Dentistry in the Era of Artificial Intelligence: Medical Behavior and Clinical Responsibility

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The article can be published in Prosthesis journal.

Author Response

We sincerely thank the reviewer for the positive evaluation and support for publication. We are pleased that the article was found suitable for the journal's scope.

Reviewer 2 Report

Comments and Suggestions for Authors

I have read your manuscript and congratulate you for its idea. The topic is interesting and innovative. I noticed that the introduction includes sufficient literature and is up-to-date. It is clear and concise in terms of the presentation and organization of the material. The material and method are appropriate; it is stated that it is a systematic review, and we know what to expect from it. The inclusion and exclusion criteria are clearly stated. However, I would have suggested that you specify the limits of your study more clearly. The results are clearly presented, well organized. The discussions and conclusions are pertinent and limited to the researched topic. The reference chapter is recent and in accordance with the topic.
I would suggest
1. Clearly specifying the limits of the study
2. Reviewing the way the bibliography is written (sometimes page numbers are missing, or they are written in a different format)
3. Continuing the study using the data obtained in a systemic review

Author Response

Comment 1: Clearly specifying the limits of the study.
Response: We thank the reviewer for this valuable suggestion. We have added a specific subsection titled “Limitations of the Study”, where the constraints of our narrative review—including selection bias, interpretative criteria, and the exclusion of gray literature—are explicitly addressed.

Comment 2: Reviewing the way the bibliography is written.
Response: The bibliography has been thoroughly revised for consistency in style and format. Missing page numbers and inconsistent referencing styles have been corrected throughout.

Comment 3: Continuing the study using data obtained in the systematic review.
Response: We appreciate the suggestion and fully agree. While not within the scope of this narrative review, we consider this a valuable direction for future empirical work, particularly in designing a follow-up observational study.

Reviewer 3 Report

Comments and Suggestions for Authors

The article reviews the impact of digitalization and artificial intelligence (AI) on dentistry, emphasizing both benefits (improved diagnostics, efficiency, access) and risks (loss of empathy, ethical issues, regulatory challenges). However there are several aspects that could be enhanced to improve the quality and impact of the work:

Lines 10–29: Simplify complex sentences for clarity.

Lines 32–47: Clearly summarize the transition to digital dentistry in fewer sentences. Use consistent terminology for prosthesis types.

Lines 55–67: Mention group related risks (e.g., autonomy, bias, overdiagnosis) and state them succinctly. Add clear legends and explanations to tables/figures.

Lines 69–76: Summarize the key statistics in one sentence.

Lines 77–88: State the aim once, clearly, do not repeat

Lines 80–110: Provide more detail on study selection and methodology.

Lines 91–110: Methodology is lengthy and could be streamlined, for example use bullet points for inclusion/exclusion criteria and search strategy.

Lines 120–140: Include a critical analysis of limitations and biases.

Lines 150–182: Merge similar ideas to avoid redundancy.

Lines 184–206: Summarize each region’s approach in one or two sentences.

Remove repetition and unnecessary detail.

Shorten long sentences for clarity.

Minor typographical and grammatical errors are present throughout. A thorough proofreading pass is recommended.

I believe the following papers add value to the current research:

Marian, D.; Toro, G.; D’Amico, G.; Trotta, M.C.; D’Amico, M.; Petre, A.; Lile, I.; Hermenean, A.; Fratila, A. Challenges and Innovations in Alveolar Bone Regeneration: A Narrative Review on Materials, Techniques, Clinical Outcomes, and Future Directions. Medicina 2025, 61, 20. https://doi.org/10.3390/medicina61010020

 

Comments on the Quality of English Language

The English could be improved to more clearly express the research.

Author Response

Comment: Multiple suggestions regarding clarity, structure, and conciseness (lines 10–206).
Response: We have carefully revised the manuscript, simplifying long and complex sentences, removing redundant aim statements, and improving paragraph transitions throughout the introduction and methods. The transition to digital dentistry is now more concise and uses consistent terminology. Bullet points have been used to streamline inclusion/exclusion criteria and the search strategy.

Comment: Lack of mention of autonomy, bias, and overdiagnosis.
Response: These aspects have been explicitly included and are discussed in multiple sections, particularly under “Ethical Concerns,” “Overdiagnosis and Overtreatment,” and “Bioethics.”

Comment: Add legends to tables and figures.
Response: The table has been reviewed and retains a clear structure, with a concise legend and explanatory title. We believe it effectively summarizes the key findings and improves reader comprehension. Nevertheless, we remain open to further refinement should the editorial board consider it necessary.

Comment: Typographical/grammatical issues.
Response: A comprehensive proofreading of the manuscript has been conducted, and several grammar and syntax issues have been corrected (e.g., subject-verb agreement, articles).

Comment: Consider adding Marian et al. (2025).
Response: Thank you for the suggestion. This article has been included and referenced in the section discussing future clinical applications and innovations in regenerative dentistry.

 

Reviewer 4 Report

Comments and Suggestions for Authors

The article "Dentistry in the Era of Artificial Intelligence" explores how AI and digital technologies are transforming dental care. It highlights major benefits such as improved diagnostic accuracy, treatment planning, and access to care, while also emphasizing critical risks, including loss of empathy, overdiagnosis, algorithmic bias, and ethical concerns.

The study draws from diverse databases and applies quality control tools like AMSTAR 2 and Newcastle-Ottawa Scale, adding credibility to its source selection. The study selection and bias control are described, but not in a fully transparent or replicable format.

Some concepts, such as the importance of the clinician’s centrality and risks of dehumanization, are repeated frequently. 

The article can be enriched with concrete case examples or data visualizations that illustrate the challenges or successes of AI in real-world dental practice.

Authors should delve deeply into specific AI technologies, models, or diagnostic tools used in dentistry. The article remains focused more on ethics and theory than technical mechanisms or clinical efficacy metrics.

Authors should describe practical implementation strategies, such as how training programs could be structured, or how informed consent could be modernized for AI-assisted diagnostics. There is a lack of engagement with patient perspectives, which could have further emphasized the relational dynamics.

 

Author Response

Comment: Improve transparency and replicability of the methodology.
Response: A detailed limitations section has been added. We also clarified that while elements of PRISMA were applied, the study remains a narrative review.

Comment: Repetition of key concepts.
Response: Redundant references to the centrality of the clinician and dehumanization have been reduced for clarity and conciseness.

Comment: Add clinical case examples or visualizations.
Response: We have included a summary table (Table 1) to improve clarity. While clinical cases are not included due to scope limitations, we note this as a recommendation for future work.

Comment: Explore concrete AI models and patient perspective.
Response: The revised manuscript now includes references to explainable AI (XAI), neural networks, and specific tools. A subsection addressing the importance of integrating the patient’s perspective has also been added.

Reviewer 5 Report

Comments and Suggestions for Authors

This is a highly relevant and well-structured narrative review that addresses a pressing topic in modern dental medicine: the ethical, clinical, and regulatory implications of artificial intelligence (AI) in dentistry. The manuscript provides a balanced and multidisciplinary analysis, going beyond technical aspects to explore themes such as the therapeutic relationship, informed consent, decision-making autonomy, and digital paternalism.

Abstract:  Clearly outlines objectives and methodology.

Introduction:  Comprehensive background and strong justification for the topic. Recommendation: Move the paragraph stating the aims (lines 78–85) to the end of the introduction for logical flow.

Methods:  Follows narrative review methodology, incorporating elements of PRISMA. Recommendation: Include a brief rationale for choosing 2014–2024 as the publication window.

Results: Thematically rich structure with clear sections: patient relationship, ethical/legal risk, overdiagnosis, etc. Excellent inclusion of Table 1 summarizing key findings.

Discussion: In-depth and philosophically sound. Demonstrates a mature grasp of bioethics, professional responsibility, and clinical decision-making.

Conclusions: Well-balanced and comprehensive.

References: The references are adequate and up-to-date.

Language & Style: Minor grammatical adjustments are needed, e.g.: “the AI offer substantial benefits” → “AI offers substantial benefits”, “lack of explainability raise” → “raises”

Author Response

Comment: Move aim paragraph to the end of the introduction.
Response: This has been implemented to improve the logical flow of the introduction.

Comment: Justify time frame 2014–2024.
Response: The rationale for selecting this time period is now included in the Materials and Methods section.

Comment: Minor grammatical adjustments.
Response: A careful language revision has been conducted to correct grammatical issues and improve fluency.