The Implications of Artificial Intelligence in Pedodontics: A Scoping Review of Evidence-Based Literature

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The reviewer likes to thank the authors for their comprehensive and well structures work on AI in pediatric dentistry, describing the potential of AI in various fields.

The literature review was conducted and reported according to the actual PRISMA 2020 statement.

Search terms, Study selection and data extraction are well described.

There is two points, the reviwer wants to suggest:

1.        In tabele 3 are listed all included studies – with details regarding the objectives of the study. It would enhance the value of the reporting, if authors would add the results of the studies. Aware of the lack of global standards to evaluate the efficacy or benefit of AI, some results are needed to understand the topic – even if the results are heterogeneously.

2.       Authors summarized very well structured the fields of AI-application in pediatric dentistry in table 4. Hence, in the summary column, the references to the studies are missing. Please include the respective references from the review to your affirmations/statements. If you state: “Research suggests…” the reader might be curious of the source (Literature).

Please report the kappa values (agreement)

Author Response

We thank the reviewer for his/her suggestions that have improved the quality of our manuscript.

 

The reviewer likes to thank the authors for their comprehensive and well structures work on AI in pediatric dentistry, describing the potential of AI in various fields.

The literature review was conducted and reported according to the actual PRISMA 2020 statement.

Search terms, Study selection and data extraction are well described.

There is two points, the reviwer wants to suggest:

Reviewer 1 – Concern 1.   In table 3 are listed all included studies – with details regarding the objectives of the study. It would enhance the value of the reporting, if authors would add the results of the studies. Aware of the lack of global standards to evaluate the efficacy or benefit of AI, some results are needed to understand the topic – even if the results are heterogeneously.

Authors response. We thank the reviewer for his/her suggestion, and we added a column “Results “ to the table”.

Reviewer 1 – Concern 2.   Authors summarized very well structured the fields of AI-application in pediatric dentistry in table 4. Hence, in the summary column, the references to the studies are missing. Please include the respective references from the review to your affirmations/statements. If you state: “Research suggests…” the reader might be curious of the source (Literature).

Please report the kappa values (agreement)

Authors response. We thank the reviewer for his/her suggestion, and we added the references in Table 4. Moreover, we added in the text “The agreement between the reviewers was highly reliable, with a kappa value of 0.963”.

Reviewer 2 Report

Comments and Suggestions for Authors

This systematic review aims to address the implications of artificial intelligence (AI) in pediatric dentistry. However, the review is flawed due to the inaccurately framed research question, “What are the current developments and challenges in the application of artificial intelligence in pediatric dentistry?” This question is not specific and does not follow the PICO format, which is crucial for systematic reviews. As a result, the review appears more appropriate for a scoping review.

This issue is reflected in several sections of the review. The results and Table 2 do not present specific outcomes; instead, they merely outline the aim and type of AI used in each study. Another critical flaw is the absence of quality assessments (Risk of bias assessment) of the included studies, which is an essential step in conducting systematic reviews.Furthermore, there is no registered protocol for this review in PROSPERO, which impacts its validity.

 

Given that this review does not adhere to systematic review guidelines, it is not suitable for publication in its current state.

For further guidance on the standards for systematic reviews, please refer to the PRISMA 2020 checklist: https://www.prisma-statement.org/prisma-2020-checklist

Author Response

We thank the reviewer for his/her suggestions that have improved the quality of our manuscript.

 

Reviewer 2 – Concern 1 This systematic review aims to address the implications of artificial intelligence (AI) in pediatric dentistry. However, the review is flawed due to the inaccurately framed research question, “What are the current developments and challenges in the application of artificial intelligence in pediatric dentistry?” This question is not specific and does not follow the PICO format, which is crucial for systematic reviews. As a result, the review appears more appropriate for a scoping review.

Authors response. We thank the reviewer for his/her suggestion and we totally agree with him/her. We have to report to the attention of the reviewer that we made a mistake in the definition of our research, because it is not a systematic review, but a scoping review, as suggested. For this reason, we have modified the title and the text, adding the terms “scoping review” instead of “systematic review”. Moreover, we added the scoping review protocol into the material and methods section. As regards the PICO question, we have removed it because it is not necessary for scoping reviews.

Reviewer 2 – Concern 2. This issue is reflected in several sections of the review. The results and Table 2 do not present specific outcomes; instead, they merely outline the aim and type of AI used in each study. Another critical flaw is the absence of quality assessments (Risk of bias assessment) of the included studies, which is an essential step in conducting systematic reviews.Furthermore, there is no registered protocol for this review in PROSPERO, which impacts its validity.

 

Given that this review does not adhere to systematic review guidelines, it is not suitable for publication in its current state.

For further guidance on the standards for systematic reviews, please refer to the PRISMA 2020 checklist: https://www.prisma-statement.org/prisma-2020-checklist

Authors response. We thank the reviewer for his/her suggestion. However, as suggested by the reviewer, we have modified the article into “scoping review” and the Prospero registration and bias assessment are not necessary. Moreover, we have removed Table 2 and added it to supplementary materials as “Supplementary Table 1”.

Reviewer 3 Report

Comments and Suggestions for Authors

Dear authors, it has been a pleasure for me to review your work. I give you some suggestions that I believe can increase the quality of your work.

Title

In the title indicate that it is a systematic narrative review.

Abstract

Indicate in the abstract methodology how many researchers participated in the review.

Introduction

-Indicate in the introduction in which field of knowledge AI was first applied.

-And the first time AI was used in the field of pediatric dentistry.

Materials and Methods

- Please include the systematic review protocol and identification number.

- The justification should be included in the introduction, just before defining the objective.

- In the eligibility criteria section you should add more information regarding the participants: age ranges, general health of the patient.... What type of studies were selected?

- Indicate the search range, they only indicate until when.

Results

- Please indicate in which countries these investigations were carried out and the journals in which they were published.

Discussion

- Please indicate the strengths and limitations of this systematic review.

Conclusion

- At the beginning of the conclusion, indicate the applications of AI in pediatric dentistry from its beginnings to the present.

References

- check the quote 4.

- In some quotes they write the full name of the journal and in others the abbreviated name.

 

 

 

Author Response

We thank the reviewer for his/her suggestions that have improved the quality of our manuscript.

 

Reviewer 3 – Concern 1. Title

In the title indicate that it is a systematic narrative review.

Authors response. We thank the reviewer for his/her suggestion, and we modified the title “The Implications of Artificial Intelligence in Clinical Pedodontics: A Scoping Review of evidence-based literature.” As suggested by another reviewer, we have modified the manuscript type from systematic review to a scoping review.

Reviewer 3 – Concern 2. Abstract

 

Indicate in the abstract methodology how many researchers participated in the review.

 

Authors response. We thank the reviewer for his/her suggestion. According to his/her suggestion, we’ve already reported in the text “A thorough exploration of scientific databases was carried out to identify studies addressing the usage of AI in pediatric dentistry until December 2023 in Embase, Scopus, PubMed, and Web of Science databases by two researchers, S.L.R. and A.L.G.”

 

Reviewer 3 – Concern 3.  Introduction

 

-Indicate in the introduction in which field of knowledge AI was first applied.

 

 

Authors response. We thank the reviewer for his/her suggestion. According to his/her suggestion, we’ve already reported in the text a brief history of AI applications” The goal was to build automated devices, also called machines, capable of carrying out human-level tasks in the field of informatics and mathematics”

Reviewer 3 – Concern 4.   -And the first time AI was used in the field of pediatric dentistry.

Authors response. According to the reviewer’s request, we’ve made appropriate changes. We reported in the text “Moreover, in pedodontics its first usage was to identify cephalometric landmarks in an automatized way, without the human help.”

Reviewer 3 – Concern 5.   Materials and Methods

 

- Please include the systematic review protocol and identification number.

Authors response. We thank the reviewer for his/her suggestion, but we have modified the study design from a systematic review to a scoping review. Moreover, we reported the protocol in supplementary Material 1 and we provided in the text the link to the project.

Reviewer 3 – Concern 6. The justification should be included in the introduction, just before defining the objective

Authors response. We thank the reviewer for his/her suggestion. We’ve moved the justification of the study from the material and methods section to introduction, reporting in the text “This scoping review aims to comprehensively investigate the existing body of lit-erature concerning the integration of AI in pediatric dentistry. The focus is on delving into re-cent advancements and the transformative possibilities that this technology holds, with a specific emphasis on its potential to enhance dental health outcomes for children.”

Reviewer 3 – Concern 7. In the eligibility criteria section you should add more information regarding the participants: age ranges, general health of the patient.... What type of studies were selected?

Authors response. According to the reviewer’s request, we’ve reported in the text “To maintain focus and rigor, incomplete texts, scoping reviews, narrative reviews, case series, consensus conferences and articles written in languages other than English have all been excluded from consideration, such as studies including adults. Moreover, there was no restriction in the year of publication of the studies. This meticulous approach ensures a thorough examination of substantive and pertinent research contributions in the specified field”.

Reviewer 3 – Concern 8. Indicate the search range, they only indicate until when.

Authors response. We thank the reviewer for his/her suggestion. We reported in the text “To assess the corpus of current literature on the subject, a few database searches were carried out from July 2023 through December 2023.”.

Reviewer 3 – Concern 9. Results

- Please indicate in which countries these investigations were carried out and the journals in which they were published.

Authors response. According to the reviewer’s request, we’ve added into Table 2 the journals and the countries of the investigations.

Reviewer 3 – Concern 10. Discussion

- Please indicate the strengths and limitations of this systematic review.

Authors response. We thank the reviewer for his/her suggestion. We’ve reported in the text the section “4.13 Strenghts and limitations”.

Reviewer 3 – Concern 11. Conclusion

- At the beginning of the conclusion, indicate the applications of AI in pediatric dentistry from its beginnings to the present.

Authors response. According to the reviewer’s request, we’ve added into the text “The early applications of AI in pedodontics focused on analyzing radiographic images and providing diagnostic support. AI systems were trained to automatically identify cavities, dental, and skeletal anomalies, facilitating dentists' work and accelerating diagnosis times. Another significant step was the development of intelligent medical records. These digital systems integrate the patient's health data, allowing a complete and organized view of their medical history. AI can analyze this data to identify potential oral health problems, suggest preventive and personalized treatments, and alert the dentist to any risk factors.”

Reviewer 3 – Concern 12. References

- check the quote 4.

Authors response. We thank the reviewer for his/her suggestion. We reported correctly the text” Kunz F, Stellzig-Eisenhauer A, Boldt J. Applications of Artificial Intelligence in Orthodontics; An Overview and Perspective Based on the Current State of the Art. Applied Sciences. 2023;13(6):3850.”

Reviewer 3 – Concern 13. - In some quotes they write the full name of the journal and in others the abbreviated name.

Authors response. According to the reviewer’s request, we’ve reported in the text all the full names of the journals in the references.