Accuracy of Artificial Intelligence-Designed Dental Crowns: A Scoping Review of In-Vitro Studies

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The topic of the manuscript is nice and interesting. However, several points needs to be addressed.

1. Please write in detail how from 206 articles 10 articles were only included in the study. Provide more details on keywords used, filters used as well as more details on the search strategy.
2. Please also include a quality assessment of the studies that were included.
3. What was the standard method or metrics used for evaluation of the crown by AI?
4. Please expand the discussion part on how AI can be potentially integrated and clinically applied in prosthodontics moreover discussion regarding the comparison between AI methods used and computational design such as CAD/CAM would be valuable.
5. Please add more figures and tables to improve the presentation of the data and to make reader friendly.
6. Please follow the referencing guidelines as per the journal's instructions.
7.  In the table 1 please try to add the limitations of each study.

Comments on the Quality of English Language

Can be improved.

Author Response

Response to reviewer #1

Comment 1:

Please write in detail how from 206 articles 10 articles were only included in the study. Provide more details on keywords used, filters used as well as more details on the search strategy.

Author’s response:

We appreciate your comment. The Methodology section has been revised to provide a clearer and more detailed explanation of our search process. We now describe the exact keywords, Boolean operators, and filters used, as well as the sequential screening process. This ensures greater transparency and reproducibility of our search strategy. Mention exactly where in the revised manuscript this change can be found in line 100-106

 

Comment 2:

Please also include a quality assessment of the studies that were included.

Author’s response:

Thank you for your valuable suggestion. To address this, we have added a new subsection, “2.4. Quality Assessment of Included Studies”, to the Methods section. In this section, we assessed the methodological transparency and clinical applicability of each included study using objective criteria:

(1) whether the AI methodology was clearly described,

(2) whether physical crowns were fabricated for evaluation, and

(3) whether in vivo validation was performed.

 

Comment 3:

What was the standard method or metrics used for evaluation of the crown by AI?

Author’s response:

Thank you for your valuable comment. We have revised the manuscript to provide a more detailed explanation of the outcome metrics used to evaluate the accuracy and clinical performance of AI-designed crowns. Specifically, we expanded Section 3.5 (Outcome Metrics) to describe the types of evaluation parameters, their frequency of use, and the methods applied for measurement.

 

Comment 4:

Please expand the discussion part on how AI can be potentially integrated and clinically applied in prosthodontics. Moreover, discussion regarding the comparison between AI methods used and computational design such as CAD/CAM would be valuable.

Author’s Response:

Thank you for your valuable suggestion. We have revised the Discussion section to address the potential integration and clinical application of AI in prosthodontics and to compare AI-based crown design methods with conventional CAD/CAM workflows. Specifically, we expanded Section 4.6 (Clinical Relevance and Limitations)

 

Comment 5:

Please add more figures and tables to improve the presentation of the data and make the manuscript more reader-friendly.

Author’s response:

Thank you for your suggestion. To improve the clarity and readability of the manuscript, we included a new table (Table 2) summarizing the quality assessment of the included studies to provide readers with a clearer understanding of the methodological rigor of each study.

 

Comment 6:

Please follow the referencing guidelines as per the journal's instructions.

Author’s response:

Thank you for your comment. We have carefully reviewed the manuscript to ensure that all references comply with the Applied Sciences referencing guidelines.

 

Comment 7:

In Table 1, please try to add the limitations of each study.

Author’s response:

Thank you for your valuable suggestion. We have revised Table 1 to include a concise summary of the main limitations reported or inferred for each study.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Review of Accuracy of Artificial Intelligence-Designed Dental Crowns: A Scoping Review

Thank you for the opportunity to review this manuscript, which scopes the literature on AI-supported crown design. While the topic is timely, I feel that important elements in the Methods and Results are missing or insufficiently reported.

 

The iThenticate similarity index is 44%, which is unacceptably high and should be reduced substantially.

 

Abstract: The abstract should be structured, also does not present well the main idea of the research. Methods are not presented clear. Results are not described precise.

 Introduction: The AIM/Purpose of the review is not well stated. Also, research question is missing.  

Material and Methods: For scoping reviews is better to use PCC (Population, Concept, Context)- framework, PICO(S) is for systematic reviews.

• Does the scoping review receive registration?
• The sentence “linked through Boolean operators” is too generic. For each database, provide the exact, reproducible search
• In vivo , in vitro should be written in italics.
• The statement: “In cases where discrepancies arose, disagreements were resolved through discussion and consensus” is methodologically weak and may conceal risk of Bias.
• The statement: “Data extracted from the included studies were charted in Microsoft Excel. The program was used to systematically organize study characteristics”. Please clarify whether you mean Microsoft Excel (specify version) or another program. Results:
• In Figure 2 – correct database names to PubMed and Web of Science
• How did you remove the duplicates? Did you use some software/tool/procedure? Can you describe more the method?
• The statement: “This upward trend may be attributed to the accelerated advancement and commercialization of AI-driven dental CAD software during this period.” Is speculative and not appropriate for the results section, better add in discussion with citation.
• Line 153-154,177 other authors cannot be cited in results section.
• After all, results contains speculative trend language, inconsistent citation style, and insufficient quantitative detail for outcomes/datasets.

 

Discussion:

• The Discussion repeats portions of the Results; please focus on synthesis, interpretation, and implications.
• Limitations of the presented research are missing.

Comments for author File: Comments.pdf

Author Response

Response to reviewer #2

 

Comment 1:

The iThenticate similarity index is 44%, which is unacceptably high and should be reduced substantially.

Author’s response:

We sincerely appreciate the reviewer’s observation regarding the high similarity index. In response, we have thoroughly revised the manuscript to substantially reduce textual overlap and improve originality.

 

Comment 2:

The abstract should be structured, also does not present well the main idea of the research. Methods are not presented clear. Results are not described precise.

Author’s response:

Thank you for the suggestion. In line with the journal’s formatting requirements, we have kept the abstract in a single-paragraph format but revised it thoroughly to make the aim, methods, and findings clearer and more concise.

 

Comment 3:

 The AIM/Purpose of the review is not well stated. Also, research question is missing.  

Author’s response:

Thank you for your valuable feedback. We have revised the end of the Introduction to clearly state the aim and explicitly include the research question to enhance clarity and focus.

 

Comment 4:

Material and Methods: For scoping reviews is better to use PCC (Population, Concept, Context)- framework, PICO(S) is for systematic reviews.

Author’s response:

We appreciate the reviewer’s suggestion and have revised the methodology to adopt the PCC framework, which is more suitable for scoping reviews. The corresponding section has been updated accordingly (Methods, Section 2.1).

 

Comment 5:

Does the scoping review receive registration?

Author’s response:

Thank you for your comment. This scoping review was not registered in any public registry, as registration is not a mandatory requirement for scoping reviews. We have clarified this point directly in the Methods section to enhance transparency.

 

Comment 6:

The sentence “linked through Boolean operators” is too generic. For each database, provide the exact, reproducible search

Author’s response:

We appreciate the reviewer’s suggestion. To enhance transparency, we have revised the Methods section to provide more detail about the search strategy. Instead of giving full, lengthy search expressions, we now describe the main keywords used and explain that Boolean operators were applied consistently across all four databases. We believe this sufficiently improves reproducibility while keeping the section concise.

 

Comment 7:

In vivo , in vitro should be written in italics.

Author’s response:

Thank you for pointing this out. We have carefully revised the entire manuscript and formatted all instances of in vivo and in vitro in italics according to the journal’s style guidelines.

 

Comment 8:

The statement: “In cases where discrepancies arose, disagreements were resolved through discussion and consensus” is methodologically weak and may conceal risk of Bias

Author’s response:

Thank you for your valuable feedback. We agree that the original statement lacked sufficient clarity and could imply potential bias in the selection process. We have revised the sentence to better reflect the rigorous and transparent methodology applied.

“In cases of disagreement, the reviewers revisited the eligibility criteria and discussed the evidence thoroughly until full agreement was achieved, ensuring a transparent and unbiased selection process.”

 

Comment 9:

The statement: “Data extracted from the included studies were charted in Microsoft Excel. The program was used to systematically organize study characteristics”. Please clarify whether you mean Microsoft Excel (specify version) or another program.

Author’s response:

Thank you for pointing this out. To improve clarity, we have revised the statement to explicitly specify the software used.

““Data extracted from the included studies were organized and charted using Microsoft Excel (version 2021; Microsoft Corp., Redmond, WA, USA). This software was used to systematically manage study characteristics and evaluation metrics, facilitating a structured qualitative synthesis.”

 

Comment 10:

In Figure 2 – correct database names to PubMed and Web of Science

Author’s Responsse:

Thank you for the observation. We have corrected the database names in Figure 2 to accurately reflect “PubMed” and “Web of Science.”

 

Comment 11:

How did you remove the duplicates? Did you use some software/tool/procedure? Can you describe more the method?

Author’s response:

Thank you for your comment. Duplicate records were removed manually using Microsoft Excel. After exporting all search results into a spreadsheet, we sorted the records by title, author, and DOI, and duplicates were identified and deleted manually. We have clarified this process in the Methods section for transparency.

 

Comment 12:

The statement: “This upward trend may be attributed to the accelerated advancement and commercialization of AI-driven dental CAD software during this period.” Is speculative and not appropriate for the results section, better add in discussion with citation.

Author’s response:

Thank you for your suggestion. We have removed the speculative statement from the Results section to maintain objectivity and ensure the section contains only descriptive information.

 

Comment 13:

Line 153-154,177 other authors cannot be cited in results section.

Author’s response:

Thank you for your comment. All citations of other authors have been removed from the Results section to ensure it only presents the findings of our review.

 

Comment 14:

After all, results contains speculative trend language, inconsistent citation style, and insufficient quantitative detail for outcomes/datasets.

Author’s response:

Thank you for pointing this out. We have carefully revised the Results section to remove speculative statements, unify the citation style, and provide more precise quantitative details regarding datasets and outcome metrics. These changes improve clarity and ensure that the section strictly reports objective findings.

 

Comment 15:

The Discussion repeats portions of the Results; please focus on synthesis, interpretation, and implications. Limitations of the presented research are missing.

Author’s response:

Thank you for your comment. We revised the Discussion to reduce repetition from the Results and focused on synthesizing findings and their clinical implications. Additionally, we added a dedicated paragraph outlining the limitations of this review to address your concern.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The authors reported that "This scoping review aims to fill that gap by summarizing the current evidence on AI-designed dental crowns and assessing their clinical applicability. "

I have some doubts about Assessing clinical applicability. Scoping reviews  provide an overview of the evidence, rather than a critical appraisal or a definitive answer to a specific question.

Please remove icons from figure 1 and use scientific diagram. 

Why did you follow the PRISMA guidelines if this is a scoping review? Is this a scoping or a systematic review? Please clarify.

"aimed to explore how AI has been applied to the design of full-coverage dental crowns and to assess its reported performance" The "point" at the end is missed. However, this aim is different from the previous, and also in the abstract the aim is not clear. Please avoid confusion and clearly define the aim.

Seems that this is a systematic reviews. Please add the "s" in the PICO. 

In the inclusion criteria: "Original research articles". Please define which type of articles.

According to the PRISMA guidelines, you need to report several data (if this is a systematic review). For example, detailed outcomes, risk of bias, effect measures, etc...

Research string must to be reported in detail

What about follow-up of there included studies?

I still don't understand if you included in-vitro study. I think so. But reading the manuscript seems that you reported in-vivo study. It is not clear.

The included study are to heterogenous to perform s systematic review.

I agree with the concept of "scoping review" however, there manuscript must to be completely rewritten for its methodology.

Please, write the manuscript as a scoping review. Remove all the reference to PRISMA!. And the aim should be an overview of the evidence, able to guide the research in further researches. For example, state of the literature about morphology and what is missed, same for marginal fit accuracy, same for software developments, same for clinical evaluation.... this is the aim of a scoping review.

 

Comments on the Quality of English Language

English could be improved.

Author Response

Response to reviewer #3

Comment 1:

The authors reported that "This scoping review aims to fill that gap by summarizing the current evidence on AI-designed dental crowns and assessing their clinical applicability."

I have some doubts about Assessing clinical applicability. Scoping reviews provide an overview of the evidence, rather than a critical appraisal or a definitive answer to a specific question.

Author’s response:

Thank you for your insightful comment. Accordingly, we have revised the aim throughout the manuscript to clarify that this review summarizes the current literature on AI-designed dental crowns and discusses potential clinical implications, without making definitive judgments on clinical applicability.

 

Comment 2:

Please remove icons from figure 1 and use scientific diagram. 

Author’s response:

We appreciate the reviewer’s comment regarding Figure 1. In this study, Figure 1 was intentionally designed as a schematic workflow diagram to provide a clear and intuitive overview of the review process. The use of icons is limited to enhancing readability and visualizing each step concisely, without affecting the scientific accuracy of the content.

Since the figure accurately reflects the methodological framework and all elements are directly related to the research workflow, we respectfully suggest retaining the current design to maintain clarity and improve accessibility for readers.

 

Comment 3:

Why did you follow the PRISMA guidelines if this is a scoping review? Is this a scoping or a systematic review? Please clarify.

Author’s response:

We appreciate the reviewer’s comment. We would like to clarify that this study is a scoping review, not a systematic review. Therefore, we followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, which are specifically designed for scoping reviews. We have revised the manuscript to make this distinction clearer and to avoid any potential confusion.

 

Comment 4:

"aimed to explore how AI has been applied to the design of full-coverage dental crowns and to assess its reported performance" The "point" at the end is missed. However, this aim is different from the previous, and also in the abstract the aim is not clear. Please avoid confusion and clearly define the aim.

Author’s response:

We appreciate the reviewer’s valuable comment. To address this, we have revised the aim of the study throughout the manuscript, including the Introduction and Abstract, to ensure consistency and clarity.

 

Comment 5:

Seems that this is a systematic reviews. Please add the "s" in the PICO. 

Author’s response:

We appreciate the reviewer’s suggestion. In line with scoping review methodology, we have revised the framework from PICO to PCC throughout the manuscript. The updated PCC framework is now clearly described in the Methods section

 

Comment 6:

In the inclusion criteria: "Original research articles". Please define which type of articles.

Author’s response:

Thank you for your comment. To clarify, our review focused exclusively on peer-reviewed original research articles presenting primary data.

 

Comment 7:

According to the PRISMA guidelines, you need to report several data (if this is a systematic review). For example, detailed outcomes, risk of bias, effect measures, etc...

Author’s response:

Thank you for your suggestion. We would like to clarify that this study followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, which are specifically designed for scoping reviews. Since this review aimed to map existing evidence rather than perform a critical appraisal, detailed reporting elements such as risk of bias, effect measures, and meta-analysis outcomes were not applicable.

 

Comment 8:

Research string must to be reported in detail

Author’s response:

We appreciate the reviewer’s suggestion. In line with this comment, we have updated the Methods section.

 

Comment 9:

What about follow-up of there included studies?

Author’s response:

Thank you for this important point. None of the included studies reported any subsequent follow-up studies or extended clinical evaluations after their initial publication.

 

Comment 10:

I still don't understand if you included in-vitro study. I think so. But reading the manuscript seems that you reported in-vivo study. It is not clear.

Author’s response:

Thank you for pointing this out. We clarify that all ten included studies were conducted in vitro, and no in vivo studies were included in this review. To avoid confusion, we have revised the Methods, Results, and Discussion sections.

 

Comment 11:

The included study are to heterogenous to perform s systematic review.

Author’s response:

We fully agree with the reviewer’s observation. Due to the heterogeneity of the included studies—such as differences in AI algorithms, dataset characteristics, and evaluation metrics—a systematic review approach was not feasible. Therefore, this study was intentionally designed and conducted as a scoping review, aiming to map the current evidence and identify knowledge gaps rather than synthesize quantitative outcomes. We have clarified this in both the Introduction and Methodology sections to avoid confusion.

 

Comment 12:

I agree with the concept of "scoping review" however, there manuscript must to be completely rewritten for its methodology.

Author’s response:

We appreciate the reviewer’s feedback. In response, we have thoroughly revised the Methodology section to align with the appropriate structure for a scoping review.

 

Comment 13:

Please, write the manuscript as a scoping review. Remove all the reference to PRISMA!. And the aim should be an overview of the evidence, able to guide the research in further researches. For example, state of the literature about morphology and what is missed, same for marginal fit accuracy, same for software developments, same for clinical evaluation.... this is the aim of a scoping review.

Author’s response:

We appreciate the reviewer’s suggestion and have revised the manuscript to better reflect the nature and objectives of a scoping review

Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

Dear authors

Congrats to the hard work. Before been accepted, the text needs some revisions.

Best regards

1. While the study identifies methodological heterogeneity, it does not deeply evaluate the quality of included studies (e.g., risk of bias, validation methods). Even though this is a scoping review, including a structured appraisal of study quality (e.g., AI-specific reporting standards such as CONSORT-AI or MINIMAR) would enhance rigor.
2. While lack of in vivo trials is mentioned, the paper could more clearly articulate how the current evidence translates (or fails to translate) into clinical decision-making.
3. Table 1 is useful but dense. It could be reorganized for better readability, e.g., separating “custom AI models” from “commercial software.”
4. Suggest collaborations with industry and multi-center trials to validate AI systems under real-world conditions as future directions.

Comments on the Quality of English Language

Some sections could be more concise, particularly the general background on AI in dentistry, to maintain focus on crowns.

Author Response

Response to reviewer #4

Comment 1:

While the study identifies methodological heterogeneity, it does not deeply evaluate the quality of included studies (e.g., risk of bias, validation methods). Even though this is a scoping review, including a structured appraisal of study quality (e.g., AI-specific reporting standards such as CONSORT-AI or MINIMAR) would enhance rigor.

Author’s response:

We appreciate the reviewer’s suggestion. Following your advice, we have included a structured overview of the methodological characteristics of the included studies in Table 2. While a full risk-of-bias assessment was not performed given the scoping nature of this review, the table summarizes key quality-related aspects

 

Comment 2:

While lack of in vivo trials is mentioned, the paper could more clearly articulate how the current evidence translates (or fails to translate) into clinical decision-making.

Author’s response:

Thank you for this insightful suggestion. We have revised the Discussion (Section 4.6, Clinical Relevance and Limitations) to better clarify how the current findings relate to clinical practice. Specifically, we now emphasize that while AI-assisted crown design demonstrates promising accuracy and efficiency in vitro, the absence of in vivo validation limits its immediate applicability in clinical decision-making.

 

Comment 3:

Table 1 is useful but dense. It could be reorganized for better readability, e.g., separating “custom AI models” from “commercial software.”

Author’s response:

We sincerely appreciate the reviewer’s suggestion to improve the readability of Table 1 by separating studies using custom AI models from those evaluating commercial software. After careful consideration, we decided to retain a single comprehensive table to maintain conciseness and consistency. However, we have revised Table 1 by adding a “Limitations” column to provide clearer context for each study, and we have also clarified in the Results narrative the distinction between studies developing custom AI models and those assessing commercial software. Furthermore, we added a new Table 2 summarizing the overall quality assessment of the included studies to enhance transparency. We hope these revisions address the reviewer’s concerns while preserving the structural integrity of the manuscript.

 

Comment 4:

Suggest collaborations with industry and multi-center trials to validate AI systems under real-world conditions as future directions.

Author’s response:

We appreciate the reviewer’s valuable suggestion regarding the inclusion of future directions. In response, we have expanded the “Future Directions” section to emphasize the importance of collaboration with industry partners and the need for multi-center clinical trials to validate AI-based dental crown design systems under real-world conditions. We believe this addition strengthens the manuscript by highlighting practical steps required for broader clinical integration and ensuring the reliability of AI-driven workflows in prosthodontics.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The authors has done the correction that was asked. The article has improved from it's earlier version. The article can be accepted with minor modification. As your topic is very interesting please add one graphical abstract to make your article reader friendly.

Author Response

Response to reviewer #1

Comment 1:

The authors has done the correction that was asked. The article has improved from it's earlier version. The article can be accepted with minor modification. As your topic is very interesting please add one graphical abstract to make your article reader friendly.

Author’s response:

We sincerely thank the reviewer for the valuable suggestion. In response, we have created and attached a newly designed graphical abstract. This addition aims to enhance the clarity and accessibility of our work and make the article more reader-friendly.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review the revised version of the manuscript. I have carefully checked the authors’ corrections and the revised text. I can confirm that all my previous suggestions and comments have been adequately addressed and incorporated into the manuscript.

The manuscript needs double check for mistakes. 

Author Response

Response to reviewer #2

Comment 1:

Thank you for the opportunity to review the revised version of the manuscript. I have carefully checked the authors’ corrections and the revised text. I can confirm that all my previous suggestions and comments have been adequately addressed and incorporated into the manuscript.

The manuscript needs double check for mistakes.

 

Author’s response:

We thank the reviewer for carefully evaluating the revised manuscript and for confirming that all previous comments have been addressed. In response to the suggestion, we have thoroughly proofread and double-checked the entire manuscript to correct minor typographical, grammatical, and formatting errors. These refinements improve the overall clarity and readability of the paper.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

In the title, a scoping review of in-vitro study ... in vitro study must to be reported.

Lines 78-80 "This scoping review was not prospectively registered, as registration is not mandatory for scoping reviews.” can be deleted or moved after conclusions, in the manuscript informations. If another reviewer ask to put this information, I defer to the editorial office.

In my opinion, icons in figure 1 are horrible (not scientific). However, I respect the authors and defer to the editorial office.

Limitations must to be emphasized several times in the manuscript. I agree with the authors, but a scoping review on in-vitro research has a very limited evidence.

 

Author Response

Response to reviewer #3

Comment 1:

In the title, a scoping review of in-vitro study ... in vitro study must to be reported.

 

Author’s response:

We appreciate the reviewer’s suggestion regarding the title. As all the studies included in this scoping review were in-vitro studies, we have updated the title accordingly to reflect this detail more accurately.

 

Comment 2:

Lines 78-80 "This scoping review was not prospectively registered, as registration is not mandatory for scoping reviews.” can be deleted or moved after conclusions, in the manuscript informations. If another reviewer ask to put this information, I defer to the editorial office.

 

Author’s response:

We appreciate the reviewer’s observation. The sentence regarding the lack of prospective registration has been deleted from the manuscript to improve clarity and conciseness.

 

Comment 3:

In my opinion, icons in figure 1 are horrible (not scientific). However, I respect the authors and defer to the editorial office.

 

Author’s response:

We appreciate the reviewer’s comment regarding Figure 1. While we maintained the current schematic diagram to illustrate the workflow, we have also prepared and uploaded a new graphical abstract designed in a more scientific style, as suggested by another reviewer. We respectfully defer the final decision regarding which figure to use to the editorial office and are happy to follow their recommendation.

 

Comment 4:

Limitations must to be emphasized several times in the manuscript. I agree with the authors, but a scoping review on in-vitro research has a very limited evidence.

 

Author’s response:

We appreciate the reviewer’s valuable comment. In the revised manuscript, we have emphasized the limitations more clearly in both the Discussion and Conclusion sections. In particular, we now highlight that all included studies were in vitro, and therefore, the strength of the current evidence is inherently limited. This clarification ensures readers understand the need for further in vivo studies and clinical validation to confirm the applicability of AI-assisted dental crown design in real-world practice.

Author Response File: Author Response.pdf