CATEGORY 100 AUSTRALASIAN DENTIST FEATURE: ARTIFICIAL INTELLIGENCE In countries with a poor or weak healthcare infrastructure, AI offers an exciting solution. However, this is precisely when fairness issues and algorithmic bias need to be considered due to a lack of technical capacity, possible prejudice against minority groups, and lack of legal protections. This forces the additional implementation of the criteria of appropriateness, fairness, and bias to evaluate the use of AI systems and their algorithms.14 In summary, AI should expand options for action and not prevent them. Thus, the principle of “man and machine” and not “man against machine” should be the top priority. AI, machine learning (ML), and big data can exhaust human oversight and storage capacity, leading to problems. Technologies have no ethical or moral status, but are always linked to human activities and serve to enable qualitative and quantitative human performance and interaction. Personal integrity, equity of resource allocation, and accountability of moral agency characterize three ethical dilemmas that arise in the development and application of AI.15 A literature review has shown that the proportion of studies with AI-related ethical issues has remained similar in recent years, despite the sharp increase in the number of publications on AI. This clearly shows a lack of interest in engaging with the topic of ethics and a lack of information about ethical challenges related to AI. This can be interpreted as disinterest in the ethical component of this issue. But it is important to consider the soft skills in the philosophy and strategy of medical and dental treatment, and to see AI as an additional component in dental treatment that supports previous concepts. Therefore, this sensitization is required based on future clinical situations for human-machine interaction and for the optimization of human-machine interaction for the best possible patient experience and care. The introduction of AI as a dependent, semi-, or fully autonomous partner in patient treatment may challenge the traditional assessment of patient and physician autonomy in treatment. Thus, the increasing progress in AI and its implementation in patient care require a discussion in order to protect humanitarian concerns in future treatment concepts. Therefore, doctors should neither accept developments in AI uncritically nor work against them, but rather actively participate in their development, constant testing, and application.17 Thus, supervisory bodies must be set up to monitor technological developments and ensure that preventive guarantees are in place to protect those involved from direct or indirect harm. So, it is the responsibility of AI researchers to ensure that future impacts tend to be positive, and ethicists and philosophers are closely involved in the development of such technologies from the beginning.18 While doctors and dentists are accustomed to base their actions on ethical considerations and implications, these detailed considerations may not always be present to the same extent when dealing with technological advances. In addition to pure decision-making, interactions with patients also play a crucial role in the doctor-patient relationship. Using the example of the transmission of bad news, a hedonistic calculus (felicific calculus according to Jeremy Bentham) can be discussed with the aim of increasing satisfaction and reducing pain. With regard to AI and the question of the transmission of a negative message, the evaluation point intensity, duration, certainty, propinquity, fecundity, purity, and extent must all be processed as comprehensively as possible to take account of the ethics involved in doctorpatient communication.19 The generation of digital twins in connection with AI is the next step or evolutionary stage of digital health technologies and has the potential to change and challenge future medical practice. This already offers the opportunity to discuss ethical, legal, and societal implications in advance.20 AI ethics must include perspectives from philosophy, computer science, law, economics, and, of course, medicine and dentistry. The goals of developing ethical AI systems should always go hand in hand with the characterization of human moral judgments and their integration into decision-making from a computational point of view.21 From an ethical point of view, two problems arise: a possible lack of transparency in a computer simulation (epistemic opacity) contradicts the human need for communication and clear assignment of responsibility in the event of failure, i.e. the concepts of understanding and responsibility. Accordingly, ways must be found to link the results of machine algorithms with the desire for discussion. Consequently, the term “explainable AI” needs to be further defined and developed.22 In conclusion, AI must respect human rights and freedoms, including the dignity and privacy of an individual. Attention should be paid to the greatest possible transparency and reliability, and the ultimate responsibility and accountability for the application of AI should remain with the human developers and operators for the foreseeable future. u Contact gapmagazines@gmail.com for a complete list of references Contact Dr Marcus Engelschalk Clinic Name: Slow Digital Dentistry Address: Frauenplatz 11, 80331 Munich, Germany Email: praxis@slow-digital-dentistry.de Website: https://slow-digital-dentistry.de/ Fig. 4: Using AI for the segmentation of different bony parts Fig. 5: The use of AI for segmentation of teeth Fig. 6: The use of AI for nerve segmentation
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