# Diagnostic Accuracy and Agreement Between AI and Clinicians in Orthodontic 3D Model Analysis
## 3 Results  
[PERSON]'s kappa analyses were conducted to evaluate the level of categorical agreement between the orthodontist and two AI-based diagnostic platforms (Titan and SoftSmile). In the Anterior Bolton analysis, no meaningful agreement was observed between the orthodontist and Titan (\(\kappa=-0.051\)), while SoftSmile demonstrated only minimal agreement (\(\kappa=0.113\)). A moderate level of agreement was found between Titan and SoftSmile for the same parameter (\(\kappa=0.496\), \(p<0.001\)). In the Overall Bolton analysis, neither AI system showed significant agreement with the orthodontist (Titan: \(\kappa=-0.077\); SoftSmile: \(\kappa=-0.124\)), though a moderate agreement was again noted between the two platforms (\(\kappa=0.406\), \(p=0.001\)). For molar classification, both right and left sides showed almost perfect agreement between the AI systems and the orthodontist (right: \(\kappa=0.955\); left: \(\kappa=0.900\); \(p<0.001\)). Inter-examiner consistency between the two orthodontists revealed substantial agreement in the Anterior Bolton analysis (\(\kappa=0.710\)) and moderate agreement in the Overall Bolton analysis (\(\kappa=0.467\)) (Table 2). In Bolton analyses, the performance of all three groups was evaluated in cases where the tooth size excess was identified in the same jaw (either maxilla or mandible). Appropriate statistical tests were selected based on the distribution characteristics of the data. Specifically, the Friedman test was used for the anterior Bolton analysis due to non-normal distribution (Friedman statistic = 2.97, \(p=0.226\)), while repeated measures ANOVA was applied to the overall Bolton analysis, which exhibited a normal distribution (F(2, 36) = 0.230, \(p=0.795\)). Neither test revealed statistically significant differences among the groups. These findings suggest that in cases where the tooth size discrepancy was located in the same arch (maxilla or mandible), the evaluations were consistent across all groups in identifying the origin of the discrepancy (Figure 11). \begin{table}
\begin{tabular}{c c c c} \hline \hline
**Comparison** & **Cohen’s Kappa** & **Level of Agreement** & \(p\)**-Value** \\ \hline Location 1 (Anterior Bolton Analysis)—Ortho vs. Titan & \(-0.051\) & None & 0.716 \\ \hline Location 1 (Anterior Bolton Analysis)—Ortho vs. SoftSmile & 0.113 & Minimal & 0.43 \\ \hline Location 1 (Anterior Bolton Analysis)—Titan vs. SoftSmile & 0.496 & Moderate & \textless{}0.001 \\ \hline Location 2 (Overall Bolton Analysis)—Ortho vs. Titan & \(-0.077\) & None & 0.489 \\ \hline Location 2 (Overall Bolton Analysis)—Ortho vs. SoftSmile & \(-0.124\) & None & 0.382 \\ \hline Location 2 (Overall Bolton Analysis)—Titan vs. SoftSmile & 0.406 & Moderate & 0.001 \\ \hline \hline  & & & \\ \hline  & & & \\ \hline  & & & \\ \end{tabular}
\end{table} 
Table 2: Agreement on categorical orthodontic parameters between the orthodontist group and AI-based orthodontic software. Regarding overjet and overbite measurements, the data were not normally distributed, and the Wilcoxon signed-rank test was applied. A significant difference was observed between the Orthodoxist group and the Titan group (\(p<0.001\)) (Figure 12). In the space analysis, the Wilcoxon signed-rank test was used for the maxillary arch, showing a significant difference between the Orthodoxist group and the Titan group (\(p<0.001\); Figure 13). For the mandibular arch, the data were normally distributed; therefore, a paired t-test was conducted, which also revealed a significant difference between the Orthodoxist and Titan groups (\(p<0.001\)) (Figure 13). Figure 11: Comparison of Anterior and Overall Bolton Analysis Values Among the Three Groups (Orthodontist, Titan, and SoftSmile). Friedman test for anterior analysis; repeated measures ANOVA for overall analysis. \(p<0.05\) indicates statistical significance. Figure 12: Comparison of Overjet and Overbite Measurements Between Orthodoxtists and Titan AI. Wilcoxon signed-rank test, ***\(p<0.001\).