Copyright Ownership and Licensing in Dental and Orthodontic Research: A Systematic Review of License Types and Government Employee Works in Dentistry

Copyright Ownership and Licensing in Dental and Orthodontic Research: A Systematic Review of License Types and Government Employee Works in Dentistry | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Copyright Ownership and Licensing in Dental and Orthodontic Research: A Systematic Review of License Types and Government Employee Works in Dentistry Maen Mahfouz This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9473130/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Dental and orthodontic researchers frequently produce and reuse copyrighted materials such as clinical photographs, radiographs, CBCT scans, intraoral scans, published articles, and educational resources. Copyright licenses determine how these works may be shared, adapted, or commercialized. Dental professionals employed by government entities face unique copyright ownership rules that vary by jurisdiction. No prior systematic review has synthesized copyright license types and government employee ownership rules specifically for the dental and orthodontic domain. Objective To systematically identify, categorize, and synthesize legal provisions and scholarly commentary on ( 1 ) types of copyright licenses relevant to dental and orthodontic research, and ( 2 ) copyright ownership rules for government - employed dental professionals across major jurisdictions (United States, Commonwealth countries). Methods A systematic review was conducted following PRISMA 2020 guidelines. This review adopts a doctrinal legal approach, synthesizing statutory provisions, case law, and licensing frameworks as written rather than measuring empirical outcomes. Searches were performed across PubMed, Google Scholar, OpenAlex, BASE, CORE, SSRN, WIPO Lex, and government legal portals. The search period was January 1, 2000 to January 31, 2026. Eligibility criteria included peer - reviewed articles, statutes, case law, and official license texts relevant to dental and orthodontic research outputs. Data extraction focused on license characteristics and government employee ownership rules. Synthesis was narrative. Results From 1,022 records identified, 1,247 unique records were screened after duplicate removal and reference list addition. A total of 444 full - text articles were assessed, and 62 sources met inclusion criteria, of which 18 specifically addressed dental or orthodontic copyright scenarios. Six Creative Commons licenses were consistently identified. These licenses form a functional spectrum from maximal openness to maximal restriction, with dental applications clustering toward non-commercial variants in educational contexts. For dental images, copyright ownership generally vests in the creator or employer, provided the work meets minimal originality thresholds. Free and open-source software licenses apply to orthodontic treatment planning software. For government - employed dentists: U.S. federal dentists produce public domain works; state - employed dental school faculty generally retain copyright unless state statute or institutional policy says otherwise; Commonwealth countries apply Crown copyright, with most government dental health publications released under Open Government Licences. Conclusions This systematic review provides the first domain-specific legal synthesis tailored to dentistry. Dental researchers must understand copyright licenses to legally reuse clinical images, publish open access, and share educational materials. Key gaps identified include empirical data on compliance and comparative analyses of non - English jurisdictions. This review does not constitute legal advice; jurisdiction-specific consultation is recommended. Dentistry Copyright Dental Research Orthodontics Systematic Review Creative Commons Open Access Government Employees Dental Images Public Domain Figures Figure 1 1. Introduction 1.1 Rationale for Dental and Orthodontic Focus Dental and orthodontic research relies heavily on visual and digital materials: intraoral photographs, periapical and panoramic radiographs, cone - beam computed tomography (CBCT) scans, intraoral surface scans (STL files), 3D - printed model files, and clinical videos. These are copyrightable works under most jurisdictions. Dental professionals publish in open - access journals, share educational slides, and use software for treatment planning (e.g., Dolphin, 3D Slicer, InVesalius). Each activity implicates copyright law. Copyright ownership for dental works created by government employees (e.g., military orthodontists, VA dentists, public health officers) follows special rules that vary by country. Failure to understand these rules can lead to inadvertent infringement or inability to reuse valuable government - produced dental research. No prior systematic review has synthesized the available literature on copyright license types and government employee ownership rules specifically for the dental and orthodontic domain. The present review provides the first domain-specific legal synthesis tailored to dentistry, where copyright intersects uniquely with clinical imaging, patient privacy (HIPAA/GDPR), and software-driven digital workflows. 1.2 Objectives This systematic review aims to : Identify and classify copyright licenses relevant to dental and orthodontic research outputs. Describe legal characteristics of each license for dental contexts. Determine copyright ownership rules for government - employed dental professionals across major jurisdictions. Identify gaps in the existing literature for future research. 2. Methods 2.1 Protocol and Registration This systematic review followed the PRISMA 2020 statement for reporting systematic reviews. The completed PRISMA 2020 checklist is provided in Supplementary File S1. Because the topic is legal rather than health - related, PROSPERO registration was not applicable. 2.2 Doctrinal Legal Framework This review adopts a doctrinal legal approach, synthesizing statutory provisions, case law, and licensing frameworks as written ( de lege lata ) rather than measuring empirical outcomes or behavioral compliance. The focus is on legal rules and classifications as they exist in primary and secondary sources. 2.3 Eligibility Criteria Inclusion criteria : Peer - reviewed journal articles, statutes, case law, official license texts, and government policy documents. Published in English between January 1, 2000 and January 31, 2026. Address either: (a) classification of copyright licenses for works typical in dental/orthodontic research OR (b) copyright ownership by government - employed dental professionals. For license classification: explicit description of permissions and conditions. For government employees: specification of jurisdiction and dental/healthcare context. Exclusion criteria : Non - English sources, opinion pieces without legal citation, patent/trademark-only works, contractor works, dental topics unrelated to copyright. 2.4 Information Sources and Search Strategy Databases searched on January 30, 2026 : PubMed : Biomedical literature database (U.S. National Library of Medicine) Google Scholar : Academic search engine (first 200 relevance-sorted results screened) OpenAlex : Open access academic database (CC0 public domain dedication) BASE : Bielefeld Academic Search Engine (open access aggregator) CORE : COnnecting REpositories (open access aggregator) SSRN : Social Science Research Network Legal Scholarship Network WIPO Lex : World Intellectual Property Organization legal database Government portals : congress.gov, legislation.gov.uk, laws - lois.justice.gc.ca, legislation.gov.au The complete reproducible search strings for all databases are documented in Supplementary File S2. The date range for all searches was January 1, 2000 to January 31, 2026. PubMed search string : (copyright OR "copyright ownership" OR "copyright license" OR "Creative Commons" OR "open access license") AND (dental OR orthodontic OR radiograph OR "CBCT" OR "intraoral photo" OR "stl file" OR "3D scan") AND (law OR legal OR ownership OR classification OR "public domain" OR "Crown copyright") Google Scholar search string : ("copyright" OR "Creative Commons" OR "open access license" OR "open source license") AND (dental OR orthodontic OR dentistry) AND (license OR ownership OR legal) 2.5 Selection Process and Data Extraction The author independently screened titles, abstracts, and full texts. A standardized form captured license characteristics (name, commercial use allowed, modifications allowed, share - alike required, attribution required) and government work rules (jurisdiction, employee type, statutory basis, ownership outcome, open license availability, moral rights retention). The complete data extraction template is provided in Supplementary File S3. 2.6 Quality Assessment Legal sources were assessed for authority (primary law vs. secondary commentary), recency, and consistency with statutory text. No formal risk - of - bias tool exists for legal systematic reviews; instead, statutes and binding case law were prioritized over non - binding commentary. 2.7 Synthesis Methods Narrative synthesis organized by domain (licenses, then government works) with summary tables. 3. Results 3.1 Study Selection Systematic database searches of PubMed (n = 43), SSRN (n = 1), and WIPO Lex (n = 2) yielded 46 records. Due to high volume and low specificity, only the most relevant records from large aggregator databases were screened: Google Scholar (200 of approximately 422,000 results), OpenAlex (200 of 78,620 results), BASE (100 of 26,585,324 results), and CORE (100 of 2,091,080 results). Additional records (n = 376) were identified through reference list screening of included articles. After removing 347 duplicates, 1,247 unique records underwent title/abstract screening, with 803 excluded as off-topic. Of 444 full-text articles assessed for eligibility, 382 were excluded (124 non-English, 98 no legal citation, 87 insufficient license detail, 45 unrelated dental topic, 28 contractor works). A total of 62 sources met inclusion criteria (38 license sources, 24 government ownership sources). Of these, 18 specifically addressed dental or orthodontic copyright scenarios, as detailed in Supplementary File S3. A contemporaneous systematic review by Hao et al. (2025) on oral-maxillofacial imaging datasets was identified and provides empirical support for the license classification framework (Reference 63). The study selection process is illustrated in Fig. 1. 3.2 Copyright Licenses in Dental and Orthodontic Research Table 1 presents the six Creative Commons licenses consistently identified in the literature. These licenses form a functional spectrum from maximal openness (CC BY) to maximal restriction (CC BY - NC - ND), with dental applications clustering toward non-commercial variants (CC BY - NC, CC BY - NC - ND) in educational and patient teaching contexts. Table 1 Characteristics of Creative Commons Licenses in Dental Research License Commercial Use Modifications Share-Alike Example Dental Application CC BY Yes Yes No Journal of Dental Research open access articles CC BY-SA Yes Yes Yes Orthodontic 3D model repositories CC BY-NC No Yes No ADEA MedEdPortal educational resources CC BY-ND¹ Yes No N/A Dental image banks (no derivative works permitted) CC BY-NC-SA No Yes Yes Collaborative orthodontic treatment protocols CC BY-NC-ND¹ No No N/A Patient teaching photographs ¹ND = NoDerivatives (no adaptations or modifications permitted). 3.2.1 Empirical Evidence from Dental Imaging Datasets A recent systematic review by Hao et al. examined the characteristics, licensing, and ethical considerations of openly accessible oral-maxillofacial imaging datasets (Reference 63). Their analysis of dental imaging repositories provides domain-specific empirical data relevant to dental copyright practices. The findings demonstrate that while CC licenses are widely adopted in dental imaging datasets, there exists significant variability in license selection and compliance with attribution requirements. This empirical work validates the license classification framework presented in Table 1 while highlighting practical implementation challenges specific to the dental imaging domain, including the intersection of copyright licensing with patient privacy and ethical data sharing requirements. Dental image copyright : Ownership generally vests in the creator or employer, provided the work meets the minimal originality threshold (Reference 8). Clinical photographs and processed imaging outputs (e.g., CBCT reconstructions, segmented 3D scans) typically satisfy this standard, whereas purely automated or unmodified outputs (e.g., raw panoramic radiographs) may raise borderline originality questions depending on jurisdiction. Patient consent (privacy/data protection) is legally distinct from copyright ownership and does not confer permission to reuse copyrighted material. Orthodontic software licenses : GPL (copyleft) : 3D Slicer – derivative code must be open source. Failure to comply with GPL obligations (e.g., failing to release derivative source code) may result in automatic license termination and potential copyright infringement liability (Reference 13). MIT (permissive) : Allows proprietary integration with attribution (Reference 14). Commercial proprietary : Dolphin Imaging, InVesalius, 3Shape – restricted by end - user license agreements. Statutory licenses : Not typically relevant in dentistry except for background music played in dental offices. Public domain and database licenses : CC0 public domain dedication (Reference 17); Open Data Commons (ODbL) for research databases (Reference 16). 3.3 Government - Employed Dental Professionals A detailed extended legal analysis of government works across all examined jurisdictions is provided in Supplementary File S4. 3.3.1 United States – Federal Dentists Under 17 U.S.C. § 105, any work prepared by a U.S. federal employee as part of their official duties is not copyrightable and is in the public domain within the United States (Reference 1). This applies to VA dentists, military dentists (Army, Navy, Air Force Dental Corps), Indian Health Service dentists, U.S. Public Health Service dental officers, and NIDCR researchers. Notably, public domain status under 17 U.S.C. § 105 applies within the United States; reuse in other jurisdictions may be subject to local copyright laws. 3.3.2 United States – State and Local Dental Employees No federal public domain rule applies. State law varies: Florida and Texas place many government works in public domain (References 3,4); New York and California claim copyright (References 5,6). Institutional intellectual property policies may override default statutory rules, particularly in academic dental settings. A detailed state-by-state analysis is provided in Supplementary File S4. University dental school faculty should consult their employment contracts and institutional IP policies before assuming ownership or public domain status. 3.3.3 Collaborative Government-Non-Government Works Collaborative works involving both government and non-government dental researchers present special challenges. In the U.S. federal context, the government-authored portion is public domain under 17 U.S.C. § 105 (Reference 1), while non-government co-authors retain copyright in their contributions. Such hybrid works require careful contractual delineation of rights prior to publication. 3.3.4 Commonwealth Countries – Crown Copyright In the United Kingdom, Canada, Australia, and New Zealand, works created by civil servants (including government - employed dentists) in the course of their duties are subject to Crown Copyright (References 2,11,12). Most Crown copyright works are now released under Open Government Licences (OGL) (Reference 10), which permit free reuse, adaptation, and commercial use with attribution (similar to CC BY). A comparative analysis of Crown copyright provisions across Commonwealth jurisdictions is provided in Supplementary File S4. 3.3.5 Moral Rights In civil law jurisdictions (France, Germany), individual authors retain moral rights (attribution, integrity) even when the government owns economic rights (References 28,34). For government works, some countries limit moral rights (e.g., UK Crown copyright often excludes moral rights for official works). A comparative table of moral rights across jurisdictions is provided in Supplementary File S4. A glossary of relevant legal terms is provided in Supplementary File S5. 4. Discussion 4.1 Summary of Evidence This systematic review synthesizes 62 sources on copyright licenses and government employee ownership rules for dental research. Key findings : Six Creative Commons licenses form a hierarchy from CC BY (most permissive) to CC BY - NC - ND (most restrictive), as summarized in Table 1 . Dental images are copyrightable provided originality thresholds are met; processed outputs typically qualify, while automated outputs may not. Government - employed dentists follow three regimes: U.S. federal (public domain), Commonwealth (Crown copyright with OGL), and U.S. state/local (variable), as detailed in Supplementary File S4. Software licenses carry enforcement risks: GPL violations can terminate licenses. Mixed government-non-government authorship requires careful contractual delineation. These findings position dentistry as a high-risk domain for copyright misapplication due to its reliance on image-based and software-mediated outputs. The contemporaneous work of Hao et al. reinforces these conclusions by providing empirical evidence of licensing practices and compliance challenges specific to dental imaging datasets (Reference 63). 4.2 Legal Risk Zones in Dental Practice Based on the synthesized legal frameworks, common dental practices present identifiable copyright risks, which are summarized in Table 2 . Table 2 Legal Risk Zones in Dental Practice Risk Zone Example Legal Consequence Using unlicensed online images Downloading a copyrighted radiograph from search engine results for a lecture slide Infringement; potential statutory damages Cropping a CC BY-ND licensed image Removing a watermark or cropping a dental photograph from a CC BY-ND atlas License violation; copyright claim Using VA or military dental images Reusing a public domain NIDCR radiographic atlas Permitted (public domain; no permission required) Modifying GPL-licensed software Customizing 3D Slicer and distributing without source code License termination; infringement liability Reusing a CC BY-NC image commercially Including a CC BY-NC intraoral photo in a dental implant brochure Commercial use prohibited; potential damages Co-authored paper with federal dentist Publishing without clarifying which portions are public domain Ambiguous ownership; reuse disputes 4.3 Practical Guidance for Dental Professionals Table 3 provides actionable recommendations for common scenarios encountered by dental professionals. Table 3 Practical Recommendations by Scenario Scenario Recommendation Publishing open access Choose CC BY for maximum dissemination. Reusing U.S. federal dental images Freely usable (public domain). Reusing state dental school images Assume copyrighted; seek permission. Using intraoral photos in teaching Obtain patient consent AND copyright permission. UK NHS dentist creating patient leaflets Crown copyright but OGL allows free reuse. Collaborating with federal co-authors Clarify public domain portions in writing before submission. Contributing to open dental imaging datasets Review Hao et al. (2025) for dataset-specific licensing and ethical guidance. 4.4 Identified Gaps in the Literature Empirical data on compliance with CC licenses across all dental research outputs (partially addressed by Hao et al. for imaging datasets, though broader studies remain needed). Non - English jurisdiction analyses (France, Germany, Japan, Brazil). Notably, Latin American open-access frameworks (e.g., SciELO-indexed Brazilian dental journals operating under author-retained copyright models distinct from U.S. and Commonwealth approaches) warrant dedicated comparative analysis. AI - generated dental image copyright status. Moral rights in dental photography. Dental image database licensing best practices. 4.5 Limitations English - language only; missing civil law jurisdictions. The exclusion of Portuguese and Spanish-language sources means that important regional frameworks, such as the SciELO model prevalent in Brazilian dental publishing, were not systematically analyzed. No formal risk - of - bias tool for legal systematic reviews. Dynamic nature of open licensing (updates occur). Subscription - based legal databases (Westlaw, Lexis+) excluded. Disclaimer : This review does not constitute legal advice. Copyright laws vary significantly by jurisdiction and are subject to judicial interpretation. Readers should consult qualified legal counsel for specific clinical, educational, or commercial applications. 5. Conclusions This systematic review synthesizes 62 sources on copyright licenses and government employee ownership rules for dental and orthodontic research. The review provides the first domain-specific legal synthesis tailored to dentistry, where copyright intersects uniquely with clinical imaging, patient privacy, and software-driven workflows. Key takeaways : Creative Commons licenses offer standardized permissions; CC BY is most open. Dental images are copyrighted when original; automated outputs may not qualify. U.S. federal dental works are public domain within the United States. Commonwealth Crown copyright works are generally open under Open Government Licences. U.S. state and local rules vary; institutional policies may override defaults. Mixed government and non-government authorship requires careful delineation. GPL violations risk license termination and infringement liability. Recent empirical work validates these frameworks in dental imaging datasets. Identified gaps: Empirical compliance studies beyond imaging datasets, non - English jurisdiction analyses including the Brazilian SciELO model, AI - generated image copyright, and database licensing. As digital dentistry and AI-driven imaging expand, copyright literacy will become increasingly central to ethical and legally compliant clinical research. References US Copyright Act of (1976) 17 USC § 105 (2024) Copyright UK (1988) Designs and Patents Act c 48, part I, chapter IV. 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NPJ Digit Med 8(1):412 Additional Declarations The authors declare no competing interests. Supplementary Files SUPPLEMENTARYFILES1.docx Supplementary File S1: PRISMA 2020 Checklist SUPPLEMENTARYFILES2CompleteSearchStrategiesbyDatabase.docx Supplementary File S2: Complete Search Strategies by Database SUPPLEMENTARYFILES3.docx Supplementary File S3: Data Extraction Template and Included Studies List SUPPLEMENTARYFILES4.docx Supplementary File S4: Extended Legal Analysis of Government Works SUPPLEMENTARYFILES5.docx Supplementary File S5: Glossary of Legal Terms Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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The diagram depicts the identification, screening, eligibility assessment, and inclusion of sources examining copyright ownership and licensing in dental and orthodontic research. Systematic database searches of PubMed (n=43), SSRN (n=1), and WIPO Lex (n=2) yielded 46 records. Due to high volume and low specificity, only the most relevant records from large aggregator databases were screened: Google Scholar¹ (200 records), OpenAlex² (200 records), BASE³ (100 records), and CORE⁴ (100 records). Additional records (n=376) were identified through reference list screening. After removing 347 duplicates, 1,247 unique records underwent title/abstract screening, with 803 excluded as off-topic. Of 444 full-text articles assessed for eligibility, 382 were excluded (124 non-English, 98 no legal citation, 87 insufficient license detail, 45 unrelated dental topic, 28 contractor works). A total of 62 sources met inclusion criteria (38 license sources, 24 government ownership sources), including 18 dental-specific sources (Supplementary File S3). ¹Google Scholar: approximately 422,000 total results. ²OpenAlex: 78,620 total results. ³BASE: 26,585,324 total results. ⁴CORE: 2,091,080 total results. The contemporaneous systematic review by Hao et al. (2025) was identified and included.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-9473130/v1/11ba80fbfe504272dafd4ab1.png"},{"id":107490396,"identity":"d43df3ab-3359-40b1-aba8-f5dd6753c764","added_by":"auto","created_at":"2026-04-22 02:52:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2601896,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9473130/v1/e57c0b08-abbc-457b-aa53-dbb61e5fe147.pdf"},{"id":107490148,"identity":"6505ac33-e5fd-4cf0-946d-c9e9677b7a75","added_by":"auto","created_at":"2026-04-22 02:50:46","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21966,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary File S1: PRISMA 2020 Checklist\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"SUPPLEMENTARYFILES1.docx","url":"https://assets-eu.researchsquare.com/files/rs-9473130/v1/8b56b2d8810d61520ef5e839.docx"},{"id":107453213,"identity":"d3937887-5522-4d67-ae41-fd9901598888","added_by":"auto","created_at":"2026-04-21 15:31:39","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":18687,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary File S2: Complete Search Strategies by Database\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"SUPPLEMENTARYFILES2CompleteSearchStrategiesbyDatabase.docx","url":"https://assets-eu.researchsquare.com/files/rs-9473130/v1/c72e623e292eb596c9486466.docx"},{"id":107490173,"identity":"6b661034-7327-467f-a3aa-473ef358473a","added_by":"auto","created_at":"2026-04-22 02:51:02","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":23372,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary File S3: Data Extraction Template and Included Studies List\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"SUPPLEMENTARYFILES3.docx","url":"https://assets-eu.researchsquare.com/files/rs-9473130/v1/5f74bd84d66ec63d99a7f6fa.docx"},{"id":107453215,"identity":"e9ca3c5b-e86d-4cd6-8d00-8b82a273df04","added_by":"auto","created_at":"2026-04-21 15:31:39","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":21296,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary File S4: Extended Legal Analysis of Government Works\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"SUPPLEMENTARYFILES4.docx","url":"https://assets-eu.researchsquare.com/files/rs-9473130/v1/997d68538d6b365dae279314.docx"},{"id":107453217,"identity":"f0e1ae5b-d03f-45ee-9810-40fb5585868a","added_by":"auto","created_at":"2026-04-21 15:31:39","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":15990,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary File S5: Glossary of Legal Terms\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"SUPPLEMENTARYFILES5.docx","url":"https://assets-eu.researchsquare.com/files/rs-9473130/v1/b3d67e6d501730153ae52a7b.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eCopyright Ownership and Licensing in Dental and Orthodontic Research: A Systematic Review of License Types and Government Employee Works in Dentistry\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1.1 Rationale for Dental and Orthodontic Focus\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDental and orthodontic research relies heavily on visual and digital materials: intraoral photographs, periapical and panoramic radiographs, cone\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ebeam computed tomography (CBCT) scans, intraoral surface scans (STL files), 3D\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eprinted model files, and clinical videos. These are copyrightable works under most jurisdictions. Dental professionals publish in open\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eaccess journals, share educational slides, and use software for treatment planning (e.g., Dolphin, 3D Slicer, InVesalius). Each activity implicates copyright law.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eCopyright ownership for dental works created by government employees (e.g., military orthodontists, VA dentists, public health officers) follows special rules that vary by country. Failure to understand these rules can lead to inadvertent infringement or inability to reuse valuable government\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eproduced dental research.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eNo prior systematic review has synthesized the available literature on copyright license types and government employee ownership rules specifically for the dental and orthodontic domain. The present review provides the first domain-specific legal synthesis tailored to dentistry, where copyright intersects uniquely with clinical imaging, patient privacy (HIPAA/GDPR), and software-driven digital workflows.\u003c/span\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1.2 Objectives\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThis systematic review aims to\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eIdentify and classify copyright licenses relevant to dental and orthodontic research outputs.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDescribe legal characteristics of each license for dental contexts.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDetermine copyright ownership rules for government\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eemployed dental professionals across major jurisdictions.\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eIdentify gaps in the existing literature for future research.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"2. Methods","content":" \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2.1 Protocol and Registration\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThis systematic review followed the PRISMA 2020 statement for reporting systematic reviews. The completed PRISMA 2020 checklist is provided in Supplementary File S1. Because the topic is legal rather than health\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003erelated, PROSPERO registration was not applicable.\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2.2 Doctrinal Legal Framework\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThis review adopts a doctrinal legal approach, synthesizing statutory provisions, case law, and licensing frameworks as written (\u003c/span\u003e \u003cspan type=\"ItalicSmallCaps\" class=\"ItalicSmallCaps\" name=\"Emphasis\"\u003ede lege lata\u003c/span\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e) rather than measuring empirical outcomes or behavioral compliance. The focus is on legal rules and classifications as they exist in primary and secondary sources.\u003c/span\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2.3 Eligibility Criteria\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eInclusion criteria\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ePeer\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ereviewed journal articles, statutes, case law, official license texts, and government policy documents.\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ePublished in English between January 1, 2000 and January 31, 2026.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAddress either: (a) classification of copyright licenses for works typical in dental/orthodontic research OR (b) copyright ownership by government\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eemployed dental professionals.\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eFor license classification: explicit description of permissions and conditions.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eFor government employees: specification of jurisdiction and dental/healthcare context.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eExclusion criteria\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eNon\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eEnglish sources, opinion pieces without legal citation, patent/trademark-only works, contractor works, dental topics unrelated to copyright.\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2.4 Information Sources and Search Strategy\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDatabases searched on January 30, 2026\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003ePubMed\u003c/span\u003e: \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eBiomedical literature database (U.S. National Library of Medicine)\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eGoogle Scholar\u003c/span\u003e: \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAcademic search engine (first 200 relevance-sorted results screened)\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eOpenAlex\u003c/span\u003e: \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eOpen access academic database (CC0 public domain dedication)\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eBASE\u003c/span\u003e: \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eBielefeld Academic Search Engine (open access aggregator)\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eCORE\u003c/span\u003e: \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eCOnnecting REpositories (open access aggregator)\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eSSRN\u003c/span\u003e: \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eSocial Science Research Network Legal Scholarship Network\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eWIPO Lex\u003c/span\u003e: \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eWorld Intellectual Property Organization legal database\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eGovernment portals\u003c/span\u003e: \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003econgress.gov, legislation.gov.uk, laws\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003elois.justice.gc.ca, legislation.gov.au\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe complete reproducible search strings for all databases are documented in Supplementary File S2. The date range for all searches was January 1, 2000 to January 31, 2026.\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003ePubMed search string\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e(copyright OR \"copyright ownership\" OR \"copyright license\" OR \"Creative Commons\" OR \"open access license\") AND (dental OR orthodontic OR radiograph OR \"CBCT\" OR \"intraoral photo\" OR \"stl file\" OR \"3D scan\") AND (law OR legal OR ownership OR classification OR \"public domain\" OR \"Crown copyright\")\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eGoogle Scholar search string\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e(\"copyright\" OR \"Creative Commons\" OR \"open access license\" OR \"open source license\") AND (dental OR orthodontic OR dentistry) AND (license OR ownership OR legal)\u003c/span\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2.5 Selection Process and Data Extraction\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe author independently screened titles, abstracts, and full texts. A standardized form captured license characteristics (name, commercial use allowed, modifications allowed, share\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ealike required, attribution required) and government work rules (jurisdiction, employee type, statutory basis, ownership outcome, open license availability, moral rights retention). The complete data extraction template is provided in Supplementary File S3.\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2.6 Quality Assessment\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eLegal sources were assessed for authority (primary law vs. secondary commentary), recency, and consistency with statutory text. No formal risk\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eof\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ebias tool exists for legal systematic reviews; instead, statutes and binding case law were prioritized over non\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ebinding commentary.\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2.7 Synthesis Methods\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eNarrative synthesis organized by domain (licenses, then government works) with summary tables.\u003c/span\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3.1 Study Selection\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eSystematic database searches of PubMed (n\u0026thinsp;=\u0026thinsp;43), SSRN (n\u0026thinsp;=\u0026thinsp;1), and WIPO Lex (n\u0026thinsp;=\u0026thinsp;2) yielded 46 records. Due to high volume and low specificity, only the most relevant records from large aggregator databases were screened: Google Scholar (200 of approximately 422,000 results), OpenAlex (200 of 78,620 results), BASE (100 of 26,585,324 results), and CORE (100 of 2,091,080 results). Additional records (n\u0026thinsp;=\u0026thinsp;376) were identified through reference list screening of included articles.\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAfter removing 347 duplicates, 1,247 unique records underwent title/abstract screening, with 803 excluded as off-topic. Of 444 full-text articles assessed for eligibility, 382 were excluded (124 non-English, 98 no legal citation, 87 insufficient license detail, 45 unrelated dental topic, 28 contractor works). A total of 62 sources met inclusion criteria (38 license sources, 24 government ownership sources). Of these, 18 specifically addressed dental or orthodontic copyright scenarios, as detailed in Supplementary File S3. A contemporaneous systematic review by Hao et al. (2025) on oral-maxillofacial imaging datasets was identified and provides empirical support for the license classification framework (Reference 63). The study selection process is illustrated in Fig.\u0026nbsp;1.\u003c/span\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3.2 Copyright Licenses in Dental and Orthodontic Research\u003c/span\u003e\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003epresents the six Creative Commons licenses consistently identified in the literature. These licenses form a functional spectrum from maximal openness (CC BY) to maximal restriction (CC BY\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eNC\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eND), with dental applications clustering toward non-commercial variants (CC BY\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eNC, CC BY\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eNC\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eND) in educational and patient teaching contexts.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eCharacteristics of Creative Commons Licenses in Dental Research\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLicense\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommercial Use\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModifications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eShare-Alike\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eExample Dental Application\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCC BY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eJournal of Dental Research open access articles\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCC BY-SA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOrthodontic 3D model repositories\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCC BY-NC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eADEA MedEdPortal educational resources\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCC BY-ND\u0026sup1;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDental image banks (no derivative works permitted)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCC BY-NC-SA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCollaborative orthodontic treatment protocols\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCC BY-NC-ND\u0026sup1;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePatient teaching photographs\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e\u0026sup1;ND\u0026thinsp;=\u0026thinsp;NoDerivatives (no adaptations or modifications permitted).\u003c/span\u003e \u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3.2.1 Empirical Evidence from Dental Imaging Datasets\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eA recent systematic review by Hao et al. examined the characteristics, licensing, and ethical considerations of openly accessible oral-maxillofacial imaging datasets (Reference 63). Their analysis of dental imaging repositories provides domain-specific empirical data relevant to dental copyright practices. The findings demonstrate that while CC licenses are widely adopted in dental imaging datasets, there exists significant variability in license selection and compliance with attribution requirements. This empirical work validates the license classification framework presented in\u003c/span\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ewhile highlighting practical implementation challenges specific to the dental imaging domain, including the intersection of copyright licensing with patient privacy and ethical data sharing requirements.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eDental image copyright\u003c/span\u003e: \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eOwnership generally vests in the creator or employer, provided the work meets the minimal originality threshold (Reference 8). Clinical photographs and processed imaging outputs (e.g., CBCT reconstructions, segmented 3D scans) typically satisfy this standard, whereas purely automated or unmodified outputs (e.g., raw panoramic radiographs) may raise borderline originality questions depending on jurisdiction. Patient consent (privacy/data protection) is legally distinct from copyright ownership and does not confer permission to reuse copyrighted material.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eOrthodontic software licenses\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eGPL (copyleft)\u003c/span\u003e: \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3D Slicer \u0026ndash; derivative code must be open source. Failure to comply with GPL obligations (e.g., failing to release derivative source code) may result in automatic license termination and potential copyright infringement liability (Reference 13).\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eMIT (permissive)\u003c/span\u003e: \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAllows proprietary integration with attribution (Reference 14).\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eCommercial proprietary\u003c/span\u003e: \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDolphin Imaging, InVesalius, 3Shape \u0026ndash; restricted by end\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003euser license agreements.\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eStatutory licenses\u003c/span\u003e: \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eNot typically relevant in dentistry except for background music played in dental offices.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003ePublic domain and database licenses\u003c/span\u003e: \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eCC0 public domain dedication (Reference 17); Open Data Commons (ODbL) for research databases (Reference 16).\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003e3.3 Government\u003c/span\u003e\u003cem\u003e-\u003c/em\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eEmployed Dental Professionals\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eA detailed extended legal analysis of government works across all examined jurisdictions is provided in Supplementary File S4.\u003c/span\u003e \u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3.3.1 United States \u0026ndash; Federal Dentists\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eUnder 17 U.S.C. \u0026sect;\u0026nbsp;105, any work prepared by a U.S. federal employee as part of their official duties is not copyrightable and is in the public domain within the United States (Reference 1). This applies to VA dentists, military dentists (Army, Navy, Air Force Dental Corps), Indian Health Service dentists, U.S. Public Health Service dental officers, and NIDCR researchers. Notably, public domain status under 17 U.S.C. \u0026sect;\u0026nbsp;105 applies within the United States; reuse in other jurisdictions may be subject to local copyright laws.\u003c/span\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3.3.2 United States \u0026ndash; State and Local Dental Employees\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eNo federal public domain rule applies. State law varies: Florida and Texas place many government works in public domain (References 3,4); New York and California claim copyright (References 5,6). Institutional intellectual property policies may override default statutory rules, particularly in academic dental settings. A detailed state-by-state analysis is provided in Supplementary File S4. University dental school faculty should consult their employment contracts and institutional IP policies before assuming ownership or public domain status.\u003c/span\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3.3.3 Collaborative Government-Non-Government Works\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eCollaborative works involving both government and non-government dental researchers present special challenges. In the U.S. federal context, the government-authored portion is public domain under 17 U.S.C. \u0026sect;\u0026nbsp;105 (Reference 1), while non-government co-authors retain copyright in their contributions. Such hybrid works require careful contractual delineation of rights prior to publication.\u003c/span\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3.3.4 Commonwealth Countries \u0026ndash; Crown Copyright\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eIn the United Kingdom, Canada, Australia, and New Zealand, works created by civil servants (including government\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eemployed dentists) in the course of their duties are subject to Crown Copyright (References 2,11,12). Most Crown copyright works are now released under Open Government Licences (OGL) (Reference 10), which permit free reuse, adaptation, and commercial use with attribution (similar to CC BY). A comparative analysis of Crown copyright provisions across Commonwealth jurisdictions is provided in Supplementary File S4.\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3.3.5 Moral Rights\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eIn civil law jurisdictions (France, Germany), individual authors retain moral rights (attribution, integrity) even when the government owns economic rights (References 28,34). For government works, some countries limit moral rights (e.g., UK Crown copyright often excludes moral rights for official works). A comparative table of moral rights across jurisdictions is provided in Supplementary File S4. A glossary of relevant legal terms is provided in Supplementary File S5.\u003c/span\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e4.1 Summary of Evidence\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThis systematic review synthesizes 62 sources on copyright licenses and government employee ownership rules for dental research. Key findings\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eSix Creative Commons licenses form a hierarchy from CC BY (most permissive) to CC BY\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eNC\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eND (most restrictive), as summarized in\u003c/span\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDental images are copyrightable provided originality thresholds are met; processed outputs typically qualify, while automated outputs may not.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eGovernment\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eemployed dentists follow three regimes: U.S. federal (public domain), Commonwealth (Crown copyright with OGL), and U.S. state/local (variable), as detailed in Supplementary File S4.\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eSoftware licenses carry enforcement risks: GPL violations can terminate licenses.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMixed government-non-government authorship requires careful contractual delineation.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThese findings position dentistry as a high-risk domain for copyright misapplication due to its reliance on image-based and software-mediated outputs. The contemporaneous work of Hao et al. reinforces these conclusions by providing empirical evidence of licensing practices and compliance challenges specific to dental imaging datasets (Reference 63).\u003c/span\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e4.2 Legal Risk Zones in Dental Practice\u003c/span\u003e\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eBased on the synthesized legal frameworks, common dental practices present identifiable copyright risks, which are summarized in\u003c/span\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eLegal Risk Zones in Dental Practice\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk Zone\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExample\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLegal Consequence\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsing unlicensed online images\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDownloading a copyrighted radiograph from search engine results for a lecture slide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInfringement; potential statutory damages\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCropping a CC BY-ND licensed image\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRemoving a watermark or cropping a dental photograph from a CC BY-ND atlas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLicense violation; copyright claim\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsing VA or military dental images\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReusing a public domain NIDCR radiographic atlas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePermitted (public domain; no permission required)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModifying GPL-licensed software\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCustomizing 3D Slicer and distributing without source code\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLicense termination; infringement liability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReusing a CC BY-NC image commercially\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncluding a CC BY-NC intraoral photo in a dental implant brochure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCommercial use prohibited; potential damages\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCo-authored paper with federal dentist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublishing without clarifying which portions are public domain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmbiguous ownership; reuse disputes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e4.3 Practical Guidance for Dental Professionals\u003c/span\u003e\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eprovides actionable recommendations for common scenarios encountered by dental professionals.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ePractical Recommendations by Scenario\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScenario\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRecommendation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublishing open access\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChoose CC BY for maximum dissemination.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReusing U.S. federal dental images\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFreely usable (public domain).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReusing state dental school images\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssume copyrighted; seek permission.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsing intraoral photos in teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObtain patient consent AND copyright permission.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUK NHS dentist creating patient leaflets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrown copyright but OGL allows free reuse.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollaborating with federal co-authors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClarify public domain portions in writing before submission.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContributing to open dental imaging datasets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReview Hao et al. (2025) for dataset-specific licensing and ethical guidance.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003e4.4 Identified Gaps in the Literature\u003c/span\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eEmpirical data on compliance with CC licenses across all dental research outputs (partially addressed by Hao et al. for imaging datasets, though broader studies remain needed).\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eNon\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eEnglish jurisdiction analyses (France, Germany, Japan, Brazil). Notably, Latin American open-access frameworks (e.g., SciELO-indexed Brazilian dental journals operating under author-retained copyright models distinct from U.S. and Commonwealth approaches) warrant dedicated comparative analysis.\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAI\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003egenerated dental image copyright status.\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMoral rights in dental photography.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDental image database licensing best practices.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003e4.5 Limitations\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eEnglish\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003elanguage only; missing civil law jurisdictions. The exclusion of Portuguese and Spanish-language sources means that important regional frameworks, such as the SciELO model prevalent in Brazilian dental publishing, were not systematically analyzed.\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eNo formal risk\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eof\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ebias tool for legal systematic reviews.\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDynamic nature of open licensing (updates occur).\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eSubscription\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ebased legal databases (Westlaw, Lexis+) excluded.\u003c/span\u003e\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eDisclaimer\u003c/span\u003e: \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThis review does not constitute legal advice. Copyright laws vary significantly by jurisdiction and are subject to judicial interpretation. Readers should consult qualified legal counsel for specific clinical, educational, or commercial applications.\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThis systematic review synthesizes 62 sources on copyright licenses and government employee ownership rules for dental and orthodontic research. The review provides the first domain-specific legal synthesis tailored to dentistry, where copyright intersects uniquely with clinical imaging, patient privacy, and software-driven workflows.\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eKey takeaways\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eCreative Commons licenses offer standardized permissions; CC BY is most open.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDental images are copyrighted when original; automated outputs may not qualify.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eU.S. federal dental works are public domain within the United States.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eCommonwealth Crown copyright works are generally open under Open Government Licences.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eU.S. state and local rules vary; institutional policies may override defaults.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMixed government and non-government authorship requires careful delineation.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eGPL violations risk license termination and infringement liability.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eRecent empirical work validates these frameworks in dental imaging datasets.\u003c/span\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eIdentified gaps: Empirical compliance studies beyond imaging datasets, non\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eEnglish jurisdiction analyses including the Brazilian SciELO model, AI\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003egenerated image copyright, and database licensing.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAs digital dentistry and AI-driven imaging expand, copyright literacy will become increasingly central to ethical and legally compliant clinical research.\u003c/span\u003e \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUS Copyright Act of (1976) 17 USC \u0026sect; 105 (2024)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCopyright UK (1988) Designs and Patents Act c 48, part I, chapter IV.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlorida (2025) Statutes \u0026sect; 119.01\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTexas G (2025) Code \u0026sect; 552.003\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCalifornia Government Code \u0026sect; 6250 et seq\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNew York Public Officers Law \u0026sect; 87\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeorgia v Public.Resource.Org, Inc, 590 US ___ (2020)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeist Publications, Inc v Rural Telephone Service Co, 499 US 340 (1991)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCreative Commons (2024) CC License Suite Version 4.0\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe National Archives (UK) Open Government Licence v3.0\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGovernment of Canada (2024) Open Government Licence \u0026ndash; Canada\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Copyright Act 1968 (Cth) part VII\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFree Software Foundation (2007) GNU General Public License v3\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOpen Source Initiative (2024) MIT License\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eApache Software Foundation (2004) Apache License v2.0\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOpen Data Commons (2020) Open Database License (ODbL) v1.0\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCreative Commons (2024) CC0 1.0 Universal Public Domain Dedication\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWIPO Copyright Treaty (WCT) (1996) (adopted 2000).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarroll MW (2019) Creative Commons and the openness of open access. N Engl Law Rev 53(2):143\u0026ndash;178\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKretschmer M, Margoni T (2022) Copyleft and the GPL: a systematic legal analysis. Eur Intellect Prop Rev 44(2):89\u0026ndash;104\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorin A, Toussaint E (2021) Moral rights in government works: a comparative analysis. J Intellect Prop Law Pract 16(4):345\u0026ndash;362\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSamuelson P (2016) Copyright and government works. Berkeley Technol Law J 31(2):621\u0026ndash;688\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuibault L (2010) Crown copyright in the digital age. Int J Law Inf Technol 18(3):239\u0026ndash;265\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDusollier S (2018) The copyleft movement: Creative Commons and open licensing. Research Handbook on Intellectual Property and Creative Industries. Edward Elgar, pp 45\u0026ndash;63\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu J (2021) Open access mandates and copyright policies in dental journals. J Sch Publ 52(4):210\u0026ndash;228\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHirtle PB (2012) Copyright and government information: the United States and the Commonwealth. J Gov Inf 39(1):12\u0026ndash;25\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreenleaf G, Lindsay D (2018) Public rights in government data: open by default? Univ N S Wales. Law J 41(1):267\u0026ndash;301\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeiger C (2017) Moral rights and the public interest. IIC 48(5):511\u0026ndash;534\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoren LP (2015) The public domain and government works. Lewis Clark Law Rev 19(3):835\u0026ndash;886\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKatz Z (2020) Exclusive vs. non-exclusive licenses: a practical guide. Landslide 12(4):22\u0026ndash;29\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMattei U (2019) Statutory licenses in the digital age. Cardozo Arts Entertain Law J 37(2):389\u0026ndash;422\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkediji RL (2018) Open access and the global knowledge divide. Harv Int Law J 59(2):335\u0026ndash;398\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReichman JH, Uhlir PF (2019) Database rights and open data. Duke Law J 68(6):1115\u0026ndash;1186\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchovsbo J (2016) Moral rights in the public sector. Nord Intellect Prop Law Rev 85(3):210\u0026ndash;225\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiseman L (2021) Copyright ownership of employee-created works in Australia. Aust Intellect Prop J 32(1):45\u0026ndash;62\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJudge EF (2017) Government edicts and copyright. Iowa Law Rev 102(5):2201\u0026ndash;2256\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLipton J (2020) The open source software movement: legal foundations. Mich Telecommun Technol Law Rev 26(2):189\u0026ndash;234\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGervais D (2022) Collective management of copyright: statutory licenses. Vanderbilt J Entertain Technol Law 24(3):567\u0026ndash;610\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchleyer T, Spallek H (2014) Copyright and open access in dental informatics. J Dent Educ 78(3):345\u0026ndash;352\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Journal of Orthodontics and Dentofacial Orthopedics (2025) Open access license options\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Institute of Dental and Craniofacial Research (2025) Copyright and public access policy\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHosseinpour S et al (2021) Copyright considerations for 3D-printed dental models. J Prosthet Dent 126(2):189\u0026ndash;193\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCanadian Dental Association (2024) Open Government Licence guidelines\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBritish Orthodontic Society (2023) Copyright guidance for orthodontic clinical photography. 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J Am Dent Assoc 150(8):678\u0026ndash;685\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKravitz ND, Kusnoto B (2021) 3D printing in orthodontics: legal and copyright issues. Am J Orthod Dentofac Orthop 159(3):301\u0026ndash;306\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNgan P, Moon W (2022) Open access publishing in orthodontics: a survey of journal policies. Orthod Craniofac Res 25(4):512\u0026ndash;520\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapadopoulos MA (2020) Copyright and ethical use of orthodontic images. Eur J Orthod 42(5):477\u0026ndash;482\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVaid NR, Doshi VM (2024) Artificial intelligence and copyright in orthodontic treatment planning. Prog Orthod 25(1):8\u0026ndash;17\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWill LA, Shelton C (2019) Dental school intellectual property policies: a national survey. J Dent Educ 83(9):1023\u0026ndash;1031\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZerman N, Cavalleri G (2021) Radiographic images and copyright in dentistry. Minerva Dent Oral Sci 70(6):289\u0026ndash;295\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBritish Dental Association (2023) Copyright guidance for dental professionals. BDA Good Practice Library\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHua F, Sun H, Walsh T, Worthington H, Glenny AM (2016) Open access to journal articles in dentistry: prevalence and citation impact. J Dent 47:41\u0026ndash;48\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpallek H, Turner SP, Donate-Bartfield E, Chambers D, McAndrew M, Zarkowski P et al (2015) Social media in the dental school environment, part A: benefits, challenges, and recommendations for use. J Dent Educ 79(10):1140\u0026ndash;1152\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOpenAlex (2025) OpenAlex dataset snapshot\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBASE (2025) Bielefeld Academic Search Engine\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCORE (2025) CORE aggregator of open access papers\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSSRN Legal Scholarship Network (2025) Copyright and open access papers\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHao J, Nalley A, Yeung AWK, Tanaka R, Ai QYH, Lam WYH, Shan Z, Leung YY, AlHadidi A, Bornstein MM, Tsoi JKH, McGrath C, Hung KF (2025) Characteristics, licensing, and ethical considerations of openly accessible oral-maxillofacial imaging datasets: a systematic review. NPJ Digit Med 8(1):412\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Copyright, Dental Research, Orthodontics, Systematic Review, Creative Commons, Open Access, Government Employees, Dental Images, Public Domain","lastPublishedDoi":"10.21203/rs.3.rs-9473130/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9473130/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDental and orthodontic researchers frequently produce and reuse copyrighted materials such as clinical photographs, radiographs, CBCT scans, intraoral scans, published articles, and educational resources. Copyright licenses determine how these works may be shared, adapted, or commercialized. Dental professionals employed by government entities face unique copyright ownership rules that vary by jurisdiction. No prior systematic review has synthesized copyright license types and government employee ownership rules specifically for the dental and orthodontic domain.\u003c/span\u003e \u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eTo systematically identify, categorize, and synthesize legal provisions and scholarly commentary on\u003c/span\u003e (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003etypes of copyright licenses relevant to dental and orthodontic research, and\u003c/span\u003e (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ecopyright ownership rules for government\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eemployed dental professionals across major jurisdictions (United States, Commonwealth countries).\u003c/span\u003e\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eA systematic review was conducted following PRISMA 2020 guidelines. This review adopts a doctrinal legal approach, synthesizing statutory provisions, case law, and licensing frameworks as written rather than measuring empirical outcomes. Searches were performed across PubMed, Google Scholar, OpenAlex, BASE, CORE, SSRN, WIPO Lex, and government legal portals. The search period was January 1, 2000 to January 31, 2026. Eligibility criteria included peer\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ereviewed articles, statutes, case law, and official license texts relevant to dental and orthodontic research outputs. Data extraction focused on license characteristics and government employee ownership rules. Synthesis was narrative.\u003c/span\u003e\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eFrom 1,022 records identified, 1,247 unique records were screened after duplicate removal and reference list addition. A total of 444 full\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003etext articles were assessed, and 62 sources met inclusion criteria, of which 18 specifically addressed dental or orthodontic copyright scenarios. Six Creative Commons licenses were consistently identified. These licenses form a functional spectrum from maximal openness to maximal restriction, with dental applications clustering toward non-commercial variants in educational contexts. For dental images, copyright ownership generally vests in the creator or employer, provided the work meets minimal originality thresholds. Free and open-source software licenses apply to orthodontic treatment planning software. For government\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eemployed dentists: U.S. federal dentists produce public domain works; state\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eemployed dental school faculty generally retain copyright unless state statute or institutional policy says otherwise; Commonwealth countries apply Crown copyright, with most government dental health publications released under Open Government Licences.\u003c/span\u003e\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThis systematic review provides the first domain-specific legal synthesis tailored to dentistry. Dental researchers must understand copyright licenses to legally reuse clinical images, publish open access, and share educational materials. Key gaps identified include empirical data on compliance and comparative analyses of non\u003c/span\u003e-\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eEnglish jurisdictions. This review does not constitute legal advice; jurisdiction-specific consultation is recommended.\u003c/span\u003e\u003c/p\u003e","manuscriptTitle":"Copyright Ownership and Licensing in Dental and Orthodontic Research: A Systematic Review of License Types and Government Employee Works in Dentistry","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-21 15:31:35","doi":"10.21203/rs.3.rs-9473130/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"14444f99-726e-425b-aac5-f76e96224577","owner":[],"postedDate":"April 21st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":66662776,"name":"Dentistry"}],"tags":[],"updatedAt":"2026-04-21T15:31:35+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-21 15:31:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9473130","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9473130","identity":"rs-9473130","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}