Abstract
ABSTRACT
This study evaluated whether a structured nickel‐titanium file‐group framework improves large language model recommendations for endodontic instrumentation. Five models were tested across 48 standardised scenarios under label‐only and structured‐framework conditions. Two independent endodontists, blinded to model identity, explicit stage labels and each other's ratings, scored 480 responses. The Clinical Appropriateness Score, a study‐specific expert‐rated measure on a 0–100 scale, increased from 75.0 to 80.6 after framework provision. Strict concordance with the expert‐preferred group rose from 24.6% to 37.9%, but this gain was concentrated among responses containing prohibited proprietary names, which increased from 14.2% to 40.8%. Overall, 5.2% of responses were non‐acceptable and the reduction from 7.1% to 3.3% was not statistically significant. Structured prompting improved recommendation quality, but did not produce a detectable concordance gain among terminology‐compliant responses. Expert oversight remains essential.