The Absent Professional in Digital Dentistry Patient Perception, Therapeutic Alliance and Trust

Background: The growing use of digital platforms and Artificial Intelligence (AI) in dentistry has redefined the patient-clinician relationship. While telemedicine and teledentistry consistently report high levels of patient satisfaction, concerns persist regarding the absence of physical presence, reduced empathy and potential disruption of the therapeutic alliance. This study evaluated whether adaptive symbolic strategies can sustain adherence and trust in orthodontic treatments mediated by digital systems. Methods: A pilot study was conducted with more than 100 adult patients (18-55 years) undergoing aligner therapy with digital follow-up via OrtoBotAI, a locally developed AI-assisted platform. Participants completed a 10-item Likert questionnaire to identify affective profiles (validation, hypervigilance, avoidance, idealization/rejection, guilt). Based on these profiles, adaptive symbolic signs-such as personalized reminders, transparent progress indicators and empathetic reinforcement-were deployed. Quantitative outcomes included adherence, satisfaction and transferential conflicts, complemented by qualitative interviews. Results: Compared with baseline digital monitoring, adherence increased by 25% (82% ± 8.5 vs. 65% ± 10.2, p < 0.01). Satisfaction improved to 85% (81% ± 7.9 vs. 69% ± 9.1, p < 0.01). Transferential conflicts decreased by 40%, particularly among hypervigilant and idealizing patients. The validation and guilt profiles achieved the highest adherence and satisfaction, whereas the idealization/rejection group showed the weakest outcomes. Conclusion: Symbolic presence, mediated through adaptive digital strategies, can effectively compensate for the orthodontist’s physical absence. OrtoBotAI enhanced adherence, reduced transferential conflicts and improved patient satisfaction, underscoring the importance of integrating symbolic and psychological dimensions into AI-assisted orthodontic platforms. These findings support the development of hybrid models in which professional supervision and digital mediation coexist ethically and effectively.