# Clinical and Patient Comparison of AI and Expert Digital Smile Design: A Prospective Paired Study

## TL;DR

This study compares AI-generated and expert-designed smiles and finds that AI designs are more aesthetically pleasing to patients and faster to create.

## Contribution

The study introduces a prospective paired comparison of AI and expert digital smile designs using clinical and patient evaluations.

## Key findings

- AI-generated designs had significantly lower DESI scores but higher patient and expert VAS ratings.
- Patients preferred AI designs in 69.7% of cases.
- AI workflows reduced design time by 51.46% compared to expert workflows.

## Abstract

Background: Artificial intelligence (AI) systems are increasingly being used in digital smile design and esthetic treatment planning; however, evidence comparing the esthetic performance of AI-generated designs with expert clinician-generated designs remains limited. Objective evaluation using standardized esthetic indices is necessary to determine whether AI-generated outcomes achieve comparable clinical quality. Methods: This prospective paired comparative study included 33 patients. For each case, two smile designs were created: one generated using a fully automated AI system (SmileFy) and one designed manually by an experienced clinician using Exocad software(version 3.2 Elefsina; exocad GmbH, Darmstadt, Germany). Twenty blinded prosthodontists evaluated all designs using the Dental Esthetic Screening Index (DESI) and a visual analog scale (VAS). Patients provided esthetic VAS ratings and forced-choice preferences. Objective geometric measurements and total design time were recorded. Paired statistical analyses were performed with a significance level of p < 0.05. Results: AI-generated designs demonstrated significantly lower total DESI scores than expert-generated designs (14.79 ± 1.63 vs. 18.73 ± 1.82; p < 0.001). Both expert and patient VAS ratings were significantly higher for AI designs (p < 0.001). Patients preferred AI-generated designs in 69.7% of cases compared with 30.3% for expert designs (p < 0.001). AI workflows were significantly faster, with a mean design time of 30.82 ± 5.14 min versus 63.48 ± 14.12 min for expert workflows, corresponding to a 51.46% reduction in planning time (p < 0.001). Conclusions: Fully automated AI-generated smile designs demonstrated favorable esthetic performance, higher patient acceptance, and substantial improvements in workflow efficiency compared with expert-driven digital designs, supporting their potential role as adjunctive tools in esthetic treatment planning.