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

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.

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.

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.

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.