# Assessing ChatGPT's Reliability in Endodontics: Implications for AI-Enhanced Clinical Learning
## 4 Discussion  
The primary objective of this study was to assess the reliability and repeatability of ChatGPT-4 and ChatGPT-4o in generating responses to closed-clinical endodontic questions from a practitioner's perspective. The findings partially reject the research hypothesis: While no significant differences in reliability were observed between the two models, ChatGPT-4o demonstrated a higher level of repeatability compared to ChatGPT-4. Based on these results, it can be interpreted that although both versions of ChatGPT show limitations in terms of absolute reliability--achieving accuracy rates close to 50%--the difference in repeatability becomes especially relevant in educational contexts. The greater consistency observed in ChatGPT-4o, both in terms of percentage agreement and concordance indices, suggests that this model may offer a more dependable learning experience by reducing confusion caused by contradictory responses to identical questions. However, the variability in response quality, even for questions with well-defined clinical content, indicates that the autonomous use of these models still involves educational and clinical risks. \begin{table}
\begin{tabular}{c c c c c c c c c c c c c} \hline \hline \multicolumn{1}{c}{**Q**} & \multicolumn{4}{c}{**ChatGPT-4**} & \multicolumn{4}{c}{**ChatGPT-4o**} & \multicolumn{4}{c}{_p_**-Value**} \\ \hline \multicolumn{1}{c}{} & \multicolumn{4}{c}{**Partially**} & \multicolumn{4}{c}{**Partially**} & \multicolumn{4}{c}{**Partially**} & \multicolumn{4}{c}{**Correct or**} & \multicolumn{4}{c}{**Correct or**} & \multicolumn{4}{c}{**Correct**} & \multicolumn{4}{c}{**Correct**} \\ \multicolumn{1}{c}{} & \multicolumn{4}{c}{**Incomplete**} & \multicolumn{4}{c}{**Incomplete**} & \multicolumn{4}{c}{**Incomplete**} & \multicolumn{4}{c}{**Incomplete**} \\ \multicolumn{1}{c}{} & \multicolumn{1}{c}{**n**} & \% & **n** & \% & **n** & \% & **n** & \% & **n** & \% & **n** & \% & \\ \hline Q1 & 3 & 10.00 & 27 & 90.0 & 0 & 0.0 & 0 & 0.0 & 30 & 100.0 & 0 &  
In terms of reliability, no statistically significant differences were observed between ChatGPT-4 and ChatGPT-4o, which aligns with previous studies reporting similar performance by both models in tasks such as radiological image interpretation [28] and assessments in restorative dentistry and endodontics [29]. Although ChatGPT-4o integrates technical improvements over ChatGPT-4 [42], the performance gap between these two models appears narrower than that observed between ChatGPT-4 and its predecessor, ChatGPT-3.5. The superiority of ChatGPT-4 over ChatGPT-3.5 has been well documented across various healthcare domains [20], including specific dental disciplines. For instance, ChatGPT-4 has outperformed its predecessor in dental licensing examinations [43], in responding to clinically relevant questions across multiple fields [22], and within specialized areas such as periodontics [44] and implantology [45]. More recent studies have also shown improved outcomes with ChatGPT-4o compared to ChatGPT-3.5 [19]. In educational contexts, the absence of significant differences in reliability indicates that both ChatGPT-4 and ChatGPT-4o may be equally viable for generating instructional content or facilitating simulated student-teacher interactions. Nonetheless, the enhanced consistency exhibited by ChatGPT-4o may prove particularly advantageous in preserving pedagogical coherence across repeated uses. In the present study, the reliability scores obtained were 52.67% for ChatGPT-4 and 55.22% for ChatGPT-4o, which are lower than those reported by [PERSON] et al. [29], who observed reliability levels of 62% and 72% for ChatGPT-4 and ChatGPT-4o, respectively. These discrepancies may be attributed to differences in methodology; while the current study employed short, closed-clinical questions from the practitioner's perspective, [PERSON] et al. utilized multiple-choice questions aimed at student assessment.