María Llorente de Pedro, Yolanda Freire, Natalia Moneo, Cristina Andreu-Vázquez, Roberto Estévez, Víctor Díaz-Flores García, Ana Suárez
Diagnostic questions related to tooth identification, pulpal diagnosis, periapical diagnosis and treatment indication showed accuracies above 96%. Overall accuracy for radiographic description was low (4.67%). Coronal radiographic interpretation showed poor performance (5.15%), whereas accuracy for pulpal and periapical structures exceeded 96%. Repeatability was almost perfect for diagnostic questions and pulpal/periapical interpretation, but moderate for coronal descriptions.
OBJECTIVES: Large language models have recently evolved into multimodal systems capable of interpreting images alongside text. The aim of this study was to assess the diagnostic accuracy and repeatability of ChatGPT-5 for reversible pulpitis, based on structured clinical information and periapical radiographs (PRs).
METHODS: Thirty expert-validated cases of reversible pulpitis were retrospectively selected. For each case, clinical data and PRs were compiled to create a reference dataset, with expert consensus serving as the reference standard. A structured prompt incorporating clinical information and PR was designed and included six predefined questions: four addressing diagnostic reasoning, one assessing whether PR information was used to establish the diagnosis, and one requiring radiographic findings description. Each case was entered thirty times into ChatGPT-5, generating a total of 900 answers. Answers were assessed by two independent experts, with disagreements resolved by a third. Radiographic descriptions were graded using a three-point Likert scale. Diagnostic accuracy and repeatability were analysed using binomial and agreement methods.
RESULTS: Diagnostic questions related to tooth identification, pulpal diagnosis, periapical diagnosis and treatment indication showed accuracies above 96%. Overall accuracy for radiographic description was low (4.67%). Coronal radiographic interpretation showed poor performance (5.15%), whereas accuracy for pulpal and periapical structures exceeded 96%. Repeatability was almost perfect for diagnostic questions and pulpal/periapical interpretation, but moderate for coronal descriptions.
DISCUSSION: ChatGPT-5 demonstrated high accuracy and repeatability in text-based diagnostic reasoning for reversible pulpitis. However, limitations in radiographic interpretation, particularly of coronal structures, indicate that its use should be limited to a supervised decision-support role.