshold scanning revealed that false-positive and false-negative rates can be optimized according to clinical requirements. Conclusion: The results show that the proposed SVM-based approach offers a reliable and feasible method for automatic caries detection from panoramic OPG images. This study highlights that traditional machine learning methods, when combined with structural feature engineering, are suitable for supporting dental diagnosis processes. Future studies should test the model on larger datasets and perform multi-classification of different dental pathologies.

Aim: Cleft lip and palate (CLP) are among the most prevalent congenital anomalies, necessitating long-term, multidisciplinary care. In recent years, patients and their families have increasingly turned to online platforms, such as YouTube, for health-related information. This study aimed to assess the quality and reliability of information in Turkish-language YouTube videos concerning CLP. Methodology: A cross-sectional analysis of YouTube videos was conducted in August 2025. The platform was searched using the keywords "cleft lip" and "cleft palate," and the first 110 relevant videos were included for analysis. Videos were evaluated using a comprehensive scoring system based on ten criteria, including etiology, surgical and orthodontic treatment, feeding, and prognosis. Videos were also categorized by their source: individual health professionals, corporate health professionals, health websites, and independent users. Descriptive statistics and the Kruskal-Wallis test were used to analyze data. Results: Of the 109 videos analyzed, the mean total information score was 5.3 ± 4.5 (out of a possible 24). The majority of videos (66.1%) were of poor quality (score 0-5). The most frequently covered topics were surgical treatment (66.1%) and prognosis (66.1%), while prenatal diagnosis (15.6%) and Nasoalveolar molding (NAM) (15.6%) were the least covered. Although videos from corporate health professionals had the highest mean score (8.0 ± 6.1), there was no statistically significant difference in the information quality across the different source categories (p = 0.086). Conclusion: While YouTube contains a vast amount of information regarding cleft lip and palate, the overall quality is poor and highly variable. Healthcare professionals should be aware of the information their patients may be accessing and should consider taking an active role in creating and directing patients to high-quality, reliable online content.

Aim: The aim of this investigation was to compare recently released ProTaper Ultimate system (PTU) instruments, ProTaper Next (PTN), and ProTaper Gold (PTG) in terms of apically extruded debris and irrigant. Methodology: Forty-five human extracted mandibular molar teeth had their mesial roots decoronated. The roots were then split into three groups (n = 15) for the root canal preparation system: PTU, PTG, and PTN. Using the Myers and Montgomery technique, the roots were embedded in the experimental apparatus to collect and analyze the extruded material. The root canals were prepared according to the manufacturer's instructions. The weights of the extruded debris and irrigant were analyzed using ANOVA with post hoc Tukey tests to evaluate the level of significance (p < 0.05). Results: The PTU group produced the least amount of irrigant and debris. The amount of extruded irrigant produced by each group was statistically significantly comparable (p > 0.05). PTU produced lower debris weight than PTG in terms of debris extrusion (p < 0.05). For apically extruded debris, no statistically significant differences were observed among the other comparison pairs (p > 0.05). Conclusion: For apically extruded irrigant extrusion, the investigated instrument systems produced comparable results. Similar to PTG, the recently introduced PTU method showed promising findings.

Aim: This study aimed to comprehensively evaluate the dimensional compatibility of bioceramic-impregnated gutta-percha cones across four ISO sizes (#20, #25, #35, and #45) by measuring their tip diameters (D0) with ISO 6877 size standards using a quantitative, in vitro approach. Methodology: Bioceramic-impregnated gutta-percha cones with four different sizes were selected, and tip diameters (D0) were measured using an endodontic gauge ruler. Groups were #20 (primary), #25 (small), #35 (medium), and #45 (large), each containing 20 gutta-percha samples. All testing was performed in accordance with ISO 6877. Cones were categorized as compliant, undersized, or oversized. A chi-square test (p = 0.74) was conducted to assess intergroup differences. Results: 72.5% of cones met ISO standards, while 27.5% were undersized. No cones were oversized. The rates of compliance across groups varied slightly but not statistically significantly. Conclusion: While most cones comply with ISO 6877 standards, a notable proportion did not, indicating the need for enhanced manufacturing precision. The gutta-percha used during the cone fit trial may be used for the final obturation without being replaced with a new one from the package until manufacturers ensure comprehensive standardization.

Aim: The aim of this study was to compare and evaluate the accuracy and completeness of responses to open-ended questions about the use of ozone in dentistry that were addressed to three recent large language models (LLMs): ChatGPT-5, Gemini 2.5 Flash, and DeepSeek-V3.2. Methodology: A total of 25 open-ended questions on the subject of ozone in dentistry were asked to three different LLMs (ChatGPT-5, Gemini 2.5 Flash, and DeepSeek-V3.2). The chat history was deleted after each response, and a new session was started for each question. All questions were asked only once using the same computer IP address, on the same day, on the same fixed fiber Internet network. The questions were asked to the chatbots in English, and English responses were obtained and recorded. The responses were evaluated independently by two restorative dentistry specialists using two separate Likert scales for accuracy and completeness. In the statistical analyses, the Intraclass Correlation Coefficient (ICC) was calculated, and the Shapiro–Wilk, Kruskal–Wallis, Dunn–Bonferroni, and Spearman tests were applied. ​Results: The agreement between the evaluators was found to be high in respect of the accuracy points and varied according to the model for the completeness points. Significant differences were determined between the LLMs in the comparisons of the accuracy scores (p < 0.001). The median points of the ChatGPT-5 and DeepSeek-V3.2 models were determined to be statistically significantly higher than those of Gemini 2.5 Flash (p = 0.002 and p < 0.001, respectively). Significant differences were observed between the LLMs in terms of completeness scores (p = 0.004). In the subgroup analyses, the mean points of the ChatGPT-5 and DeepSeek-V3.2 models were determined to be statistically significantly higher than those of Gemini 2.5 Flash (p = 0.006 and p = 0.021, respectively). Conclusion: The responses to questions about the use of ozone in dentistry showed differences among the LLMs in terms of accuracy and completeness. ChatGPT-5 and DeepSeek-V3.2 demonstrated better performance than Gemini 2.5 Flash. Despite the high accuracy rates, it must not be forgotten that incorrect healthcare information can lead to serious outcomes. Therefore, it should be recommended that LLMs be used under human supervision in clinical applications and that future research focus on increasing the diagnostic reliability of artificial intelligence.

Aim: To evaluate postoperative pain of teeth with apical periodontitis after sonic irrigation activation. Methodology: One hundred five asymptomatic patients with periapical lesions were included in this study. After chemomechanical canal preparation using rotary instruments and NaOCl, the teeth were randomly assigned to three groups (n=35 per group): control (conventional needle irrigation-CNI), manual dynamic irrigation activation (MDI), and sonic irrigation activation (SI). In each group, final irrigation was performed using 3 ml of 2.5% NaOCl and 2 ml of 17% EDTA solution, and the relevant activation method. Patients recorded their pain intensity at 24 h, 48 h, and 7 days after treatment on a modified visual analogue scale (VAS), as well as their analgesic consumption. Demographic data and pain levels were compared across groups using Fisher’s Exact and one-way ANOVA tests, with differences of p < 0.05 considered statistically significant. Results: There was a significant increase in pain levels at 24 and 48 hours postoperatively, and no difference was found between the groups (p = 0.1464 and p = 0.0655, respectively). At day 7 postoperatively, pain intensity and incidence were significantly lower in the SI group compared to the CNI and MDI groups (p = 0.0435). However, the frequency of analgesic intake did not differ significantly between the groups (p = 0.863). Furthermore, none of the methods resulted in any adverse effects. Conclusion: The conventional needle irrigation and manual dynamic activation used in this study were associated with a similar intensity of postoperative pain in asymptomatic patients receiving primary root canal treatment. However, on the seventh day, sonically activated irrigation resulted in lower postoperative pain.

Aim: This study aimed to evaluate the effect of different surface treatment protocols on the color stability of two CAD/CAM restorative materials, a hybrid ceramic (Vita Enamic) and a resin-based composite (Shofu Block HC), when exposed to filter coffee. Methodology: Sixty disk-shaped specimens (12 mm diameter, 1.5 mm thickness) were prepared from Vita Enamic and Shofu Block HC. The specimens were divided into six groups (n=10) based on the material and surface treatment: Mechanical Polishing Only, Glaze (Optiglaze) Only, and Mechanical Polishing + Glaze. After the surface treatments, baseline color measurements were performed using a spectrophotometer (Vita EasyShade V). The specimens were then immersed in a freshly prepared filter coffee solution, which was renewed daily for 15 days (simulating ~3 years of clinical exposure). Post-immersion color measurements were taken, and the color difference (ΔE) and lightness difference (ΔL) were calculated. Data were analyzed using two-way ANOVA and Tukey's HSD test (p < 0.05). Results: Two-way ANOVA revealed significant main effects of Material and Surface Treatment on both ΔE and ΔL (p < 0.001). A significant Material × Surface Treatment interaction was found for ΔL (p = 0.012) but not for ΔE (p = 0.207). Vita Enamic demonstrated significantly lower ΔE and higher ΔL values than Shofu Block HC, indicating better overall color stability and less darkening. For both materials, Mechanical Polishing Only resulted in significantly lower ΔE than glaze only or the combination group. For ΔL, Mechanical Polishing was superior for Vita Enamic, whereas Glaze Only yielded the most unfavorable results for Shofu Block HC. Conclusion: The color stability of CAD/CAM materials is significantly influenced by both material composition and surface treatment applied. Mechanical polishing provided the best color stability for both materials tested. Clinically, for restorations prone to coffee exposure, selecting a hybrid ceramic like Vita Enamic and finishing it with mechanical polishing is recommended to optimize long-term aesthetic performance.

With advances in adhesive dentistry, endocrowns have emerged as a minimally invasive alternative to traditional methods for restoring endodontically treated teeth with severe tooth structure loss. Unlike traditional post applications, endocrowns are monoblock restorations anchored in the pulp chamber and the remaining coronal tooth tissue. The aim of this review is to evaluate the biomechanical properties, clinical performance, and key factors affecting the success of endocrown restorations in light of the current literature. While traditional post-core applications can weaken the tooth structure and increase the risk of root fractures, endocrowns offer advantages such as lower cost, shorter preparation time, and maximum preservation of tooth tissue. The literature reports that endocrowns exhibit excellent survival rates and adequate clinical performance in molar teeth. However, the higher non-axial (horizontal/lateral) forces and narrower bonding surfaces encountered in premolar and anterior teeth can increase the risk of restoration failure. One of the most important factors affecting clinical success is the preparation design. For optimal retention, the central retention cavity should have a minimum depth of 3 mm and a cervical margin width of at least 2 mm. Adding a ferrule, short axial walls, and a shoulder/chamfer finish line to the restoration design significantly increases fracture resistance. Furthermore, the application of immediate dentin sealing (IDS) protocols improves dentin bond strength and minimizes the risk of debonding. During fabrication, direct methods using composite resins can be used, or indirect methods using CAD/CAM technology with materials such as lithium disilicate, zirconia-reinforced ceramics, polymer-infiltrated ceramic networks (PICN), or PEEK can be preferred. Provided that appropriate cavity design, bonding surface, and material selection are ensured, endocrowns can perform similarly to, or better than, conventional treatments such as inlays/onlays, post-core restorations, or direct composite restorations. As a promising alternative for restoring heavily damaged, endodontically treated teeth, further long-term clinical studies are needed to confirm their overall suitability.

Oral health and function are critical components of a patient's overall quality of life. Pulp necrosis in immature permanent teeth, resulting from trauma, caries, or developmental anomalies, presents a significant clinical challenge. Traditionally, apexification has been the routine treatment; however, it fails to promote continued root development, often leaving teeth brittle and susceptible to fractures. This review examines regenerative endodontic procedures (REPs), which represent a paradigm shift toward biologically based treatments designed to replace damaged structures and cells of the pulp-dentin complex. The success of REPs relies on the interaction of three key components: stem cells, bioactive molecules (growth factors), and scaffolds. During these procedures, a blood clot is typically induced to act as a scaffold, facilitating the influx of undifferentiated stem cells, such as stem cells of the apical papilla (SCAPs). The review details current clinical protocols recommended by the American Association of Endodontists (AAE) and the European Society of Endodontology (ESE). Key technical aspects include the use of low-concentration sodium hypochlorite (1.5%) to maintain cell viability and EDTA to promote the release of growth factors from the dentin matrix. Intracanal medicaments, specifically triple antibiotic paste (TAP) and calcium hydroxide, are evaluated for their disinfection efficacy and impact on stem cell survival. While REPs demonstrate high success rates in terms of symptom resolution and apical healing, histological evidence suggests the resulting tissue is often a repair (bone or cementum-like) rather than true pulpal regeneration. Despite these challenges, REPs offer a promising therapeutic pathway for increasing root length and wall thickness, ultimately enhancing the long-term retention of immature permanent teeth.

Ozone (O 3 ) therapy has been applied in medicine and dentistry for many years and has become increasingly widespread. Ozone, composed of three oxygen atoms (O 3 ), is a strong antioxidant and a highly effective antimicrobial agent. Ozone gas has high oxidizing properties and exhibits a 1.5-fold higher antimicrobial effect than chloride. Its use has become popular in many fields of dentistry in recent years, owing to its various properties. It is categorized as one of the non-invasive, atraumatic, protective, and preventive treatment modalities that have been improved by modern dentistry, and its acceptability among patients has increased as a result. Ozone is an antimicrobial, analgesic, and biosynthetic agent that stimulates the immune system, enhances blood circulation capacity, and positively affects oxygen transport mechanisms. It influences both cellular and humoral immunity. All three forms of ozone (gaseous, oil, and solution) can be used in dentistry. It is indicated for the treatment of approximately 300 different pathological conditions. Ozone is used in endodontics (irrigation solution, intracanal medicament, abscess cases, disinfection), periodontology (gingivitis, periodontitis, periimplantitis, surgical injuries, prophylaxis), oral pathology (stomatitis, aphthous ulceration, candidiasis, herpes lesions), oral, dental, and jaw surgery (implantation, reimplantation, simple-to-complicated tooth extraction, homeostasis, wound healing, temporomandibular joint (TMJ) surgery, osteonecrosis cases), prosthetic dental treatment (disinfection of fixed and removable prostheses), restorative dental treatment (caries lesions, dentine hypersensitivity, cracked tooth, bleaching), orthodontics (remineralization and prophylaxis of white spot lesions), pedodontics (caries lesions, root canal treatment, positive psychological impact, short treatment duration), and sterilization of dental instruments and units. This review aimed to describe the usage fields and effects of ozone in dental applications, provide insights into clinical practices in other fields of dentistry, and introduce newly conducted in vitro and in vivo studies.

Sjögren’s Disease (SD) is a chronic systemic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands, primarily affecting the lacrimal and salivary glands. The etiology and pathophysiology of the disease remain unclear. Fatigue and weakness are among the most common systemic symptoms, alongside ocular and oral dryness. Reduced salivary flow leads to dry mouth and lips, erythema of the oral mucosa and tongue, burning sensations in the tongue, atrophy of the filiform papillae, fissured tongue, and loss of taste. Patients with SD often experience a higher prevalence of dental caries and early tooth loss, which significantly impairs their oral health-related quality of life. This case report presents the comprehensive dental management of a 32-year-old female patient with a history of chronic SD over a 10-year follow-up period. The patient was referred to our clinic with multiple dental complaints. Clinical and radiographic examinations revealed extensive carious lesions, periapical pathoses, periodontal problems, pronounced tooth sensitivity, and hyposalivation. For treatment, a combination of surgical (e.g., apical resection) and nonsurgical procedures, including coronal restorations, endodontic therapies, and prosthodontic rehabilitations, was performed. During the 10-year follow-up, the treated teeth remained asymptomatic, and radiographic evaluations showed complete healing of the lesions, with no need for additional surgical intervention.