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PubMed, Embase, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov, Google Scholar, and Open Science Framework were searched. Studies using 2D facial photographs, 3D facial scans, or AI\u2010generated facial models were included. Risk of bias was assessed with an adapted QUADAS\u20102 tool and certainty of evidence with GRADE. The protocol was registered in PROSPERO (CRD420261452521). Fifteen studies were included. Landmark\u2010localization performance varied substantially by imaging modality, landmark definition, data set, reference standard, and error metric; central and anatomically well\u2010defined landmarks were generally more accurate than peripheral or subjective points. Agreement for AI\u2010derived measurements ranged from poor to excellent, with ICCs of approximately 0.01\u20130.984. Classification accuracy ranged from approximately 0.83 to 0.98, with AUCs up to 0.98. Given only two narrowly scoped classification studies, these findings should be considered exploratory and hypothesis\u2010generating rather than broadly generalizable. Because of substantial methodological heterogeneity, findings were synthesized qualitatively. Current evidence supports AI as an adjunctive tool, but routine clinical implementation requires robust external validation and clinician oversight.<\/jats:p>\n                  <jats:p>PROSPERO registration: CRD420261452521<\/jats:p>","DOI":"10.1111\/eos.70162","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T11:26:47Z","timestamp":1792668407000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Artificial intelligence for facial soft\u2010tissue landmark localization, measurement, and classification in orthodontics: A systematic review"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0550-9636","authenticated-orcid":false,"given":"Hugo Henrique dos Santos Dantas","family":"Guimar\u00e3es","sequence":"first","affiliation":[{"name":"Department of Restorative Dentistry Federal University of Minas Gerais  Belo Horizonte Minas Gerais Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4001-5488","authenticated-orcid":false,"given":"Karla Nogueira","family":"Matos","sequence":"additional","affiliation":[{"name":"Department of Dentistry S\u00e3o Paulo University  S\u00e3o Paulo 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