Aesthetic Evaluation of AI-generated Digital Smile Designs among Dental Students: A Cross-sectional Study

Introduction: Smile design integrates art, science and technology to enhance facial aesthetics. Digital tools, including Artificial Intelligence (AI), have advanced personalised smile design. Aim: To evaluate the aesthetic perception of digitally altered smile designs among dental students and assess their preferences for specific smile parameters such as smile arc, smile line, incisor shape, anterior tooth proportion and incisal edge form. Materials and Methods: A cross-sectional study was conducted at the Department of Prosthodontics, Malla Reddy Dental College for Women, Hyderabad, Telangana, India, from January 2025 to March 2025, among 257 dental students using a structured Google Form survey containing AI-generated and Photoshop-modified images illustrating five aesthetic smile parameters. Participants rated the aesthetic appeal of each variant. The collected data were analysed using IBM Statistical Package for Social Sciences (SPSS) Statistics version 25.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics summarised responses and the Chi-square test assessed associations between categorical variables. Results: The parallel smile arc was the most preferred across all smile line categories (64.6-72.0%), while the reverse arc was the least favoured. Square incisors were the most preferred shape, with significant variation in ovoid preferences based on smile line (p=0.001). The golden proportion was favoured overall, especially by those with average and low smile lines, while the Recurring Aesthetic Dental (RED) proportion was more preferred among participants with high smile lines (p<0.001). Rounded incisal edges were generally preferred, but without a significant association with smile line (p=0.331). Conclusion: Dental students showed significant preferences for specific smile design elements, with notable associations between smile line and both anterior tooth proportions and incisor shape. These insights reflect an individualised aesthetic approach that combines clinical principles with personal perception.