Autonomy, Externality, and the Ontological Stakes of Artificial Structures: The Mirage of Reality and the Erosion of Paediatric Dentistry

Abstract Reality is rarely located where it appears to be. Henry James’s “The Portrait of a Lady” demonstrates this with unsettling precision: a narrative ostensibly centred on Isabel Archer reveals, in its final movement, that its true moral axis was Ralph Touchett all along. Identity, James suggests, is often a mirage, externally visible yet internally displaced. Keisuke Suzuki’s “Artificial Externality: A Three-Layer Model of Reality from Substrate to Smart Contract” offers a unique philosophical framework for understanding this disjunction that we encounter daily (Suzuki, 2026). Suzuki argues that reality is not substance but resistance: the ways the world frustrates epistemic, judgmental, and practical mastery. His three modalities (Substrate, Contingency, and Inexorable) form a stack through which absoluteness can be found or technologically produced. This commentary extends Suzuki’s model into an unexpected domain: the erosion of autonomy in scientific disciplines, paediatric dentistry as an example under the lens. As paediatric dentists increasingly focus more, in the course of their specialty’s research, on endodontics, technological advancements, AI-driven diagnostics, and even general dentistry, the specialty risks becoming externally defined, losing the internal resistance that once grounded its identity. Drawing on several related concepts as well, we argue that paediatric dentistry’s crisis exemplifies the broader stakes of Artificial Externality. When disciplines lose their internal sources of resistance, they cease to be real in Suzuki’s sense. They become mirages, existing institutionally but ontologically hollow. Reclaiming disciplinary autonomy is therefore not merely a professional necessity but a philosophical imperative. Data Availability Not Applicable. References Ballouk, M. A., & Altinawi, M. (2026a). 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Professor Dr. Mohamed ALTINAWI supervised all the stages of this work and participated in the writing of the original draft as well as revising and editing it, too. Both authors reviewed and approved the final version of the paper. Corresponding author Ethics declarations Competing Interests The authors declare that they have no competing interests. Consent for Publication Not Applicable. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article BALLOUK, M.AH., ALTINAWI, M. Autonomy, Externality, and the Ontological Stakes of Artificial Structures: The Mirage of Reality and the Erosion of Paediatric Dentistry. Philos. Technol. 39, 163 (2026). https://doi.org/10.1007/s13347-026-01174-6 Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s13347-026-01174-6