Comparative perception of smiles designed by AI vs. dentist using standard esthetic rules: a visual preference study among laypeople and dental professionals.

Artificial intelligence (AI) has rapidly emerged as a transformative tool in digital smile design, offering automated and data-driven esthetic solutions. However, the comparative perception of AI-generated smiles and those designed by dental professionals remains unclear. To compare the esthetic perception, preference, and acceptance of smiles designed by artificial intelligence and dental professionals using standard esthetic principles among laypeople and dental professionals. A prospective, cross-sectional visual preference study was conducted involving 180 participants, including dental professionals and laypersons. Two patients (one male and one female) were selected, and for each, two smile designs were created: one using AI and the other by a dentist following standard esthetic guidelines. Participants evaluated both designs using a 5-point Likert scale based on extraoral and intraoral parameters. Preference and identification of designs were assessed using comparative questions. Statistical analysis included Wilcoxon signed-rank test, Mann-Whitney U test, exact binomial test, and chi-square test, with p< 0.05 considered significant. Dentist-designed smiles received significantly higher esthetic scores than AI-generated designs (Patient 1: 3.89± 1.03 vs 2.93 ± 1.04; Patient 2: 3.95 ± 1.15 vs 3.04 ± 1.05; p < 0.001). A majority of participants preferred dentist-designed smiles as more natural (76.1% and 78.3%) and more attractive (80.6% and 81.1%) (p < 0.001). Participants were able to correctly identify AI-generated designs in 66.1% and 69.4% of cases. Most participants (87.1%) favored a collaborative approach combining AI with dentist expertise. Under the conditions of this study, dentist-designed smiles received higher ratings and were perceived as more esthetic than AI-generated designs. A combined approach integrating AI with professional judgment is recommended for optimal esthetic outcomes.