Global Insights into Oral Hygiene & Gingivitis During Orthodontic Treatment with Artificial Intelligence

Maintaining adequate oral hygiene and preventing gingival inflammation during orthodontic treatment remains one of the most persistent challenges in orthodontic practice, yet comparative evidence between clear aligner therapy (CAT) and fixed appliances (FA) has been limited to small cross-sectional studies with substantial methodological constraints. This thesis leverages the Dental Monitoring™ (DM) artificial intelligence-driven remote monitoring (AI-DRM) platform to present three interconnected analyses of oral hygiene and gingivitis outcomes across a global cohort of 40,748 patients (30,237 CAT; 10,511 FA) with up to 462,735 monthly assessments over 24 months. Cross-sectional comparison demonstrated significantly lower median gingivitis scores for CAT versus FA patients (0.00 vs. 16.00; Cohen's d=−0.57) and lower hygiene scores (0.00 vs. 16.00; Cohen's d=−0.48), with FA patients facing an 8.69-fold increased risk of moderate-to-severe gingivitis and a 6.37-fold increased risk of poor hygiene. A 13-year mean age difference between groups (FA: 18.67 years; CAT: 31.36 years) represents the primary confounding factor addressed in the longitudinal analyses. Longitudinal zero-inflated negative binomial mixed-effects models revealed a critical mechanistic dissociation: gingivitis trajectories progressively diverged between groups (treatment×time IRR=1.02; χ²=573.54, p<0.001), while hygiene trajectories remained largely parallel (treatment×time IRR=0.998; χ²=9.6, p=0.002)—a 60-fold difference indicating that FA imposes inflammatory burden through mechanisms beyond plaque retention alone. Age was the dominant effect modifier: teenagers showed 93% worse baseline gingivitis than adults (IRR=1.93), while children paradoxically showed 33% better gingivitis (IRR=0.67) despite inferior hygiene. All non-Americas regions demonstrated better gingivitis control than the Americas. Paradoxical hygiene reversals were observed in children and teenagers on CAT, challenging assumptions about removability conferring automatic hygiene advantages. These findings support risk-stratified, age-appropriate, and geographically sensitive approaches to orthodontic preventive care, and demonstrate that AI-driven remote monitoring enables a paradigm shift from reactive, appointment-based assessments to continuous, objective surveillance capable of identifying deteriorating patients before irreversible damage occurs.

Author dc:creator

• Eric J. Coy (24399710)

• orthodontics
• risk factors

Statement dc:rights

• In Copyright

DOI dc:identifier

https://doi.org/10.25417/uic.32994194.v1

OAI identifier oai:identifier

oai:figshare.com:article/32994194