## 2 Materials and Methods
### Question Development and Content  
The questions used in this study were developed based on the most recent clinical guideline on TDIs in the primary dentition, published by the IADT [21]. Two experienced pediatric dentits independently reviewed the guideline and collaboratively designed an initial pool of 33 questions intended to evaluate the performance of advanced AI models in terms of accuracy, completeness, response time, and readability. To ensure clarity and eliminate redundancy, a second independent review was conducted by two additional pediatric dentits. During this phase, questions that overlapped in content or could be merged without compromising clinical relevance were identified and revised. As a result of this refinement process, a final set of 25 distinct questions was established. These standardized questions were subsequently submitted to each of the four AI models for evaluation. To enhance content validity, the final set of 25 questions was subjected to an informal pilot review by the expert panel. Although no formal content validity index or inter-rater reliability metrics were calculated at this stage, the panel confirmed the clarity, representativeness, and clinical relevance of each item through iterative discussion and consensus. This process ensured that the question set appropriately covered the key domains of TDIs in primary dentition. While the inclusion or exclusion of certain questions may influence specific performance scores to some extent, the current set was intentionally designed to reflect a broad and clinically relevant sample of real-world scenarios. Therefore, the core trends observed in model behavior--particularly regarding accuracy and guideline adherence--are expected to remain robust even with minor modifications to the item set. The complete list of questions is presented in Table 2, while the questions along with the corresponding responses generated by the AI models are provided in the Supplementary Materials. \begin{table}
\begin{tabular}{p{42.7 pt} p{42.7 pt} p{42.7 pt} p{42.7 pt} p{42.7 pt} p{42.7 pt}} \hline \hline
**Model** & **Developer** & **Release Date** & **Multimodal** & **Public Access** & **Healthcare Use Cases** & **Included** \\ \hline ChatGPT-to & OpenAI & May 2024 & Yes & Yes (paid) & Extensive use in medical Q&A & ✓ \\ \hline DeepSeek & DeepSeek AI & Dec 2024 & No & Yes (free) & Growing number of studies in China & ✓ \\ \hline Gemini Advanced & Google & Feb 2024 & Yes & Yes (paid) & Clinical scenario support (limited) & ✓ \\ \hline Claude 3.7 Sonnet & Anthropic & Mar 2024 & Yes & Yes (paid) & Used in diagnostic case evaluations & ✓ \\ \hline Copilot & Microsoft & Mar 2024 & Yes & Limited & Common in documentation, no output & ✗ \\ \hline Mistral & Mistral AI & Nov 2023 & No & Yes (open) & No known medical applications & ✗ \\ \hline LLaMA 3 & Meta & Apr 2024 & No & Yes (open) & Research-focused, not user-facing & ✗ \\ \hline \hline \end{tabular}  
* ChatGPT-to: ChatGPT-4 Omni, AI: Artificial Intelligence, Q&A: Question and Answer, Dec: December, Feb: February, Mar: March, Nov: November, Apr: April.  
\end{table} 
Table 1: Overview of large language models considered for inclusion in the study and rationale for final selection. \begin{table}
\begin{tabular}{p{42.7 pt} p{42.7 pt} p{42.7 pt}} \hline \hline
**Questions.** & \\ \hline
1. & In which types of traumatic dental injuries in the primary dentition is radiographic examination recommended, and which types of radiographic approaches should be used? \\ \hline
2. & Following which types of traumatic dental injuries in the primary dentition is the risk of developmental anomalies in the permanent teeth higher, and what types of pathologies may occur in the permanent teeth as a result of dental trauma? \\ \hline
3. & According to the current International Association of Dental Traumatology guidelines, what is recommended when the root of a traumatized primary tooth is displaced toward the permanent tooth germ in cases of intrusion and lateral luxation injuries? \\ \hline \hline \end{tabular}  
\end{table}