Vol. 16 (2026): International Dental Research

DOI: https://doi.org/10.5577/idr.2026.vol16

Published: 01.01.2026

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Original Article

Comparative analysis of the performance of ChatGPT-5.4, Claude Sonnet 4.6, and Gemini 3.1 Pro large language models on theoretical orthodontic questions

Aim: This study aimed to comparatively evaluate the performance of ChatGPT-5.4, Claude Sonnet 4.6, and Gemini 3.1 Pro large language models (LLMs) in answering theoretical orthodontic questions under web search-enabled conditions. Methodology: A total of 30 open-ended questions covering the topics of growth and development, functional analysis, mixed dentition, extraoral appliances, malocclusion, and orthodontic treatment planning were prepared from Contemporary Orthodontics (7th edition, 2025). The questions were presented to all three models under standardized conditions in separate sessions in March 2026 with web search enabled. The responses were anonymized and independently evaluated in a blinded manner by two orthodontists using a 5-point Likert scale incorporating accuracy, scientific adequacy, completeness, and clarity into a single overall score. Data were analyzed using IBM SPSS Statistics (version 31.0); the Friedman test was used for model comparisons, and statistical significance was set at p < 0.05. Results: Mean performance scores were 4.40 ± 0.72 for ChatGPT-5.4, 4.43 ± 0.61 for Claude Sonnet 4.6, and 4.32 ± 0.88 for Gemini 3.1 Pro. Median scores were 4.50, 4.50, and 4.75, respectively. No statistically significant difference in overall performance was found among the models (χ² = 0.400; df = 2; p = 0.819; Kendall's W = 0.007). Subgroup analyses by topic category also revealed no significant differences in any category (all p > 0.05). Inter-rater reliability was limited (α = 0.706). Conclusion: All three models achieved high-performance scores, with no statistically significant difference in overall performance among them; this does not establish equivalence. With independent verification, these LLMs may serve as supportive tools in orthodontic education.

Artificial intelligence, ChatGPT, dental education, knowledge assessment, large language models, orthodontics

Buket Erdem, Salih Baver Ataş, Meriç Arslan, Çağla Şar
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e260777
Abstract Views: 187 Download: 64 10.5577/intdentres.777
Evaluation of the prevalence of malocclusion in individuals applying for orthodontic treatment in the Turkish community: A cross-sectional study

Aim: This study aimed to determine the prevalence of different types of dental and skeletal malocclusions among individuals seeking orthodontic treatment and to evaluate the relationship between these classifications. Methodology: This retrospective cross-sectional study included 5160 individuals (3096 females and 2064 males) who presented for orthodontic consultation and had complete clinical records, including intraoral examinations and lateral cephalometric radiographs. Dental malocclusions were classified according to Angle’s classification system (Class I, II, and III) based on molar relationships. Skeletal malocclusions were determined using ANB angle measurements obtained from cephalometric analyses, with standard values used to categorize patients into skeletal Class I, II, or III groups. Results: Class II (63.6%) was the most common dental malocclusion, Class I (18.4%) and Class III (18.0%) were less common. In terms of skeletal classification, Class II (50.0%) was the most common, followed by Class I (30.4%) and Class III (19.5%). Malocclusion distributions differed significantly by sex (dental: p = 0.007; skeletal: p < 0.001), although the effect sizes were negligible. There was a moderate positive correlation between the dental and skeletal classifications ( rho =0.401, p <0.001). Conclusion: Class II malocclusion was the most prevalent in both dental and skeletal classifications. The relatively similar rates of Class I and Class III in dental classification highlight the need for careful diagnostic assessment. The moderate correlation between dental and skeletal classifications emphasizes the importance of combining occlusal and cephalometric evaluations to inform individualized treatment planning.

Angle's classification, cephalometry, dental occlusion, epidemiology, malocclusion, prevalence

Handan Göze Oğuz, Fırat Oğuz, Onur Kaya
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e260640
Abstract Views: 350 Download: 134 10.5577/intdentres.640
3D micro-CT analysis of void formation of glass fiber posts bonded using different resin cements

Aim: The aim of this in vitro study was to evaluate and compare the void volumes at the dentin–post interface when glass fiber posts were bonded using different resin cements, as assessed by 3D micro-computed tomography (µCT). Methodology: For this investigation, thirty extracted human maxillary central incisors with a single root were chosen. The specimens were divided into three groups at random (n = 10) and restored with glass fiber posts that were cemented using Variolink N, Panavia F 2.0, and RelyX Unicem resin cements, respectively. A resolution of 13.7 µm was used for high-resolution µCT scanning to obtain detailed images of the specimens. The Kruskal–Wallis test (post hoc: Mann–Whitney U with Bonferroni correction), the Friedman test, and the Spearman rank correlation test (α = 0.05) were used for statistical evaluation. Results: µCT analysis revealed that the mean total void volume at the dentin–post interface was 1.67 ± 0.69 mm³ for the Variolink N group, 2.59 ± 1.75 mm³ for the Panavia F 2.0 group, and 3.28 ± 2.13 mm³ for the RelyX Unicem group. The differences between the groups were statistically significant (p < 0.05), with the lowest void volume in the Variolink N group and the highest in the RelyX Unicem group. Within each group, void formation was distributed homogeneously across root levels (p > 0.05), whereas specimens cemented with RelyX Unicem showed significantly higher void formation in the apical third than the other two cements (p < 0.05). No correlation was found between empty canal volume or empty canal surface area and void volume (p = 0.34 and p = 0.19, respectively). Conclusion: Post-cementation analysis revealed significant differences in total void volume among the resin cements, whereas within-group regional comparisons did not yield statistically significant differences. Decementation of fiber posts is frequently associated with voids within the luting cement layer, so the choice of resin cement and its delivery technique remains clinically relevant.

Fiber post, resin cement, micro-CT, void formation, luting agent

Zuhal Görüş, Anastasiia Bilei, Hayriye Yasemin Yay Kuşçu, Nur Sena Alioğlu Koparal
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e260766
Abstract Views: 617 Download: 163 10.5577/intdentres.766
Evaluation of gingival crevicular fluid apelin levels in relation to periodontal status and type 2 diabetes

Aim: Adipokines in gingival crevicular fluid (GCF) may reflect systemic metabolic and inflammatory conditions, including diabetes and periodontitis. Apelin, a multifunctional peptide expressed in adipose tissue and various organs, is involved in both metabolic regulation and inflammatory pathways and therefore represents a biologically relevant mediator for exploring the link between diabetes mellitus and periodontitis. This study aimed to investigate GCF apelin levels in periodontally healthy individuals, patients with periodontitis, and those with periodontitis and Diabetes Mellitus (DM). Methodology: Ninety participants were enrolled and equally distributed into three groups (n=30 each): Healthy, periodontitis, and periodontitis+DM. Clinical parameters were recorded, and GCF samples were collected for apelin measurement using ELISA. Data were analyzed using nonparametric and categorical statistical tests according to the distribution and type of variables. Results: GCF apelin levels were comparable among the periodontally healthy, periodontitis, and periodontitis+DM groups, showing no statistically significant differences (p = 0.991). An inverse correlation was observed between GCF volume and apelin concentration (r s = –0.39; p <0.001). No significant differences were observed among the groups in terms of age, gender, or BMI (p > 0.05). Conclusion: GCF apelin levels did not differ significantly among the study groups. The inverse correlation between apelin concentration and GCF volume, an indirect indicator of local inflammation, may reflect a relationship with local inflammatory status. These findings suggest that GCF apelin alone has limited clinical value for distinguishing periodontitis with DM. Therefore, measuring GCF apelin as a single biomarker is not recommended for identifying periodontal disease status or diabetic individuals within a periodontal population. Nevertheless, these results contribute to understanding the relationship between metabolic conditions and periodontal inflammation. Further longitudinal and mechanistic studies are needed to clarify the origin and regulation of apelin in periodontal tissues and to determine its potential role as a biomarker or therapeutic target.

Apelin, periodontitis, diabetes mellitus, gingival crevicular fluid, adipokine, periodontal health

Canan Akdeniz, Arzum Güler Doğru, Revşa Evin Canpolat Erkan
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e260729
Abstract Views: 835 Download: 268 10.5577/intdentres.729
Comparative evaluation of apical pressure generated by EDDY, GentleWave G4, and passive ultrasonic irrigation: A 3D-printed root canal model

Aim: This in vitro study compared the mean and peak apical pressures generated by EDDY, GentleWave G4, and passive ultrasonic irrigation (PUI) in a standardized 3D-printed root canal model. Methodology: A standardized straight root canal model (apical diameter 0.25 mm, 4% taper, 16 mm working length) was fabricated by resin-based stereolithographic printing. Apical pressure was measured with a validated setup comprising a piezoresistive pressure transducer (PXM409-350; Omega), a DAQ board (USB6008; National Instruments), and LabVIEW software. Distilled water served as the irrigating medium. Twenty measurements were performed per group (n=20, 60 total), with each recording 12,020 data points over 12 seconds. EDDY was activated with a TA-200 air scaler (power level 2, #25/.04 tip); GentleWave G4 was operated per the manufacturer's protocol; and PUI was performed with a Newtron P5 XS ultrasonic unit (power level 6, IrriSafe #20 tip, 2 mm short of the working length). Normality was confirmed by the Shapiro-Wilk test, and group comparisons were performed using Welch ANOVA with Games–Howell post hoc comparisons. The study followed PRILE 2021 reporting guidelines. Results: Significant differences were observed across all groups for both mean and peak apical pressures (p < 0.001). EDDY produced the highest mean (16.03 ± 4.04 mmHg) and peak (35.53 ± 2.84 mmHg) apical pressures, exceeding the safety threshold in every measurement. GentleWave G4 yielded a negative mean apical pressure (−15.60 ± 7.96 mmHg) and a mean peak of 8.00 ± 6.76 mmHg, remaining below the threshold throughout. PUI generated near-zero mean apical pressure (−0.07 ± 0.05 mmHg) and a mean peak of 2.27 ± 0.05 mmHg, consistently below the critical threshold. All pairwise comparisons were significant (p < 0.001), including GentleWave G4 vs. PUI for peak pressure (p = 0.003). Conclusion: GentleWave G4 and PUI produced apical pressures below the established safety threshold, whereas EDDY exceeded it in all measurements, indicating a higher risk of periapical irrigant extrusion. Further ex vivo and in vivo studies with anatomically complex geometries are warranted.

Apical pressure, endodontic irrigation, GentleWave G4, irrigant extrusion, sonic activation, PUI

Hande Özyürek, Taha Özyürek, Olcay Özdemir, Ali Aminimofrad, Özkan Adıgüzel, Mustafa Gündoğar
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e260742
Abstract Views: 1091 Download: 320 10.5577/intdentres.742
Knowledge, attitudes, and clinical practices of Turkish medical and dental practitioners regarding botulinum toxin use: A cross-sectional survey

Aim: This study aimed to evaluate the knowledge, attitudes, clinical practices, preferred indications, and adverse effects associated with botulinum toxin (BTX) use among medical and dental practitioners in Türkiye. Methodology: An online, self-administered questionnaire adapted from previously published studies was conducted between October 9 and December 9, 2023. A total of 276 physicians and dentists across Türkiye voluntarily participated. Participants were recruited using convenience sampling via online distribution. The survey consisted of 16 questions assessing demographic characteristics, BTX experience, indications for use, number of patients treated annually, preferred commercial formulations, adverse effects, and bruxism management preferences. Statistical analyses were performed using descriptive statistics, chi-square test, and the Fisher–Freeman–Halton exact test, with significance determined at p < 0.05. Results: A total of 53.3% of practitioners reported using BTX in clinical practice. The most common indications were bruxism (75.5%), facial wrinkles (67.3%), masseter hypertrophy (51.7%), and gummy smile (49%). OnabotulinumtoxinA was the most preferred formulation (73.5%). The most frequently reported treatment-related adverse effects were insufficient therapeutic response (49%) and localized stinging or burning pain during injection (22.4%). The injection-related adverse effects included pain (57.1%), bruising (49%), and headache (24.5%). Significant differences were observed across specialties and experience levels. BTX use was also significantly higher among practitioners working in private settings. Conclusion: The findings show that BTX was used by a considerable proportion of medical and dental practitioners in the study sample across both aesthetic and therapeutic indications. Differences observed according to workplace setting, certification status, specialty, and experience suggest that BTX-related practice patterns may not be uniform. These results highlight the potential need for structured education, certification, and standardization regarding BTX use in clinical practice.

Botulinum toxin, bruxism, temporomandibular disorders, medical practitioners, dental practitioners, onabotulinumtoxinA, incobotulinumtoxinA, abobotulinumtoxinA

Esra Bilgi Özyetim, Merve Dede
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e260695
Abstract Views: 1102 Download: 346 10.5577/intdentres.695

Year	Citations
2019	37
2020	49
2021	71
2022	112
2023	145
2024	139
2025	202
2026 (to date)	185

Vol. 16 (2026): International Dental Research

Full Issue

Original Article

Comparative analysis of the performance of ChatGPT-5.4, Claude Sonnet 4.6, and Gemini 3.1 Pro large language models on theoretical orthodontic questions

Evaluation of the prevalence of malocclusion in individuals applying for orthodontic treatment in the Turkish community: A cross-sectional study

3D micro-CT analysis of void formation of glass fiber posts bonded using different resin cements

Evaluation of gingival crevicular fluid apelin levels in relation to periodontal status and type 2 diabetes

Comparative evaluation of apical pressure generated by EDDY, GentleWave G4, and passive ultrasonic irrigation: A 3D-printed root canal model

Knowledge, attitudes, and clinical practices of Turkish medical and dental practitioners regarding botulinum toxin use: A cross-sectional survey

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