Challenges of Local Ethics Review in a Global Healthcare AI Market

Artificial intelligence applications in smile design dentistry: A scoping review

PURPOSE

Artificial intelligence (AI) applications are growing in smile design and aesthetic procedures. The current expansion and performance of AI models in digital smile design applications have not yet been systematically documented and analyzed. The purpose of this review was to assess the performance of AI models in smile design, assess the criteria of points of reference using AI analysis, and assess different AI software performance.

METHODS

An electronic review was completed in five databases: MEDLINE/PubMed, EMBASE, World of Science, Cochrane, and Scopus. Studies that developed AI models for smile design were included. The search strategy included articles published until November 1, 2024. Two investigators independently evaluated the quality of the studies by applying the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Quasi-Experimental Studies and Textual Evidence: Expert Opinion Results.

RESULTS

The search resulted in 2653 articles. A total of 2649 were excluded according to the exclusion criteria after reading the title, abstract, and/or full-text review. Four articles published between 2023 and 2024 were included in the present investigation. Two articles compared 2D and 3D points while one article compared the outcome of satisfaction between dentists and patients, and the last article emphasized the ethical components of using AI.

CONCLUSION

The results of the studies reviewed in this paper suggest that AI-generated smile designs are not significantly different from manually created designs in terms of esthetic perception. 3D designs are more accurate than 2D designs and offer more advantages. More articles are needed in the field of AI and smile design.

Artificial intelligence and smile design: An e-Delphi consensus statement of ethical challenges

PURPOSE

Smile design software increasingly relies on artificial intelligence (AI). However, using AI for smile design raises numerous technical and ethical concerns. This study aimed to evaluate these ethical issues.

METHODS

An international consortium of experts specialized in AI, dentistry, and smile design was engaged to emulate and assess the ethical challenges raised by the use of AI for smile design. An e-Delphi protocol was used to seek the agreement of the ITU-WHO group on well-established ethical principles regarding the use of AI (wellness, respect for autonomy, privacy protection, solidarity, governance, equity, diversity, expertise/prudence, accountability/responsibility, sustainability, and transparency). Each principle included examples of ethical challenges that users might encounter when using AI for smile design.

RESULTS

On the first round of the e-Delphi exercise, participants agreed that seven items should be considered in smile design (diversity, transparency, wellness, privacy protection, prudence, law and governance, and sustainable development), but the remaining four items (equity, accountability and responsibility, solidarity, and respect of autonomy) were rejected and had to be reformulated. After a second round, participants agreed to all items that should be considered while using AI for smile design.

CONCLUSIONS

AI development and deployment for smile design should abide by the ethical principles of wellness, respect for autonomy, privacy protection, solidarity, governance, equity, diversity, expertise/prudence, accountability/responsibility, sustainability, and transparency.