Exploring the potential of artificial intelligence chatbots in prosthodontics education
The rapid advancement of artificial intelligence (AI) chatbots has generated significant interest in their potential applications in medical and dental education . One of the transformative technologies in this field is large language models (LLMs), which offer advanced natural language processing and response generation capabilities, and are increasingly being applied . Trained on extensive datasets, these models can comprehend complex queries and deliver evidence-based responses, which are valuable for education and support both students and professionals in clinical decision-making . With these innovative educational functions, LLMs are also gaining attention for exam preparation and quick access to information . AI models are increasingly recognized for their potential to facilitate and complement traditional learning resources . Recent studies have highlighted the role of LLMs as interactive educational tools, facilitating learning by providing access to information and clinical scenarios across various fields of medicine and dentistry . Traditionally, medical and dentistry knowledge acquisition has relied on textbooks, academic journals, and search engines. However, for personalized, immediate, and interactive learning experiences, LLMs can be integrated into educational programs and clinical decision-support systems . This integration requires careful consideration . The five major commercial LLMs used in this study are among the most popular models, reaching millions of users worldwide. Chat Generative Pre-Trained Transformer (ChatGPT) 3.5, developed by OpenAI, is a large language model with advanced natural language processing capabilities. Gemini Advanced, produced by Google DeepMind, is a highly trained AI model based on extensive datasets. Claude Pro, created by Anthropic, is a LLM focused on security and interpretability. Microsoft’s Copilot model is based on GPT-4 and provides real-time web access to current information. Lastly, Perplexity, developed in 2022 by Aravind Srinivas and his team, functions as an AI-powered search engine that delivers responses in natural language. Recent studies have highlighted that LLMs, such as ChatGPT and Google Gemini, have demonstrated significant potential in transforming medical and dental diagnostics, especially by improving diagnostic precision and patient outcomes through advanced natural language processing capabilities​ . However, challenges such as hallucinations, outdated information, and accuracy inconsistencies underline the need for ongoing evaluations and refinements in their applications within dental specialties ​. In dentistry education, the evaluation of broad knowledge using multiple-choice questions (MCQs) holds an important place. Recent studies have compared different LLMs in examinations such as the European Certification in Implant Dentistry Exam , Oral and Maxillofacial Surgery Board Exam , periodontology in-service exam , pediatric dentistry in the Korean National Dental Board Exam , Polish Medical-Dental Verification Exam  to assess their accuracy and reliability. For the Polish Medical-Dental Verification Exam, ChatGPT and Gemini demonstrated comparable performance to Claude in prosthodontics, with Claude not showing a clear advantage in this specialty despite its overall high accuracy . These results may point out that AI models may lack data in the field of prosthodontics. In Turkey, the Dentistry Specialization Residency Examination (DSRE) is a test consisting of MCQs with five options each, assessing candidates’ knowledge in various fundamental and clinical sciences, including prosthodontics. This exam is mandatory for those seeking to pursue specialty education in dentistry after graduation. This study aimed to assess and compare the performance of ChatGPT-3.5, Gemini Advanced, Claude Pro, Copilot, and Perplexity in the field of prosthodontics, using questions from the DSRE in Turkey. To the best of the authors’ knowledge, the present study is the first study comparing performance of five different AI chatbots on questions of DSRE in the literature. The findings of this study aim to offer valuable insights into the integration of AI applications in educational processes and clinical decision-support systems, while exploring their potential as reliable educational tools. The first null hypothesis of this study posited that there was no statistically significant difference in the accuracy of responses provided by different AI chatbot models for prosthodontics questions. The second null hypothesis assumed that there was no statistically significant difference in the accuracy of responses across subtopics among these models. 

The questions of the DSRE held in Turkey since 2012 can be accessed from the internet link: https://www.osym.gov.tr/TR,15070/dus-cikmis-sorular.html . The system has 13 exams installed and is open to public access. There are 10 questions on prosthodontics in each exam. Although there were 130 questions in total, 4 questions were excluded because they contained images. All questions were translated into English by authors, and this version was used for the study (Additional file ). The remaining 126 questions were divided into 7 subtopics according to the content. These categories were dental morphology, materials science, fixed dentures, removable partial dentures, complete dentures, occlusion/temporomandibular joint (TMJ), and dental implantology (Fig. ). The questions consisting of MCQs with five options each and a correct answer were asked to 5 different AI chatbots. The answers were recorded as correct or incorrect. Following the identification of correct and incorrect responses, the performance of the AI models was evaluated using accuracy metrics. Accuracy was calculated as the percentage of correct responses relative to the total number of questions. In this study, the accuracy percentage was determined by dividing the number of correct answers provided by each model by the total number of questions and multiplying the result by 100. The primary application programming interface (API) of each chatbot was used for the simulation of real-world interactions. The following approaches were employed: The APIs were accessed using https://copilot.microsoft.com/ ; https://chat.openai.com/ ; https://claude.ai.com/ ; https://gemini.google.com/ ; https://www.perplexity.ai/ respectively for Copilot (Microsoft Copilot, Model: GPT-4, Microsoft, Redmond, WA, USA), ChatGPT (Chat Generative Pre-Trained Transformer 3.5, Model: GPT-3.5, OpenAI, San Francisco, CA, USA), Gemini (Gemini Advanced, Google DeepMind, London, United Kingdom), Claude (Claude Pro, Anthropic, San Francisco, CA, USA), and Perplexity (Perplexity AI, Aravind Srinivas et al., San Francisco, CA, USA). To simulate the most used form, free versions were selected except Claude and Gemini. All the questions were asked of each chatbot within seven days (September 28–October 5, 2024). The chat was reset prior to each new question. A new chat was initiated for each question. The questions were grouped based on the number of AI models that provided incorrect answers. Group 2 included questions for which two AI models gave incorrect answers; Group 3 included questions for which three AI models gave incorrect answers; Group 4 included questions for which four AI models gave incorrect answers; and Group 5 included questions for which all five AI models gave incorrect answers. Additionally, a level classification was made based on the number of AI models that provided incorrect answers simultaneously. Level 0 referred to questions where all AI models simultaneously provided correct answers; Level 1 referred to questions where one AI model provided an incorrect answer; Level 2 referred to questions where two AI models simultaneously provided incorrect answers; Level 3 referred to questions where three AI models simultaneously provided incorrect answers; Level 4 referred to questions where four AI models simultaneously provided incorrect answers; and Level 5 referred to questions where all five AI models simultaneously provided incorrect answers. The relationship between the responses given to all questions or questions of each subtopic and the type of AI was analyzed by Pearson Chi-Square tests and Fisher’s Exact Test. Comparisons between columns were performed with z-tests. All analyses were performed in a statistical program (SPSS 20) at a significance level of 0.05. Ethical approval was not applicable to this study as the study does not involve any humans or animals. 

When the accuracy of all the answers given to the questions was evaluated using the chi-square analysis, a statistically significant difference was found among AI chatbots (Table ). The overall accuracy rates for the chatbots were as follows: Copilot achieved the highest accuracy rate of 73%, answering 92 out of 126 questions correctly. ChatGPT followed with an accuracy rate of 61.1% (77/126), while Gemini showed a similar performance with an accuracy rate of 63.5% (80/126). Claude demonstrated an accuracy rate of 57.9% (73/126), and Perplexity had the lowest performance with an accuracy rate of 54.8% (69/126). Table summarizes these results. Copilot answered a significantly higher number of questions correctly compared to Perplexity ( P = 0.035). For all subtopics, the rate of correct answers did not differ statistically among the AI chatbots (Table ). A statistically significant relationship was found between the subtopics and the rate of correct answers provided (Table ). The rate of the correct answers to questions on removable partial dentures was found to be lower than that of fixed dentures, materials science, occlusion/TMJ, and dental implantology ( P = 0.013). The rate of the correct answers to questions on dental implantology was found to be significantly higher than that of complete dentures and removable partial dentures ( P = 0.013). When the similarity ratios of incorrect answers were analyzed, the rate in Group 5, where all AI models simultaneously provided incorrect answers, was found to be the highest at 81.82% (Table ). At least one AI gave an incorrect answer to 67.7% of the questions. All AIs answered incorrectly simultaneously for 8.7% of the questions, while all AIs answered correctly simultaneously for 33.3% of the questions (Fig. ). 

In this study, the accuracy of responses provided by five different AI models to prosthodontics questions in DSRE was compared. Statistical analysis revealed a significant difference among the chatbots, and the first null hypothesis was rejected. Copilot, which had the highest correct answer rate (73%), demonstrated a notably better performance compared to Perplexity (54.8%) ( P = 0.035). The lowest correct answer rate that was observed in Perplexity suggests that this model has a limited database in the context of prosthodontics. However Hancı et al.  highlighted that Perplexity stood out in reliability and quality evaluations (e.g., JAMA and Modified DISCERN scores) compared to other artificial intelligence models. These findings highlight Perplexity’s potential to deliver detailed and comprehensive information within a limited range of topics, rather than covering a wide breadth of knowledge. Ahmad et al. investigated the performance of ChatGPT-4.0, Claude 3 Opus, and Gemini Advanced, using the performance of second-year periodontics residents in the periodontology in-service examination. ChatGPT-4 demonstrated the highest accuracy rate at 92.7%, followed by Gemini Advanced with 81.6% and Claude 3 Opus with 78.5%, whereas second-year periodontics residents achieved a rate of only 61.9% ( P < 0.001) . Similarly, recent studies have shown that LLMs like ChatGPT and Google Gemini can significantly enhance diagnostic accuracy and patient outcomes in various dental specialties, including prosthodontics and endodontics. For example, a study evaluating Google Gemini’s performance in endodontics highlighted its potential for accurate diagnostics, despite occasional errors such as incomplete responses or hallucinations in complex scenarios​ . These findings align with the current study’s results, where Gemini Advanced demonstrated moderate accuracy in prosthodontics. Revilla-León et al. evaluated the performance of ChatGPT-3.5, ChatGPT-4.0, and licensed dentists in responding to the European Certification Exam in implant dentistry . They found a statistical difference between ChatGPT-4.0 (mean score of 84%) and ChatGPT-3.5 (mean score of 72%) ( P < 0.001); and between ChatGPT-4.0 and dentists (mean score of 74%) ( P = 0.010). However, no statistically significant difference was found in the mean score between the ChatGPT-3.5 and dentist groups ( P = 0.828). ChatGPT-4.0 was revealed the highest score among the groups tested . In the present study ChatGPT-3.5 revealed the third highest score after Copilot and Gemini. However, the results might differ if ChatGPT-4, the subscription-based version, were used. To simulate mostly used form by the public, the free version was included in this study. However, the advanced versions of the Gemini and Claude chatbots were utilized for expanded functionality due to the limited number of questions the free versions could answer. In addition, a systematic review by Umer et al. emphasized that LLMs are increasingly being utilized to assist with patient queries and clinical decision-making, particularly in areas like prosthodontics and oral surgery . However, challenges such as the reliance on outdated data and accuracy inconsistencies underscore the need for further refinements in these technologies​. This aligns with the current study’s findings, where varying performance levels were observed among the models, highlighting the importance of database quality and model training. Chen et al. evaluated ChatGPT-4.0 by posing 509 neurology questions from an online question bank. The cumulative performance of ChatGPT compared to users’ total correct answers showed a success rate of 65.82% in a single attempt and 75.25% across three attempts. The total correct answers provided by users were reported to be 72.63%. A statistically significant difference was not found between Chat-GPT 4.0 and the users . Wójcik et al.  highlighted that Claude provided higher accuracy rates in integrated medical fields and emphasized the importance of performance alignment across different languages. However, in the present study, Claude demonstrated a moderate accuracy rate, indicating that it may not be sufficiently optimized for specific areas of dentistry. When the number of correct answers was investigated according to the subtopic no statistically difference was found among AIs. Therefore, the second null hypothesis has been accepted. Interestingly Gemini revealed an 87% correct answer rate on dental morphology and Copilot revealed an 85.2% correct answer rate on fixed dentures. Guerra et al. were evaluated of the performance of ChatGPT-4 on 643 Congress of Neurological Surgeons Self-Assessment Neurosurgery Exam (SANS) board-style questions by comparing SANS users, medical students, and neurosurgery residents. ChatGPT-4 (79%) outperformed medical students (26.3%), neurosurgery residents (61.5%), and the national average of SANS users (69.3%) across all categories . In the study conducted by Warwas and Heim on oral and maxillofacial surgery examinations, ChatGPT-4 was reported to perform better in general medical topics such as pharmacology (92.8%) and anatomy (73.3%), but showed significantly weaker performance in specialized topics like implants (37.5%) and reconstructive surgery (42.9%) . Farhadi Nia et al. highlighted that while AI models like ChatGPT have improved accessibility and efficiency in dentistry, they often show limitations in specialized areas such as removable partial dentures . Similarly, in this study, lower performance was observed, particularly in specific topics such as removable partial dentures (50.8%) and complete dentures (54.7%) regardless of AI type. Jung et al. investigated the performance of ChatGPT-3.5 and Gemini in answering pediatric dentistry questions from the Korean National Dental Board Exam. It was stated that both AI-based chatbots (ChatGPT-3.5 35.3 ± 5.6% and Gemini 33.0 ± 4%) could not sufficiently answer the questions . Mahajan et al. investigated the potential use and reliability of ChatGPT for answering questions in the otolaryngology-head and neck surgery exam. The study demonstrated a correct answer rate of 53% and a correct explanation rate of 54%. They found that with increasing difficulty of questions there was a decreasing rate of answer and explanation accuracy . Table ; Fig. highlight the shared challenges AI models face in specific areas and reveal their limitations in these domains. The group data presented in Table , particularly in Group 5 (where all models provided incorrect answers), shows a high similarity rate (81.82%), indicating that some question types are especially challenging for the models. This can be linked to knowledge deficiencies in areas such as removable partial dentures, which demonstrated a low accuracy rate (50.8%). The proportion of questions where all models provided correct answers simultaneously (Level 0, 33.3%) is significantly higher than the proportion of questions where all models provided incorrect answers (Level 5, 8.7%) (Fig. ). These results indicate that while AI models are effective in general topics relying on broad knowledge bases, their performance in specific and in-depth topics remains limited. In the context of education, it is evident that AI needs to be optimized to enhance knowledge transfer in complex and specialized areas. This study has several limitations that warrant consideration. Firstly, the limited dataset of 126 questions from the DSRE may not comprehensively represent the full scope of prosthodontics knowledge. Secondly, only two of the five AI models evaluated, (Claude and Gemini) were tested in their advanced versions, while the other three were assessed in their standard versions. This discrepancy in model versions may have contributed to the observed performance differences. Additionally, the study focused solely on a specific field of expertise, which limits the generalizability of the findings. Moreover, repeatability was not assessed in this study, which constitutes another limitation. Future research should consider larger and more diverse datasets, evaluate all models using their advanced versions, and explore a broader range of specialized topics for a more comprehensive assessment. 

Copilot achieved the highest accuracy rate, with 73% (92/126) correct answers, while Perplexity had the lowest, at 54.8% (69/126). Among the subtopics, dental implantology demonstrated the highest accuracy rate (75%), whereas removable partial dentures had the lowest (50.8%). AI models demonstrate potential as educational support tools but currently face limitations in serving as reliable educational or clinical decision-support tools across all areas of prosthodontics. However, as models like Copilot demonstrate higher accuracy rates, selecting the appropriate AI model is crucial for the effective integration of AI into educational processes. As AI applications continue to evolve, it is likely that more successful outcomes will be achieved in the future. 

Below is the link to the electronic supplementary material. Supplementary Material 1 

