BUFFALO, N.Y.: Every year, millions of children and teenagers walk into dental clinics with a silent problem hidden behind their smiles — permanent teeth that never formed. For families, it means uncertainty. For orthodontists, it means high-stakes decisions that can shape facial appearance, confidence, and oral health for life. Now, a new scientific breakthrough is stepping into this critical moment of care: artificial intelligence is being trained to help dentists choose the safest and smartest treatment path for patients born without permanent teeth.
A newly published study from the University at Buffalo School of Dental Medicine suggests artificial intelligence can accurately guide treatment decisions for patients born without permanent teeth — a condition affecting millions worldwide.
Tooth agenesis, the congenital absence of one or more teeth, is among the most common yet complex challenges in orthodontics. Permanent second premolars usually erupt around age 11, replacing baby teeth. But in 2% to 11% of people, these teeth never form, forcing orthodontists to choose between keeping baby molars, closing spaces, or preparing for implants or bridges later in life.
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“This condition adds an entire layer of complexity,” explained Thikriat Al-Jewair, DDS, L.B. Badgero Endowed Chair and associate professor of orthodontics at the University at Buffalo. She noted that clinicians must balance facial aesthetics, crowding, patient preferences, and cost — all while protecting long-term oral health.
To reduce guesswork, researchers trained artificial intelligence models using dental models, radiographs, photographs, and clinical histories from 100 orthodontic patients treated between 2010 and 2024. All patients had intact primary second molars and missing permanent successors.
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Among four machine-learning systems tested, the Random Forest algorithm achieved 96.4% accuracy in predicting the best treatment option. Key decision factors included patient preference for restoration, degree of mandibular crowding, and the presence of ankylosis — a condition where teeth fuse to bone and sink below gum level.
“Errors in orthodontic decisions can have lasting consequences, from facial imbalance to bone loss and patient dissatisfaction,” Al-Jewair said. “AI gives us a way to enhance diagnostic accuracy and improve treatment predictability.”
The study was published in the January 2026 issue of Orthodontics and Craniofacial Research and involved a multidisciplinary team, including statistician William Tanberg and AI specialist Mohammed Elnagar. Their findings highlight how modern machine learning can act as an “expert system,” offering clinical guidance rather than replacing professional judgment.
AI is not entirely new to dentistry. It has long been used for imaging and digital planning. What has changed is its ability to analyze multiple clinical variables simultaneously and support complex treatment decisions — something previously possible only through years of specialist experience.
“Less experienced orthodontists struggle with these cases,” Al-Jewair said. “If AI can be integrated into everyday clinical tools, it could significantly improve outcomes for patients.”
For families facing the uncertainty of missing permanent teeth, this innovation signals hope. For dentistry, it marks another step toward precision-based care — where technology and human expertise work together to design healthier, more confident smiles.
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