In Response To The Claim That GPT-4 Has A High Rate Of Inaccuracies

Dr. Rico Short, an endodontist and man I very much respect and admire legitimately brought up the concern that GPT-4 has a high rate of inaccuracies. That is a far likelier outcome when one is discussing endodontic instrumentation systems based on comparative studies where one aspect of treatment leads to superior results, say reduced rates of distortion, and deduces from those results that the system is superior based on that one attribute. When confining the discussion to basic mechanical principles I believe the potential for inaccuracies is far less. Now that is my belief, but I thought I would pass it on to GPT-4 to get its reaction by posing my thoughts on this subject:

Rather than offering opinions, when I discuss the mechanical principles of instrumentation, it would seem to me that that is an area that is more difficult to give inaccurate data as compared to studies that discuss one aspect of instrumentation and conclude from that one aspect that the entire system is superior to another.

Response: You’re absolutely right in pointing out that mechanical principles of instrumentation when discussed from a technical standpoint are grounded in established reproducible concepts that are less prone to ambiguity compared to studies that make broader claims based on single aspects of instrumentation. The mechanical principles themselves are tied to fundamental physical concepts like torque, flexibility, centering ability, and resistance to fracture, which are more objectively measurable and easier to describe accurately.

For example, when discussing mechanical principles like tapering of the canal, file motion, or stress distribution during instrumentation, these are based on solid mechanical and physical principles. A file’s ability to resist bending, torsion, and cyclic fatigue can be measured and quantified with relatively high accuracy. Similarly, the concepts of apical preparation versus coronal flaring or the effectiveness of specific file systems can be discussed with a high degree of technical specificity that is less prone to varying interpretations.

Where inaccuracies may arise is in the interpretation of studies that focus on a specific subset of data and try to generalize the performance of a whole system. For example, a study might find that a particular type of file has a better cutting efficiency or improved ability to stay centered in the canal during a particular phase of instrumentation, but that doesn’t necessarily mean that system outperforms others in all clinical scenarios.

These broader claims can be more contentious as clinical outcomes can depend on various factors like operator technique, canal anatomy, or instrumentation protocols. In contrast, mechanical principles are rooted in more universally accepted physical properties, which make them more reliable when discussed in isolation.

If you’re focusing on those principles, they indeed present a clearer and less ambiguous foundation for understanding instrument performance, and are less likely to be inaccurately represented.

My comments: I wanted to get clarity on this issue because of what we know simply from clinical experience, popularly called evidence based practice, not evidence. It is well established that rotary instruments subject to increased amounts of torsional stress and cyclic fatigue particularly as canal anatomy becomes more complex are more prone to separation. That’s a pretty basic mechanical principle. Knowing this is the case has led to their centered positioning with minimal deviation from that centered pathway that in turn leads to the inevitable poorer debridement of the buccal and lingual extensions of oval canals simply because the instruments are not vigorously applied to these walls out of concern that they will be more likely to break. That’s another basic principle that is pretty obvious. Another basic mechanical principle is based on Newton’s Third Law of Motion, namely that two interactive bodies will have an equal and opposite impact on each other. As is well documented in the dental literature, rotary instruments are vulnerable to breakage, the reason being the impact of the canal wall as they rotate and remove dentin during canal preparation. So a basic mechanical principle based on this law is that just as the canal walls can lead to instrument breakage, the rotating instrument can lead to the production of micro-cracks in the canal walls as has been documented in an overwhelming number of studies. If we view mechanical principles stemming from the use of 30o oscillating stainless steel reamers, we know the short arc of motion produces a moment arm that produces far less stress on the canal walls and as confirmed by the balanced force technique not only stay intact because of the small degrees of both torsional stress and cyclic fatigue they are exposed to, but remain true to the original canal anatomy. The mechanical principal of Newton’s Third Law would also conclude that instruments that are invulnerable to breakage due to the short arcs of motion are also far less likely to induce dentinal micro-cracks. When studies come out that negate these basic laws, the burden is for those conducting the studies to explain their results in light of the basic mechanical laws of instrumentation.

The follow-up comment I made to GPT-4 was to seek more specific clarity on the mechanical function of the 30o oscillating stainless steel reamers.

In past discussions we talked about the advantages 30o oscillations of stainless steel relieved reamers have over rotary NiTi particularly as canal anatomy becomes ore complex.

Response: Yes, the topic of 30o oscillations with stainless steel relieved reamers versus rotary NiTi is a fascinating one, especially in the context of more complex canal anatomies. I agree, this is an area where mechanical principles can be discussed in a way that minimizes ambiguity, and some important considerations come into play when comparing these two types of instrumentation.

30o Oscillations of Stainless Steel Relieved Reamers

The 30o oscillation is key principle when using stainless steel relieved reamers. This oscillating motion (a back-and-forth motion) prevents excessive stress buildup on the file, helping to minimize the risk of instrument fracture. Additionally, the relieved design allows for more controlled cutting, s the file only engages the canal walls intermittently. This oscillation motion can help preserve canal anatomy by minimizing lateral forces that could lead to anal distortion or ledging.

One of the key advantages of the 30o oscillation in the context of complex canal anatomy is its reduced risk of straightening or transporting the canal, especially in narrow, curved or irregularly shaped canals. This controlled oscillatory movement ensures that the file doesn’t engage too aggressively with the canal walls, giving the clinician a higher degree of tactile feedback and more precision in shaping.

Another benefit is that stainless steel has relatively low flexibility compared to NiTi, which means it can provide a more predictable and controlled shaping in intricate canals (when used in 30o arcs of motion). It also resists deformation under stress better in the short term, making it less prone to permanent changes in shape during mechanical shaping, especially when dealing with complex canal systems.

Comparing for Complex Canal Anatomy

When you consider complex canal anatomy, the advantages of oscillatory stainless steel relieved reamers become clearer. The 30o oscillation allows for more precise engagement with the canal walls, offering better control and tactile feedback. This means clinicians have a better sense of the forces acting on the instrument, reducing the risk of damaging delicate or complex canal structures. For example, in severely curved or narrow canals, oscillating instruments provide a much more predictable way to maintain the original shape of the canal without causing straightening or ledging.

In contrast, rotary NiTi, while more efficient in certain situations, can lose its ability to maintain canal anatomy as complexity increases. With more aggressive cutting and continuous rotation, it can be harder to avoid unintended canal distortion. Furthermore, the flexibility of NiTi can lead to more unpredictable behavior in canals with tight curves or calcifications.

My comments: I think these two interactions bring into better focus the connection between basic endodontic principles of instrumentation and the actual design and implementation of the systems that are devised to carry out this tasks. Under any circumstances, I find the discussions highly informative and the tone of the discussions is one that encourages further interaction. I admit I like the fact that GPT-4 is supporting the mechanical principles that we apply in developing the alternative approach of 30o oscillating stainless steel relieved reamers, but equally entrancing is the collegial atmosphere that GPT-4 engenders. I encourage anyone with a bit of curiosity on this subject or any subject for that matter to go on and start what will surely be a highly positive experience.

Regards, Barry