Why Dentists Must Adopt AI Cautiously: A Case Against Over-Automation in Restorative and Orthodontic Practice

Prologue: A Call from New Jersey to a Farmhouse Near Bangalore

It was a warm monsoon afternoon, and the rains had washed the air clean in the countryside outside Bangalore. The leaves danced in the wind as if whispering ancient truths. Dr. Nabeel, seated on the wooden porch of his farmhouse, sipped his filter coffee slowly, gazing over the turmeric fields that glowed like gold under the shy sun.

The peace was interrupted by a call. It was Catherine, a passionate periodontist from New Jersey, who had just returned from yet another International Congress on AI in Dentistry. Her voice, though crackled by distance, was brimming with urgency.

“Dr. Nabeel,” she began, “AI was everywhere. Every speaker claimed it was the future. But something in me… felt unsettled. Is it right to hand over so much to machines? Aren’t we losing something sacred?”

There was silence on the line—then the slow, steady voice of a man who had spent three decades walking between science and soul.

“Catherine,” he said, “AI is a guest in our house, not the heir. Dentistry is more than algorithms—it’s the ability to hold trembling hands and rebuild broken smiles. If we forget that, we’ll have perfect crowns but no connection.”

Their conversation unfolded over the next hour, crossing continents and convictions. It became more than a dialogue—it became a meditation. And this blog is born from that reflection.

1. The Limits of Algorithmic Design in Crowns, Bridges, and Aligners

The fabrication of crowns, bridges, and aligners is not merely a computational exercise. It is a synthesis of biomechanics, aesthetics, and patient-specific context. While AI-driven CAD/CAM systems excel at optimizing occlusal geometry or aligner sequencing, they fall short in capturing:

• Tactile expertise: The nuanced judgment of a seasoned clinician assessing occlusal dynamics or marginal fit cannot be distilled into algorithms. For instance, a crown’s longevity depends on understanding bruxism’s impact on material wear—a subtlety AI often overlooks.
• Patient-specific factors: Neuromuscular variations, periodontal health, and temporomandibular joint constraints defy standardized templates. AI may propose an aligner trajectory, but it cannot intuit the biological limits of ligament remodeling.
• Cultural and aesthetic nuance: A smile’s harmony reflects ethnicity, age, and personality—variables that require human perception beyond data-driven patterns.

In healthcare, IBM’s Watson for Oncology misjudged treatment plans due to insufficient contextual understanding of patient histories, leading to recommendations misaligned with clinical realities (Somashekhar et al., 2018). Similarly, in dentistry, over-reliance on AI risks restorations that are technically precise but biologically or aesthetically deficient.

2. The Fallacy of AI Precision

AI thrives on pattern recognition, not clinical judgment. It delivers solutions based on aggregated data, not individualized care. This gap is evident in:

• Over-engineered restorations: AI may prioritize idealized occlusal schemes, ignoring pragmatic compromises needed for patients with atypical anatomy or financial constraints.
• Erosion of critical thinking: Over-dependence on automation dulls a dentist’s ability to deviate from protocol when clinical intuition demands it.
• False confidence: AI’s polished outputs can mask underlying approximations, as seen in finance, where algorithmic trading models failed to predict the 2010 Flash Crash due to unmodeled market dynamics (Kirilenko et al., 2017).

A crown may fit perfectly in a digital model but fail under the stress of a patient’s parafunctional habits if the algorithm overlooks subtle clinical cues.

3. The Irreplaceable Human Element

Dentistry is as much an art as a science, rooted in empathy and contextual awareness. Consider:

• A patient seeking smile correction post-trauma, where emotional healing outweighs cosmetic perfection.
• A budget-constrained individual requiring a balance between function and affordability.
• An elderly patient needing minimal intervention tailored to comorbidities.

These scenarios demand human insight—empathy for a patient’s unspoken fears, instinct honed by experience, and context that no algorithm can parse. In autonomous driving, over-reliance on AI led to fatal errors when systems failed to interpret ambiguous human behaviors, such as a pedestrian’s hesitation (NTSB, 2018). Similarly, AI in dentistry cannot replicate the clinician’s ability to sense a patient’s needs beyond the scan.

4. The Perils of AI in Academic Research

The use of large language models (LLMs) like ChatGPT for academic tasks—literature reviews, manuscript drafting, or data synthesis—poses significant risks:

• Fabricated references: LLMs are notorious for generating plausible but nonexistent citations, undermining scholarly integrity (OpenAI, 2023).
• Superficial analysis: AI can summarize studies but lacks the capacity to critique study design, bias, or journal credibility—critical for evidence-based dentistry.
• Erosion of originality: Overuse of AI-generated content risks producing derivative work, diminishing the clinician’s intellectual contribution.

In journalism, AI-generated articles have propagated misinformation due to unchecked outputs (Diakopoulos, 2020). Dentistry must resist the same.

5. AI in Dental Education: A Double-Edged Sword

Integrating AI into dental curricula offers benefits but carries risks that must be managed:

Dental education must remain principle-driven, not technology-driven. AI should augment—not dominate—the development of clinical acumen. In aviation, over-automation led to pilots’ diminished situational awareness, contributing to crashes like Air France Flight 447 (BEA, 2012). Dentistry risks a similar fate if we over-rely on digital tools.

Final Thoughts: Preserving the Art and Science of Dentistry

AI holds immense potential to streamline workflows and enhance precision. Yet, it is not a panacea. Dentistry remains a biological art, a discipline of human-centered healing. Cross-sector lessons—from healthcare’s algorithmic missteps to finance’s over-optimizations—remind us that technology must serve, not dictate, our practice.

Dentists must lead this integration with awareness, humility, and boundaries. Embrace AI as a tool, but never cede your clinical judgment or empathy. Your hands, your mind, and your heart remain the soul of dentistry.

References

• BEA (2012). Final Report on Air France Flight 447. Bureau d’Enquêtes et d’Analyses.
• Diakopoulos, N. (2020). Automating the News: How Algorithms Are Rewriting the Media. Harvard University Press.
• Kirilenko, A., et al. (2017). “The Flash Crash: The Impact of High-Frequency Trading.” Journal of Finance.
• NTSB (2018). Collision Between a Car and an Autonomous Vehicle. National Transportation Safety Board.
• OpenAI (2023). Technical Report on LLM Limitations.
• Somashekhar, S., et al. (2018). “Watson for Oncology: A Review.” The Lancet Oncology.

Author: Dr. Syed Nabeel, BDS, D.Orth, MFD RCS (Ireland), MFDS RCPS (Glasgow) is a clinician-scholar whose professional trajectory spans over a quarter century at the intersection of orthodontics, neuromuscular dentistry, and digitally driven diagnostics. As the Clinical Director of Smile Maker Clinics Pvt Ltd, he has articulated a refined philosophy of care that integrates anatomical exactitude with contemporary digital modalities, particularly in the nuanced management of temporomandibular disorders, esthetic smile reconstruction, and algorithm-guided orthodontic therapy. Grounded in the principles of occlusal neurophysiology, his approach is further distinguished by an enduring commitment to AI-enhanced clinical workflows and predictive modeling in complex craniofacial therapeutics. In 2004, Dr. Nabeel established DentistryUnited.com, a visionary digital platform designed to transcend clinical silos and foster transnational dialogue within the dental fraternity. This academic impetus culminated in the founding of Dental Follicle – The E-Journal of Dentistry (ISSN 2230-9489), a peer-reviewed initiative dedicated to the dissemination of original scholarship and interdisciplinary engagement. A lifelong learner, educator, and mentor, he remains deeply invested in cultivating critical thought among emerging clinicians, with particular emphasis on orthodontic biomechanics and the integrative neurofunctional paradigms that underpin both form and function.