Tooth-level spatial distribution of AI-detected oral hygiene insufficiency in fixed appliance versus clear aligner patients: A large-scale analysis using the dental monitoring™ platform.

BACKGROUND: To characterize the tooth-level spatial distribution of AI-detected oral hygiene insufficiency across the full dentition in patients undergoing fixed appliance (FA) and clear aligner therapy (CAT) using the Dental Monitoring (DM) remote monitoring platform at population scale. METHODS: A retrospective analysis of 15,331,019 Dental Monitoring oral hygiene scan notifications from 40,748 orthodontic patients (9,940,299 CAT; 5,390,720 FA) was performed. Notifications were scored on a 0-2 ordinal scale; absent notifications were excluded. Hygiene scores were aggregated by appliance type, arch, region, tooth type, quadrant, and individual tooth. Mann-Whitney U (MWU) tests compared FA and CAT distributions; rank-biserial correlation (RBC) quantified effect size. Chi-square tests compared hygiene category frequency distributions between groups; Cramér's V quantified effect size. RESULTS: FA patients exhibited significantly higher AI-detected hygiene insufficiency than CAT patients at every tooth, arch, tooth type, and quadrant (all P < 0.0001). Overall FA mean score was 0.85 ± 0.46 versus 0.55 ± 0.52 for CAT (mean difference = 0.30); effect sizes were small (RBC = 0.090-0.104), though patient-level analysis yielded a medium effect (RBC = 0.401). Within both groups, mandibular and anterior teeth demonstrated greater insufficiency than maxillary and posterior teeth. Canines and incisors carried the greatest burden across tooth types, with the mandibular right lateral incisor recording the highest FA mean (0.88). Near-bilateral symmetry was observed across all quadrant comparisons. CONCLUSIONS: At unprecedented scale, AI-driven remote monitoring confirms that FA patients carry a substantially higher oral hygiene burden than CAT patients across the entire dentition. The spatial distribution of insufficiency, concentrated at mandibular and anterior teeth, identifies tooth-level targets for precision hygiene intervention during orthodontic treatment.