Comparing Facial Attractiveness and Professional Acceptance Between Real and <scp>AI</scp> ‐Generated Orthodontic Treatment Outcome Images

BACKGROUND: Facial attractiveness influences social and professional perceptions, including competence and employability. With the increasing use of artificial intelligence (AI) to generate photorealistic faces, it is important to understand how these images compare to real orthodontic treatment outcomes. OBJECTIVE: To compare perceptions of real versus AI-generated orthodontic treatment results in terms of attractiveness, employability, and distinguishability. METHODS: A cross-sectional online survey included 288 Brazilian adults. PARTICIPANTS: Dentists (n = 76), dental students (n = 63), and laypeople (n = 149). Each evaluated three sets of images (pre-treatment, post-treatment, and AI-generated post-treatment) for three patients. Participants rated facial attractiveness (VAS 0-100), assessed employability, and identified whether the image was AI-generated. RESULTS: AI-generated images were rated significantly more attractive than real post-treatment ones (mean VAS: AI = 68.8; Real = 54.4; p < 0.001). Dentists, students, and laypeople all rated AI images higher. Employability was also greater for AI images (50.4%) than real ones (39.1%) (p = 0.007). Misclassification was common, with dental students achieving the highest accuracy (66.8%). CONCLUSION: Participants showed limited ability to accurately distinguish between real and AI-generated images. AI-generated images were perceived as more attractive and had a greater positive impact on employability judgements compared to real post-treatment images.