Real-time AI feedback for novice intraoral imaging - a pilot three-arm randomized study

Abstract Background This pilot randomized controlled trial evaluated the effectiveness of an artificial intelligence (AI)–assisted solo workflow for intraoral photography training. The study examined whether real‑time AI feedback could enhance photographic quality, procedural efficiency, learner self‑efficacy, and patient comfort compared with conventional approaches. Methods Fifty-four first‑year dental students were randomly assigned to one of three groups: assistant‑supported workflow (four‑handed technique, control), solo workflow without AI support, and solo workflow with AI‑driven real‑time feedback. All participants performed standardized intraoral photography tasks. The primary outcome was a composite photographic quality score derived from expert ratings of three standardized intraoral views (frontal intercuspal, frontal open-bite, and lateral intercuspal), each rated on a 0–10 scale (total range 0–30). Data were analyzed using ANOVA; mean differences (MD) with 95% confidence intervals (CI) were calculated. Results Inter‑rater reliability for expert image ratings was good (ICC = 0.84, 95% CI: 0.72 to 0.90). The AI-supported solo group achieved the highest composite quality scores (18.2 ± 2.7). This was significantly superior to the unassisted solo group (15.8 ± 3.3), with a mean difference (MD) of 2.4 points (95% CI: 0.45 to 4.35; p = 0.027) and a large effect size (Cohen’s d = 0.80). Compared to the assistant-supported group (17.1 ± 2.1), the difference was not statistically significant (MD = 1.1; 95% CI: -0.65 to 2.85; p = 0.28). Secondary outcomes, including task completion time (F(2,51) = 1.25, p = 0.30), self‑efficacy (all p > 0.40), and patient‑reported comfort (χ²(4, N = 54) = 5.2, p = 0.27), showed no significant between‑group differences. Conclusion In this single‑centre pilot trial, an AI‑assisted solo workflow enabled novice dental students to achieve higher intraoral photographic quality than unguided solo operation, with performance broadly comparable to a conventional four‑handed assistant‑supported workflow and without detectable compromises in efficiency, self‑efficacy, or patient‑reported comfort. These preliminary findings may serve as a valuable adjunct for autonomous skill acquisition, warranting further validation in larger, multi-institutional cohorts. Clinical trial number Not applicable. This study evaluated an educational training intervention rather than a clinical treatment, and prospective trial registration was not required under institutional policy at the time of initiation. Ethical approval was obtained from Shanghai Ninth People’s Hospital Ethics Committee (SH9H-2022-T30-1).