Precision Assessment of Facial Asymmetry Using 3D Imaging and Artificial Intelligence

<b>Objectives</b>: There is a growing interest among practitioners in employing artificial intelligence (AI) to enhance the precision and efficiency of diagnostic methods. The objective of this study is to assess the precision of an AI-based method for facial asymmetry assessment using 3D facial images. <b>Methods</b>: The study included 130 patients (84 female, 46 male), analyzing 3D facial images from the Vectra^® M3 imaging system using both manual and AI-based methods. Seven bilateral facial landmarks were identified for manual analysis, calculating the asymmetry index for facial symmetry assessment. An AI-based program was developed to automate the identification of the same landmarks and calculate the asymmetry index. The reliability of the manual measurements was assessed using intraclass correlation coefficients (ICC) with 95% confidence intervals (CI). Precision of automated landmark identification was compared to the manual method. <b>Results</b>: The ICCs for the manual measurements demonstrated moderate to excellent reliability, both within raters (ICC = 0.62-0.99) and between raters (ICC = 0.72-0.96) each calculated with 95% CI. Agreement was observed between the manual and automated methods in calculating the asymmetry index for five landmarks. There was a statistically significant difference between the two methods in determining the asymmetry index for alare (median: 2.05 mm manual vs. 1.54 mm automated, <i>p</i> = 0.0056) and cheilion (median: 2.77 mm manual vs. 2.30 mm automated, <i>p</i> = 0.0081). <b>Conclusions</b>: The AI-based method provides efficient and comparable precision of facial asymmetry analysis using 3D images. The disagreement observed between the two methods can be addressed through further improvement and training of the automated software. This innovative approach opens doors to significant advancements in both research and clinical orthodontics.