OrthoAI v2: From Single-Agent Segmentation to Dual-Agent Treatment Planning for Clear Aligners

Abstract

We present OrthoAI v2, the second iteration of our open-source pipeline for AI-assisted orthodontic treatment planning with clear aligners, substantially extending the single-agent framework previously introduced. The first version established a proof-of-concept based on Dynamic Graph Convolutional Neural Networks (\dgcnn{}) for tooth segmentation but was limited to per-tooth centroid extraction, lacked landmark-level precision, and produced a scalar quality score without staging simulation. \vtwo{} addresses all three limitations through three principal contributions: (i)~a second agent adopting the Conditioned Heatmap Regression Methodology (\charm{})~\cite{rodriguez2025charm} for direct, segmentation-free dental landmark detection, fused with Agent~1 via a confidence-weighted orchestrator in three modes (parallel, sequential, single-agent); (ii)~a composite six-category biomechanical scoring model (biomechanics $\times$ 0.30 + staging $\times$ 0.20 + attachments $\times$ 0.15 + IPR $\times$ 0.10 + occlusion $\times$ 0.10 + predictability $\times$ 0.15) replacing the binary pass/fail check of v1; (iii)~a multi-frame treatment simulator generating $F = A \times r$ temporally coherent 6-DoF tooth trajectories via SLERP interpolation and evidence-based staging rules, enabling ClinCheck 4D visualisation. On a synthetic benchmark of 200 crowding scenarios, the parallel ensemble of OrthoAI v2 reaches a planning quality score of $92.8 \pm 4.1$ vs.\ $76.4 \pm 8.3$ for OrthoAI v1, a $+21\%$ relative gain, while maintaining full CPU deployability ($4.2 \pm 0.8$~s).