5D orthodontics: integration of multidimensional imaging and predictive technologies—a scoping review

Abstract This review explores the emerging concept of fifth-dimension (5D) Orthodontics, a framework that brings together 3D spatial anatomy, temporospatial changes, biologically responsive behaviour, predictive artificial intelligence, and advanced fabrication technologies. The aim is to outline the scientific basis of these developments, describe recent technological progress, and evaluate how 5D concepts may influence orthodontic diagnosis, treatment planning, and appliance design. The reviewed literature highlights the multidimensional imaging techniques including 5D MRI, ultrasound, and near-infrared optical systems. AI-driven predictive modelling, and both 5D and 4D printing technologies are enabling increasingly precise, patient-specific appliances. Digital-twin platforms show particular promise by combining spatial, temporal, and functional data into unified predictive simulations. Despite this progress, full integration of all five dimensions remains limited. While 3D modelling and AI-assisted imaging are nearing routine use, incorporation of biological responses, time-dependent changes, and patient behaviour is still developing. Methodological heterogeneity, limited longitudinal evidence, computational demands, and lack of standardised protocols continue to challenge widespread adoption. 5D Orthodontics may represent an emerging conceptual framework from static, single-dimension approaches to a predictive, biologically informed, and patient-specific framework. By combining spatial anatomy, temporal dynamics, biological behaviour, computational intelligence, and advanced fabrication, it offers potential for more precise diagnostics, personalized treatment simulations, and adaptive appliance design. Future development will require interdisciplinary research, standardization of data and modelling protocols, ethical governance, and clinical validation to fully realize the 5D paradigm in routine orthodontic practice.