IAES
Inter
national
J
our
nal
of
Articial
Intelligence
(IJ-AI)
V
ol.
15,
No.
1,
February
2026,
pp.
97
∼
105
ISSN:
2252-8938,
DOI:
10.11591/ijai.v15.i1.pp97-105
❒
97
Articial
intelligence
in
orthodontics:
modeling
decision
support
systems
f
or
tr
eatment
planning
So
wmya
Lakshmi
Belur
Subramanya,
Adv
aith
V
ijaya
Mohan,
Achala
V
arsha
V
ishla
v
ath
Pr
emalatha,
Manchikanti
V
arunsai
Department
of
Machine
Learning,
B.M.S.
Colle
ge
of
Engineering,
Beng
aluru,
India
Article
Inf
o
Article
history:
Recei
v
ed
Aug
12,
2024
Re
vised
Oct
15,
2025
Accepted
Dec
15,
2025
K
eyw
ords:
Articial
intelligence
Machine
learning
Orthodontics
Predicti
v
e
modeling
T
reatment
planning
ABSTRA
CT
Orthodontic
treatment
planning
in
v
olv
es
comple
x
clinical
decision-making
that
can
benet
from
articial
intel
ligence
(AI).
This
study
e
v
aluates
machine
learning
and
deep
learning
models—including
random
forest,
AdaBoost,
gradient
boosting,
and
articial
neural
netw
orks
(ANNs)—for
predicting
orthodontic
treatment
strate
gies
using
a
dataset
of
612
anon
ymized
patient
records
wit
h
66
clinically
v
alidated
features
across
four
cate
gories
(e
xtraction,
non-e
xtraction,
functiona
l
appliance,
and
orthopedic
case
).
Preprocessing
included
imputation,
normalization,
and
synthetic
minority
o
v
ersampling
technique
(SMO
TE)
for
class
imbalance,
while
performance
w
as
assessed
via
10-fold
cross-v
alidation.
Results
sho
wed
that
ANNs
achie
v
ed
the
highest
balanced
accurac
y
(0.83),
F1-score
(0.84),
and
recei
v
er
operating
characteristic
-
area
under
the
curv
e
(R
OC-A
UC)
(0.90),
outperforming
ensemble
and
baseline
models.
Shaple
y
additi
v
e
e
xplanations
(SHAP)
analysis
conrmed
clinically
meaningful
predictors
such
as
v
ertical
f
ace
proportions
and
mandib
ular
plane
angle,
enhancing
interpretability
.
Although
promising,
the
study
is
limited
by
its
single-institution
dataset
and
lack
of
e
xternal
v
alidation.
Future
research
should
incorporate
multicenter
,
multimodal
datasets
and
interpretable-by-design
frame
w
orks
t
o
enable
clinically
trusted
AI
decision-support
systems
in
orthodontics.
This
is
an
open
access
article
under
the
CC
BY
-SA
license
.
Corresponding
A
uthor:
So
wmya
Lakshmi
Belur
Subraman
ya
Department
of
Machine
Learning,
B.M.S
Colle
ge
of
Engineering
Bull
T
emple
Road,
Basa
v
anagudi,
Beng
aluru,
Karnataka,
India
Email:
so
wmyalakshmibs.mel@bmsce.ac.in
1.
INTR
ODUCTION
Orthodontics,
a
branch
of
dentistry
,
subject
to
diagnose,
pre
v
ent,
and
correct
malocclusions,
or
misalignments,
of
the
teeth
and
ja
ws
[1].
Be
yond
enhancing
the
aesthetic
appearance
of
smiles,
orthodontic
interv
entions
play
a
vital
role
in
impro
ving
o
v
erall
oral
health
and
functional
well-being
[2].
T
raditional
orthodontic
treatments
in
v
olv
e
a
meticulous
process
of
clinical
e
xaminations,
radiographic
analyses,
and
the
use
of
dental
impressions
to
create
indi
vidualized
treatment
programs
based
on
the
particular
requirements
of
each
patient.
Recent
adv
ancements
in
articial
intelligence
(AI)
ha
v
e
spark
ed
a
transformati
v
e
shift
in
orthodontic
care,
signicantly
enhancing
precis
ion
and
ef
cienc
y
through
sophisticated
algorithms
and
machine
learning
[3].
AI
can
analyze
v
ast
datasets
of
clinical
information,
unco
v
er
patterns,
and
generate
predicti
v
e
insights
that
assist
orthodontists
in
treatment
planning,
thereby
augmenting
clinical
decision-making
and
e
xpertise.
In
addition
to
increasing
treatment
prediction
accurac
y
,
this
feature
enables
more
indi
vidualised
treatment
plans
J
ournal
homepage:
http://ijai.iaescor
e
.com
Evaluation Warning : The document was created with Spire.PDF for Python.
98
❒
ISSN:
2252-8938
that
are
catered
to
the
requirements
of
each
patient.
The
application
of
AI
in
orthodontics
encompasses
a
spectrum
of
machine
learning
models,
including
ensemble
techniques
such
as
AdaBoos
t
and
gradient
boost,
as
well
as
deep
learning
methods
lik
e
articial
neural
netw
orks
(ANNs).
These
models
le
v
erage
comple
x
datasets
and
comprehensi
v
e
patient
histories,
to
deli
v
er
insights
that
surpass
traditional
analytical
capabilities,
optimizing
treatment
outcomes
and
appliance
design
[4].
Be
yond
data
analysis,
AI
inte
gration
automates
routine
tasks
lik
e
image
analysis
and
treatment
simulation,
which
allo
ws
orthodontists
to
allocate
more
time
and
attention
to
direct
patient
care.
Real-time
feedback
from
AI
systems,
dri
v
en
by
current
clinical
data,
empo
wers
orthodontists
with
timely
insights
for
rened
treatment
planning
and
impro
v
ed
precision
in
clinical
outcomes
[5],
[6].
This
paper
critically
e
xamines
AI’
s
transformati
v
e
impact
on
orthodontic
treatment
planning.
It
assesses
the
performance
of
adv
anced
AI
techniques
in
predicting
treatment
outcomes
and
enhanci
ng
care
precision.
Emphasizing
the
potential
of
ensemble
methods
and
deep
learning
models,
this
study
underscores
AI’
s
capacity
to
re
v
olutionize
orthodontic
practice
by
ef
fecti
v
eness,
enhancing
clinical
judgement,
and
ultimately
enhancing
patient
satisf
action.
2.
LITERA
TURE
SUR
VEY
The
inte
gration
of
AI
into
orthodontics
has
accelerated
in
the
past
decade.
It
spans
diagnosis,
tr
eatment
planning,
monitoring,
and
orthodontic
sur
gery
.
Scoping
re
vie
ws
conrm
that
AI-dri
v
en
methods
enhance
diagnostic
precision,
reduce
inter
-e
xaminer
v
ariability
,
and
support
e
vidence-based
treatment
planning
[7].
Diagnosis
and
cephalometric
analysis,
AI
has
been
widely
applied
to
cephalometric
landmark
detection,
a
traditionally
labor
-intensi
v
e
task.
Con
v
olutional
neural
netw
orks,
U-Net,
and
ense
mble
learning
approaches
ha
v
e
achie
v
ed
landmark
detection
accuracies
e
xceeding
92%,
reducing
manual
errors
and
increasing
reproducibility
[8],
[9].
Automated
cephalometric
systems
demonstrate
substantial
impro
v
ements
in
diagnostic
reliability
and
standardization
across
institutions
[10].
T
reatment
planning
and
decision
support,
machine
learning
models,
and
ANNs—ha
v
e
been
used
to
predict
orthodontic
treatment
strate
gies.
Studies
report
accuracies
up
to
87%
in
distinguishing
e
xtraction
v
ersus
non-e
xtraction
cases
and
recommending
appliances
[11]–[13].
AI-po
wered
decision-support
systems
also
impro
v
e
communication
by
pro
viding
patients
with
treatment
outcome
simulations
[14].
Orthognathic
sur
gery
planning,
AI
models
ha
v
e
also
been
applied
in
sur
gical
conte
xts.
3D
con
v
olutional
neural
netw
orks,
reinforcement
learning,
and
generati
v
e
models
predict
sur
gical
outcomes,
simulate
osteotomy
procedures,
and
impro
v
e
pre-operati
v
e
planning.
Performance
metrics
such
as
Dice
similarity
(0.85–0.90)
conrm
clinical
feasibility
[15],
[16].
These
tools
enable
personalized
sur
gical
planning,
reducing
operati
v
e
times
and
enhancing
post-sur
gical
stability
.
T
reatment
monitoring
and
progress
assessment,
AI
has
been
e
xtended
to
monitoring
treatment
progression.
Deep
learning
methods
including
recurrent
neural
netw
orks
(RNNs)
and
Siamese
netw
orks
analyze
sequential
progress
images
and
wearable
sensor
data
to
detect
compliance
issues
and
early
relapse.
Reported
precision
and
recall
v
alues
e
xceed
0.80,
sho
wing
promising
reliability
for
real-time
clinical
feedback
[17],
[18].
Such
systems
assist
clinicians
in
early
interv
ention
and
indi
vidualized
monitoring.
Challenges
and
g
aps,
despit
e
adv
ances,
se
v
eral
g
aps
remain.
Most
datasets
are
single-inst
itutional,
limiting
generalizability
across
populations
[19]–[21].
Interpretability
is
often
inadequate,
creating
barriers
to
clinical
trust
[22],
[23].
Ethical
concerns
such
as
data
pri
v
ac
y
and
re
gulatory
appro
v
al
pathw
ays
further
constrain
deplo
yment
[24]–[26].
Addressing
these
issues
requires
multicenter
collaborations,
interpretable-by-design
models,
and
inte
gration
into
orthodontic
w
orko
ws.
3.
METHOD
The
suggested
AI-based
orthodontic
treatment
planning
model’
s
general
w
orko
w
is
sho
wn
in
Figure
1.
Ev
ery
step
of
the
procedure
is
described
in
the
o
wchart.
These
steps
include
dataset
g
athering,
preprocessing,
model
training,
v
alidation,
and
interpretability
analysis.
3.1.
Dataset
composition
and
sampling
The
dataset
w
as
curated
from
anon
ymized
patient
case
histories
pro
vided
by
the
Go
v
ernment
Dental
Colle
ge
and
Research
Institute,
Beng
aluru,
under
institutional
ethical
appro
v
al.
From
an
initial
pool
of
97
clinical
features,
66
were
identied
as
most
rele
v
ant
in
consultation
with
orthodontic
e
xperts.
These
included
Int
J
Artif
Intell,
V
ol.
15,
No.
1,
February
2026:
97–105
Evaluation Warning : The document was created with Spire.PDF for Python.
Int
J
Artif
Intell
ISSN:
2252-8938
❒
99
Care
y’
s
analysis,
composite
analysis,
v
ertical
f
ace
proportions,
mandib
ular
plane
angle,
and
sella-nasion-point
A/sella-nasion-point
B
(SN
A/SNB)
v
alues.
A
total
of
612
patient
records
were
a
v
ailable,
stratied
into
four
treatment
cate
gories:
e
xtraction
(27.6%),
non-e
xtraction
(32.8%),
functional
appliance
(21.7%),
and
orthopedic
case
(17.9%).
Stratied
sampling
ensured
proportional
representation
across
classes.
Exclusion
criteria
included
incomplete
records
and
ambiguous
treatment
plans.
Figure
1.
Flo
wchart
of
the
proposed
model
3.2.
Data
pr
epr
ocessing
Data
preprocessing
w
as
designed
to
ensure
consistenc
y
and
f
airness
across
models.
Missing
v
al
ues
were
imputed
using
the
median
(numerical)
or
mode
(cate
gorical).
Label-encoding
w
as
used
for
binary
cate
gorical
data,
whereas
one-hot
encoding
w
as
used
for
multi-class
features.
Numerical
features
normalized
via
min–max
scaling
(0–1).
T
o
handle
class
imbalance,
the
synthetic
minority
o
v
ersampling
technique,
or
SMO
TE,
w
as
used
to
augment
minority
classes
and
reduce
bias.
3.3.
Model
de
v
elopment
Six
models
were
implemented:
random
forest,
AdaBoost,
gradient
boosting,
and
ANN,
along
with
tw
o
baseline
classiers
(logistic
re
gression
and
decision
tree)
for
benchmarking.
–
Random
forest:
random
forest
b
uilds
se
v
eral
decision
trees
and
combines
their
results
as
sho
wn
in
(1),
where
B
is
the
number
of
trees
and
f
i
(
x
)
is
the
prediction
of
the
i
th
tree.
ˆ
y
R
F
=
1
B
B
X
i
=1
f
i
(
x
)
(1)
–
AdaBoost:
AdaBoost
adjusts
instance
weights
iterati
v
ely
to
impro
v
e
classication
as
in
(2),
where
D
t
(
i
)
is
the
weight
of
instance
i
,
α
t
is
classier
weight,
h
t
(
x
i
)
is
prediction,
and
Z
t
is
a
normalization
f
actor
.
D
t
+1
(
i
)
=
D
t
(
i
)
exp(
−
α
t
y
i
h
t
(
x
i
))
Z
t
(2)
–
Gradient
boosting:
gradient
boosting
minimizes
residual
loss
by
iterati
v
ely
adding
weak
learners
as
depicted
in
(3),
where
f
n
(
x
)
are
weak
learners
(decision
trees)
and
K
is
the
number
of
iterations.
ˆ
y
GB
=
N
X
n
=1
f
k
(
x
)
(3)
–
ANN:
ANNs
consist
of
layers
of
neurons
with
we
ighted
connections.
F
orw
ard
propag
ation
is
dened
as
gi
v
en
belo
w
,
where
W
(
l
)
is
the
weight
matrix,
b
(
l
)
bias,
a
(
l
−
1)
pre
vious
acti
v
ation,
and
g
(
l
)
acti
v
ation
function
(ReLU
or
sigmoid).
Dropout
re
gularization
w
as
applied
to
minimize
o
v
ertting.
z
(
t
)
=
W
(
t
)
a
(
t
−
1)
+
b
(
t
)
(4)
a
(
t
)
=
g
(
t
)
(
z
(
t
)
)
(5)
–
Baselines:
logistic
re
gression
and
decision
trees
were
i
mplemented
as
baseline
models
to
conte
xtualize
performance
impro
v
ements
of
adv
anced
algorithms.
Articial
intellig
ence
in
orthodontics:
modeling
decision
...
(Sowmya
Lakshmi
Belur
Subr
amanya)
Evaluation Warning : The document was created with Spire.PDF for Python.
100
❒
ISSN:
2252-8938
3.4.
V
alidation
strategy
T
o
mitig
ate
o
v
ertting
10-fold
cross-v
alidation
w
as
emplo
yed.
Statistical
signicance
of
dif
f
erences
between
models
w
as
assessed
using
paired
t
-tests
and
W
ilcoxon
signed-rank
t
ests
(
p
<
0
.
05
).
Ov
erall
accurac
y
for
each
fold
w
as
computed
as:
Accur
acy
=
T
r
ueP
ositiv
e
+
T
r
ueN
eg
ativ
e
T
r
ueP
ositiv
e
+
T
r
ueN
eg
ativ
e
+
F
al
seP
ositiv
e
+
F
al
seN
eg
ativ
e
(6)
3.5.
Inter
pr
etability
analysis
T
o
enhance
clinical
trust,
model
interpretability
w
as
e
xamined
using:
–
Shaple
y
additi
v
e
e
xplanations
(SHAP)
v
alues:
identied
k
e
y
predictors
inuencing
model
decisions.
–
Permutation
importance:
quantied
performance
drops
when
features
were
randomly
shuf
ed.
–
ANN
visualization:
decision
boundaries
and
acti
v
ation
patterns
were
inspected
for
clinical
rele
v
ance.
These
insights
were
mapped
to
orthodontic
principles,
enabling
clinicians
to
v
alidate
AI-dri
v
en
recommendations.
4.
RESUL
TS
AND
DISCUSSION
4.1.
Cr
oss-v
alidation
perf
ormance
All
models
were
tested
for
prediction
performance
using
10-fold
cross-v
alidation.
T
able
1
s
ummarizes
the
performance
results.
ANN
achie
v
ed
the
highest
balanced
accurac
y
(0.83)
and
macro-F1
(0.84),
signicantly
outperforming
the
ensemble
and
baseline
model
s
(
p
<
0
.
05
).
Gradient
boosting
and
random
forest
sho
wed
competiti
v
e
results,
b
ut
struggled
with
minority
class
recall.
T
o
further
assess
generalization,
training
and
v
alidation
accurac
y
curv
es
are
presented
in
Figure
2.
ANN
demonstrated
smooth
con
v
er
gence
with
minimal
o
v
ertting
com
pared
to
the
ensemble
methods,
which
sho
wed
lar
ger
g
aps
between
the
v
alidation
and
training
scores.
ANN
achie
v
ed
the
highest
generalization
ability
with
minimal
o
v
ertting.
T
able
1.
Cross-v
alidation
results
(mean
±
SD)
Model
Accurac
y
(%)
Balanced
acc
Precision
Recall
F1-score
R
OC-A
UC
Logistic
re
gression
72.4
±
2.1
0.69
±
0.02
0.71
±
0.03
0.70
±
0.02
0.70
±
0.03
0.75
±
0.02
Decision
tree
74.1
±
2.8
0.71
±
0.03
0.72
±
0.03
0.71
±
0.03
0.71
±
0.03
0.77
±
0.03
Random
forest
79.8
±
1.9
0.76
±
0.02
0.78
±
0.02
0.77
±
0.02
0.77
±
0.02
0.83
±
0.02
Gradient
boosting
81.2
±
2.3
0.78
±
0.02
0.80
±
0.02
0.79
±
0.03
0.79
±
0.02
0.85
±
0.02
AdaBoost
77.5
±
2.6
0.74
±
0.03
0.75
±
0.03
0.74
±
0.03
0.74
±
0.03
0.81
±
0.03
ANN
86.9
±
1.5
0.83
±
0.01
0.85
±
0.02
0.84
±
0.02
0.84
±
0.02
0.90
±
0.01
Figure
2.
V
alidation
v
ersus
training
curv
es
of
accurac
y
for
the
models
Int
J
Artif
Intell,
V
ol.
15,
No.
1,
February
2026:
97–105
Evaluation Warning : The document was created with Spire.PDF for Python.
Int
J
Artif
Intell
ISSN:
2252-8938
❒
101
4.2.
Confusion
matrix
analysis
While
cross-v
alidation
metrics
highlight
a
v
erage
performance,
confusion
matrices
pro
vide
insi
ght
into
class-specic
errors
as
sho
wn
in
Figure
3.
Logistic
re
gression
and
decision
trees
e
xhibited
high
misclassication
rates
for
functional
appliance
and
orthopedic
case
cate
gories.
Ensemble
models
reduced
these
errors,
b
ut
ANN
demonstrated
the
most
balanced
performance
across
all
four
treatment
cate
gories.
ANN
sho
ws
fe
wer
misclassications,
particularly
in
minority
classes.
This
nding
is
clinically
signicant
because
errors
in
minority
classes
may
directly
af
fect
treatment
prescriptions,
s
uch
as
o
v
erlooking
orthopedic
interv
entions
or
prescribing
incorrect
appliances.
Figure
3.
Confusion
matrices
of
the
models
across
four
treatment
cate
gories
4.3.
Inter
pr
etability
analysis
T
o
address
interpretability
,
SHAP
v
alues
were
computed
to
e
xamine
feature
importance.
V
ert
ical
f
ace
proportions,
mandib
ular
plane
angle,
and
SN
A/SNB
v
alues
consistently
emer
ged
as
k
e
y
predictors
inuencing
treatment
decisions.
These
align
with
established
orthodontic
principles,
conrming
that
the
models
rely
on
clinically
meaningful
features
rather
than
spurious
correlations.
4.4.
Comparati
v
e
discussion
T
able
2
compares
ANN,
ensemble/baseline
models,
and
logistic
re
gression/decision
trees
acros
s
performance,
interpretability
,
ef
cienc
y
,
and
clinical
rele
v
ance.
ANN
sho
wed
the
highest
accurac
y
and
clinical
alignment
b
ut
required
more
resources,
while
ensemble
and
baseline
models
performed
moderately
.
Logistic
re
gression
and
decision
trees
were
f
astest
b
ut
less
accurate
and
less
suited
for
comple
x
cases.
Articial
intellig
ence
in
orthodontics:
modeling
decision
...
(Sowmya
Lakshmi
Belur
Subr
amanya)
Evaluation Warning : The document was created with Spire.PDF for Python.
102
❒
ISSN:
2252-8938
T
able
2.
Comparison
of
ANN,
ensemble/baseline
models,
and
logistic
re
gression/decision
tree
Aspect
ANN
(deep
learning)
Ensemble/baseline
models
Logistic
re
gression/decision
tree
Predicti
v
e
performance
Achie
v
ed
the
highest
accurac
y
with
notable
impro
v
ements
in
minority
class
recall
Demonstrated
moderate
performance,
particularly
weak
er
in
minority
class
prediction
Produced
comparati
v
ely
lo
wer
accurac
y
across
classes
Interpretability
SHAP
analysis
highlighted
clinically
meaningful
predictors
recognized
by
orthodontists
Of
fered
limited
insights
into
feature
contrib
utions
Pro
vided
basic
interpretability
b
ut
lack
ed
clinical
depth
Computational
ef
cienc
y
Required
greater
comput
ational
resources
and
training
time
Sho
wed
moderate
computational
demand
Deli
v
ered
the
f
astest
results
b
ut
with
reduced
predicti
v
e
po
wer
Clinical
rele
v
ance
Ef
fecti
v
ely
bridged
AI
outputs
with
e
xpert
orthodontic
judgment
Limited
applicability
in
clinical
decision-making
Suitable
for
quick
assessments
b
ut
insuf
cient
for
comple
x
cases
5.
DISCUSSION
AND
LIMIT
A
TIONS
5.1.
Comparati
v
e
analysis
of
models
The
comparati
v
e
results
demonstrate
that
ANNs
achie
v
ed
the
best
o
v
erall
performance
across
accurac
y
,
balanced
accurac
y
,
F1-score,
and
R
OC-A
UC.
Ensemble
models
such
as
gradient
boosting
and
random
forest
performed
competiti
v
ely
b
ut
were
less
ef
fecti
v
e
at
handling
minority
classes,
which
are
clinically
important.
Baseline
models
(logistic
re
gression
and
decision
tree)
pro
vided
useful
references
b
ut
underperformed,
conrming
the
adv
antage
of
adv
anced
AI
methods
in
orthodontic
decision
support.
5.2.
Generalizability
A
k
e
y
limitation
of
this
study
is
the
reliance
on
a
single-institution
dataset.
Although
s
tratied
sampling
and
SMO
TE
were
applied
to
impro
v
e
class
balance,
e
xternal
v
alidation
across
mult
iple
clinics,
di
v
erse
populations,
and
v
arying
imaging
equipment
w
as
not
performed.
W
ithout
multicenter
testing,
generalizability
remains
uncertain.
Future
research
should
prioritize
e
xternal
v
alidation
and
domain
adaptation
techniques
to
ensure
rob
ustness
under
real-w
orld
clinical
v
ariability
.
5.3.
Inter
pr
etability
and
clinical
trust
While
deep
learning
models
deli
v
ered
the
highest
predicti
v
e
performance,
their
black-box
nature
poses
challenges
for
clinical
adoption.
SHAP
analysis
w
as
emplo
yed
to
highlight
inuential
features
such
as
v
ertical
f
ace
proportions,
mandib
ular
plane
angle,
and
SN
A/SNB
v
alues,
which
align
with
orthodontic
diagnostic
principles.
Ho
we
v
er
,
further
ef
forts
to
w
ard
interpretable-by-design
models
or
visualizati
o
n
of
decision
boundaries
are
needed
to
enhance
transparenc
y
and
clinician
trust.
5.4.
Clinical
translation
barriers
Despite
promising
results,
se
v
eral
issues
must
be
handled
before
AI
tools
can
be
deplo
yed
in
orthodontics.
Important
obstacles
in
clinical
deplo
yment
include
achie
ving
re
gulatory
compliance
(such
as
food
and
drug
administration
(FD
A)
and
European
Conformity
(CE)
certication)
and
safe
guarding
patient
pri
v
ac
y
through
strong
anon
ymisation
and
safe
data-sharing
procedures.
The
seamless
inte
gration
of
AI
technologies
into
current
orthodontic
operations
and
the
reduction
of
biases
resulting
from
unrepresentati
v
e
or
unbalanced
datasets
are
equally
crucial.
5.5.
Futur
e
dir
ections
Building
on
the
ndings
of
this
study
,
se
v
eral
directions
are
recommended.
T
o
impro
v
e
model
generalisability
,
future
studies
should
concentrate
on
gro
wing
datasets
to
encompass
multicente
r
and
multiethnic
groups.
Comprehensi
v
e
treatment
planning
can
be
further
supported
by
incorporating
multimodal
data,
such
as
radiographs,
photos
,
and
clinical
records.
Furthermore,
in
v
estig
ating
domain
adaptation
and
transfer
learning
strate
gies
might
lessen
performance
de
gradation
in
dif
ferent
data
scenarios.
Clinical
trust
depends
on
the
creation
of
interpretable
AI
frame
w
orks
that
strik
e
a
compromise
between
predicted
accurac
y
and
transparenc
y
.
Lastly
,
to
enable
clinical
trials
and
of
cial
certication
of
AI-based
solutions,
cooperation
with
orthodontic
associations
and
re
gulatory
bodies
w
ould
be
essential.
Int
J
Artif
Intell,
V
ol.
15,
No.
1,
February
2026:
97–105
Evaluation Warning : The document was created with Spire.PDF for Python.
Int
J
Artif
Intell
ISSN:
2252-8938
❒
103
6.
CONCLUSION
The
proposed
w
ork
illustrates
ho
w
AI
can
be
used
to
optimize
orthodontic
treatments
by
systematically
e
v
aluating
ensemble
models
and
deep
learning
architectures
ag
ainst
baseline
classiers.
Among
the
models,
ANNs
achie
v
ed
the
highest
balanced
accurac
y
and
F1-scores,
particularly
e
xcelling
in
correctly
identifying
minority
treatment
cate
gories.
Ensemble
methods
such
as
gradient
boosting
and
random
forest
pro
vided
competiti
v
e
alternati
v
es
with
lo
wer
computational
cost,
while
baseline
models
conrmed
the
relati
v
e
g
ains
achie
v
ed
by
adv
anced
AI
methods.
Importantly
,
interpretability
analysis
using
SHAP
re
v
ealed
that
clinically
meaningful
features—including
v
ertical
f
ace
proportions,
mandib
ular
plane
angle,
and
SN
A/SNB
v
alues—were
consistently
prioritized
by
the
models.
This
re
inforces
the
clinical
v
alidity
of
AI-assi
sted
decision-making
and
pro
vides
transparenc
y
to
bridge
the
g
ap
between
algorithmic
outputs
and
orthodontic
e
xpertise.
Nonetheless,
se
v
eral
limitations
must
be
ackno
wledged.
The
reliance
on
a
single-institution
dataset
constrains
generalizability
,
and
the
absence
of
e
xternal
v
alidation
restricts
broader
applicability
.
Ethical
concerns,
re
gulatory
appro
v
al,
and
seamless
w
orko
w
inte
gration
also
remain
challenges
for
real-w
orld
adoption.
Looking
ahead,
future
w
ork
should
e
xpand
datasets
across
multiple
populations
and
clinical
settings,
inte
grate
multimodal
inputs
such
as
radiographs
and
photographs,
and
de
v
elop
interpretable-by-design
AI
frame
w
orks.
By
addressing
these
challenges,
AI-dri
v
en
systems
can
e
v
olv
e
from
e
xperimental
tools
into
clinically
trusted
decision-support
systems
that
enhance
orthodontic
ef
cienc
y
,
reliability
,
and
patient
care.
A
CKNO
WLEDGMENTS
The
management
of
B.M.S.
Colle
ge
of
Engineering,
Beng
aluru,
is
deeply
appreciated
by
the
authors
for
their
unw
a
v
ering
support
and
funding
under
F
aculty
Research
Promotion
Scheme,
which
enabled
this
research.
The
y
also
wish
to
e
xpress
deep
appreciation
to
the
Go
v
ernment
Dental
Colle
ge
and
Research
Institute,
Beng
aluru
for
pro
viding
in
v
aluable
data
and
their
e
xpertise
in
t
he
eld
of
orthodontics.
Further
thanks
are
due
to
all
the
f
aculty
members,
their
support
and
dedication
ha
v
e
been
pi
v
otal
in
adv
ancing
this
research.
FUNDING
INFORMA
TION
This
research
w
as
supported
by
B.M.S.
Colle
ge
of
Engineering,
Beng
aluru.
The
authors
appreci
ate
the
nancial
and
infrastructural
support
pro
vided
by
the
institution
to
carry
out
this
study
.
A
UTHOR
CONTRIB
UTIONS
ST
A
TEMENT
This
journal
uses
the
Contrib
utor
Roles
T
axonomy
(CRediT)
to
recognize
indi
vidual
author
contrib
utions,
reduce
authorship
disputes,
and
f
acilitate
collaboration.
Name
of
A
uthor
C
M
So
V
a
F
o
I
R
D
O
E
V
i
Su
P
Fu
So
wmya
Lakshmi
Belur
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Subraman
ya
Adv
aith
V
ijaya
Mohan
✓
✓
✓
✓
✓
✓
✓
Achala
V
arsha
V
ishla
v
ath
✓
✓
✓
✓
✓
✓
✓
Premalatha
Manchikanti
V
arunsai
✓
✓
✓
✓
✓
✓
✓
C
:
C
onceptualization
I
:
I
n
v
estig
ation
V
i
:
V
i
sualization
M
:
M
ethodology
R
:
R
esources
Su
:
Su
pervision
So
:
So
ftw
are
D
:
D
ata
Curation
P
:
P
roject
Administration
V
a
:
V
a
lidation
O
:
Writing
-
O
riginal
Draft
Fu
:
Fu
nding
Acquisition
F
o
:
F
o
rmal
Analysis
E
:
Writing
-
Re
vie
w
&
E
diting
CONFLICT
OF
INTEREST
ST
A
TEMENT
Re
g
arding
the
publishing
of
this
paper
,
the
authors
state
that
the
y
ha
v
e
no
conicts
of
interest.
Articial
intellig
ence
in
orthodontics:
modeling
decision
...
(Sowmya
Lakshmi
Belur
Subr
amanya)
Evaluation Warning : The document was created with Spire.PDF for Python.
104
❒
ISSN:
2252-8938
D
A
T
A
A
V
AILABILITY
The
corpus
is
not
publicly
accessible
due
to
condentiality
and
pri
v
ac
y
agreements.
Ho
we
v
er
,
upon
request
from
the
corresponding
author
and
institutional
appro
v
al,
we
may
mak
e
it
a
v
ailable.
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Evaluation Warning : The document was created with Spire.PDF for Python.
Int
J
Artif
Intell
ISSN:
2252-8938
❒
105
BIOGRAPHIES
OF
A
UTHORS
Dr
.
So
wmya
Lakshmi
Belur
Subramanya
an
assistant
professor
in
the
Department
of
Machine
Learning
at
BMS
Colle
ge
of
Engineering,
has
research
interests
in
deep
learning,
machine
learning,
natural
language
processing,
and
inf
ormation
retrie
v
al.
She
graduated
from
Adichunchangiri
Institute
of
T
echnology
,
Chikmag
alur
in
2011
and
completed
her
post-graduation
at
Dayanand
Sag
ar
Colle
ge
of
Engineering
in
2013.
She
recei
v
ed
her
Ph.D.
from
V
isv
esv
araya
T
echnological
Uni
v
ersity
for
her
thesis
titled
‘cross-language
information
retrie
v
al
for
code-mix
ed
Kannada-English
queries’
in
2021.
She
joined
B.M.S.
Colle
ge
of
Engineering
as
an
assistant
professor
in
October
2021.
She
has
20
publications
to
her
credit
in
international
journals
and
conferences
in
the
domains
of
natural
language
proces
sing
and
information
retrie
v
al.
She
can
be
contacted
at
email:
so
wmyalakshmibs.mel@bmsce.ac.in.
Adv
aith
V
ijaya
Mohan
recei
v
ed
his
Bachelor
of
Engineering
de
gree
in
Articial
Intelligence
and
Machine
Learning
from
B.M.S.
Colle
ge
of
Engineering,
Beng
aluru,
India,
in
2024.
He
is
currently
associated
with
Cisco
Syste
ms
as
a
b
usiness
analyst,
where
he
contrib
utes
to
the
de
v
elopment
and
implementation
of
AI-dri
v
en
solutions
across
di
v
erse
b
usiness
domains.
His
research
interests
include
natural
language
processing,
data
science,
and
the
application
of
articial
intelligence
in
supply
chain
and
healthcare
systems.
He
has
demonstrated
strong
procienc
y
in
combining
technical
inno
v
ation
with
practical
problem-solving.
His
w
ork
reects
a
continued
dedication
to
adv
ancing
applied
AI
research
and
intell
igent
system
de
v
elopment.
He
can
be
contacted
at
email:
adv
aithvij@gmail.com.
Achala
V
arsha
V
ishla
v
ath
Pr
emalatha
is
currently
w
orking
as
a
data
scientist
at
A
T&T
.
She
has
comple
ted
her
Bachelor
of
T
echnology
in
Articial
Intelligence
and
Machine
Learning
from
BMS
Colle
ge
of
Engineering.
Her
academic
background
has
pro
vided
a
strong
foundation
in
computational
intelligence
and
data-dri
v
en
technologies.
Her
k
e
y
research
interests
include
machine
learning,
deep
learning,
natural
language
processing,
and
generati
v
e
AI,
with
a
focus
on
applying
these
techniques
to
solv
e
real-w
orld
challenges.
In
the
current
paper
,
she
contrib
uted
to
conducting
a
detailed
literature
re
vie
w
,
data
collection,
and
model
de
v
elopment.
She
played
a
k
e
y
role
in
inte
grating
articial
intelligence
methods
into
the
study
frame
w
ork
and
ensuring
the
model’
s
accurac
y
and
ef
cienc
y
.
Her
contrib
utions
reect
a
strong
interest
in
adv
ancing
the
practical
applications
of
AI
in
emer
ging
interdisciplinary
domains
such
as
healthcare
and
automat
ion.
She
can
be
contacted
at
email:
achala
vp@gmail.com.
Manchikanti
V
arunsai
holds
a
Bachelor
of
Engineering
(B.E.)
de
gree
in
Articial
Intelligence
and
Machine
Learning
from
BMS
Colle
ge
of
Engineering,
equipping
him
with
a
rob
ust
understanding
of
AI,
data
science,
and
natural
language
processing
(NLP).
Currently
,
he
serv
es
as
a
b
usiness
intelligence
analyst
at
Dell
T
echnologies
while
acti
v
ely
eng
aging
in
research
focused
on
general
articial
intelligence
and
related
elds.
W
ithin
this
study
,
he
played
a
vital
role
in
establishing
the
research
methodology
and
pro
viding
essential
resources.
He
can
be
contacted
at
email:
v
arunsaimanchikanti@gmail.com.
Articial
intellig
ence
in
orthodontics:
modeling
decision
...
(Sowmya
Lakshmi
Belur
Subr
amanya)
Evaluation Warning : The document was created with Spire.PDF for Python.