Artificial intelligence in orthodontics: modeling decision support systems for treatment planning

Abstract

Orthodontic treatment planning involves complex clinical decision-making that can benefit from artificial intelligence (AI). This study evaluates machine learning and deep learning models—including random forest, AdaBoost, gradient boosting, and artificial neural networks (ANNs)—for predicting orthodontic treatment strategies using a dataset of 612 anonymized patient records with 66 clinically validated features across four categories (extraction, non-extraction, functional appliance, and orthopedic case). Preprocessing included imputation, normalization, and the synthetic minority oversampling technique (SMOTE) for class imbalance, while performance was assessed via 10-fold cross-validation. Results showed that ANNs achieved the highest balanced accuracy (0.83), F1-score (0.84), and receiver operating characteristic area under the curve (ROC-AUC) (0.90), outperforming ensemble and baseline models. Shapley additive explanations (SHAP) analysis confirmed clinically meaningful predictors such as vertical face proportions and mandibular plane angle, enhancing interpretability. Although promising, the study is limited by its single-institution dataset and lack of external validation. Future research should incorporate multicenter, multimodal datasets and interpretable-by-design frameworks to enable clinically trusted AI decision-support systems in orthodontics.