Three-Dimensional Accuracy of Digitally Planned Orthodontic Tooth Movement in a Fully Customized Self-Ligating Lingual System

<b>Background</b>: Lingual orthodontic systems have recently advanced with the introduction of fully customized CAD/CAM-based designs featuring self-ligating (SL) mechanisms. This study aimed to evaluate the three-dimensional accuracy of a customized SL lingual system in reproducing digitally planned tooth positions. <b>Methods</b>: A total of 280 teeth were analyzed following treatment with a fully customized self-ligating lingual system (Harmony^®, Aso International Inc., Tokyo, Japan). Digital models obtained before treatment (T0), from the setup (TS), and after treatment (T1) were superimposed using a best fit algorithm in GOM Inspect. Tooth movements were quantified across seven biomechanically relevant parameters including tip, torque, rotation, buccolingual, mesiodistal, vertical, and overall displacement. Predicted and achieved movements were compared using paired <i>t</i> tests and Bland-Altman analysis. <b>Results</b>: The fully customized SL lingual appliance achieved an overall dentition accuracy of 92.1%. Mean accuracy for linear tooth movements was 94.5% ± 2.1% in the maxilla and 93.8% ± 2.5% in the mandible. For angular movements, mean accuracy was 90.8% ± 3.4% in the maxilla and 89.3% ± 3.9% in the mandible. The highest precision was observed in anterior teeth for mesiodistal (96.2%) and buccolingual (95.8%) movements, whereas the lowest accuracy occurred in rotational movements of the posterior segments (87.1%). No statistically significant differences were found between predicted and achieved movements for most parameters (<i>p</i> > 0.05). <b>Conclusions</b>: The fully customized SL lingual orthodontic system demonstrated high accuracy in reproducing digitally planned tooth movements, particularly in the anterior segments. Although accuracy was slightly lower in the posterior regions, the overall outcomes remained mechanically and clinically acceptable across all evaluated dimensions.