{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T02:34:44Z","timestamp":1768444484632,"version":"3.49.0"},"reference-count":37,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Background: 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. Methods: A total of 280 teeth were analyzed following treatment with a fully customized self-ligating lingual system (Harmony\u00ae, 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 t tests and Bland\u2013Altman analysis. Results: The fully customized SL lingual appliance achieved an overall dentition accuracy of 92.1%. Mean accuracy for linear tooth movements was 94.5% \u00b1 2.1% in the maxilla and 93.8% \u00b1 2.5% in the mandible. For angular movements, mean accuracy was 90.8% \u00b1 3.4% in the maxilla and 89.3% \u00b1 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 (p &gt; 0.05). Conclusions: 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.<\/jats:p>","DOI":"10.3390\/bioengineering13010094","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T15:47:37Z","timestamp":1768405657000},"page":"94","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Three-Dimensional Accuracy of Digitally Planned Orthodontic Tooth Movement in a Fully Customized Self-Ligating Lingual System"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8920-8605","authenticated-orcid":false,"given":"Arda","family":"Ar\u0131san","sequence":"first","affiliation":[{"name":"Independent Researcher, Ankara 06510, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T\u00fclin","family":"Taner","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Faculty of Dentistry, Hacettepe University, Ankara 06230, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1007\/s00056-002-0211-5","article-title":"A New Bracket System for Lingual Orthodontic Treatment. Part 1: Theoretical Background and Development","volume":"63","author":"Wiechmann","year":"2002","journal-title":"J. Orofac. Orthop."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1007\/s00056-016-0058-9","article-title":"Therapeutic Accuracy of the Completely Customized Lingual Appliance WIN: A Retrospective Cohort Study","volume":"78","author":"Pauls","year":"2017","journal-title":"J. Orofac. Orthop."},{"key":"ref_3","unstructured":"Rafi, R., Silvia, G., and Pablo, E. (2011). Lingual & Esthetic Orthodontics, Quintessence Publishing Co., Ltd."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1007\/s00056-002-0124-3","article-title":"Lingual Technique--Patients\u2019 Characteristics, Motivation and Acceptance. Interpretation of a Retrospective Survey","volume":"63","author":"Fritz","year":"2002","journal-title":"J. Orofac. Orthop."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1093\/ejo\/cjs093","article-title":"Self-Ligating Fully Customized Lingual Appliance and Chair-Time Reduction: A Typodont Study Followed by a Randomized Clinical Trial","volume":"35","author":"Dalessandri","year":"2013","journal-title":"Eur. J. Orthod."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1053\/j.sodo.2018.10.004","article-title":"Accuracy of Digital Predictions with CAD\/CAM Labial and Lingual Appliances: A Retrospective Cohort Study","volume":"24","author":"Awad","year":"2018","journal-title":"Semin. Orthod."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1038\/s41405-023-00167-3","article-title":"The Accuracy of Virtual Setup in Simulating Treatment Outcomes in Orthodontic Practice: A Systematic Review","volume":"9","author":"Sereewisai","year":"2023","journal-title":"BDJ Open"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Li, Y., Zhou, L., Chen, M., Du, Y., Gan, Y., Li, B., and Feng, J. (2025). Accuracy of Digital Indirect Bonding Technology for Customized Orthodontic Brackets Based on Personalized Typodonts. BMC Oral Health, 25.","DOI":"10.1186\/s12903-025-05777-x"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Sabbagh, H., Khazaei, Y., Baumert, U., Hoffmann, L., Wichelhaus, A., and Rankovic, M.J. (2022). Bracket Transfer Accuracy with the Indirect Bonding Technique\u2014A Systematic Review and Meta-Analysis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11092568"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"67","DOI":"10.2319\/013120-70.1","article-title":"Comparison of the Transfer Accuracy of Two Digital Indirect Bonding Trays for Labial Bracket Bonding","volume":"91","author":"Niu","year":"2020","journal-title":"Angle Orthod."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s40510-022-00426-3","article-title":"Comparison of the Accuracy of Bracket Positioning between Direct and Digital Indirect Bonding Techniques in the Maxillary Arch: A Three-Dimensional Study","volume":"23","author":"Aboujaoude","year":"2022","journal-title":"Prog. Orthod."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Elabed, I., Zheng, Z., Zhang, Y., Chung, C.H., and Li, C. (2024). The Mechanical and Clinical Properties of Customized Orthodontic Bracket Systems\u2014A Comprehensive Review. J. Funct. Biomater., 15.","DOI":"10.3390\/jfb15100299"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Hartogsohn, C.R., and Sonnesen, L. (2025). Clear Aligner Treatment: Indications, Advantages, and Adverse Effects\u2014A Systematic Review. Dent. J., 13.","DOI":"10.3390\/dj13010040"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Nedzinskait\u0117, R., Augyt\u0117, B., Smailiene, D., Vasiliauskas, A., Lopatiene, K., Zas\u010diurinskiene, E., and Trakiniene, G. (2024). Well-Being of Orthodontic Patients Wearing Orthodontic Appliances. Medicina, 60.","DOI":"10.3390\/medicina60081287"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"9000","DOI":"10.1038\/s41598-023-36085-5","article-title":"A Retrospective Study of the Accuracy of Invisalign Progress Assessment with Clear Aligners","volume":"13","author":"Li","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"160","DOI":"10.4041\/kjod23.268","article-title":"Accuracy of Orthodontic Movements with 3D Printed Aligners: A Prospective Observational Pilot Study","volume":"54","author":"Migliorati","year":"2024","journal-title":"Korean J. Orthod."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1111\/ocr.12846","article-title":"Accuracy of Clear Aligners in the Orthodontic Rotational Movement Using Different Attachment Configurations","volume":"27","author":"Fiorillo","year":"2024","journal-title":"Orthod. Craniofacial Res."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Keilig, L., Fittgen, A., Schneider, H., Sifa, R., Schwarze, J., Bourauel, C., and Konermann, A. (2024). Accuracy of Digital Orthodontic Treatment Planning: Assessing Aligner-Directed Tooth Movements and Exploring Inherent Intramaxillary Side Effects. J. Clin. Med., 13.","DOI":"10.3390\/jcm13082298"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"D\u2019Ant\u00f2, V., Bucci, R., De Simone, V., Ghislanzoni, L.H., Michelotti, A., and Rongo, R. (2022). Evaluation of Tooth Movement Accuracy with Aligners: A Prospective Study. Materials, 15.","DOI":"10.3390\/ma15072646"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Benedetti, G., Sicca, N., Lopponi, G., Dettori, C., Verdecchia, A., and Spinas, E. (2025). Evaluating the Clinical Success of Clear Aligners for Rotational Tooth Movements in Adult Patients: A Systematic Review. Dent. J., 13.","DOI":"10.3390\/dj13100440"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1111\/ocr.12177","article-title":"Efficiency, Effectiveness and Treatment Stability of Clear Aligners: A Systematic Review and Meta-Analysis","volume":"20","author":"Zheng","year":"2017","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.ajodo.2019.12.015","article-title":"Has Invisalign Improved? A Prospective Follow-up Study on the Efficacy of Tooth Movement with Invisalign","volume":"158","author":"Haouili","year":"2020","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s40510-022-00406-7","article-title":"Accuracy Evaluation of Orthodontic Movements with Aligners: A Prospective Observational Study","volume":"23","author":"Bilello","year":"2022","journal-title":"Prog. Orthod."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"15","DOI":"10.4103\/jos.JOS_45_20","article-title":"Accuracy of Three Different Customized Lingual Orthodontic Appliance Systems in Achieving Predicted Results on Maxillary Anterior Teeth: A Retrospective Cohort Study","volume":"10","author":"Fernandes","year":"2021","journal-title":"J. Orthod. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s40510-023-00482-3","article-title":"Accuracy of Lingual Straight-Wire Orthodontic Treatment with Passive Self-Ligating Brackets and Square Slot: A Retrospective Study","volume":"24","author":"Scisciola","year":"2023","journal-title":"Prog. Orthod."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"714","DOI":"10.2319\/031522-220.1","article-title":"Accuracy of Planned Tooth Movement with Lingual Straight Wire Technique","volume":"92","author":"Albertini","year":"2022","journal-title":"Angle Orthod."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e0032","DOI":"10.1590\/pboci.2021.157","article-title":"Effectiveness of Fully Customized Lingual Orthodontic Treatment: A Retrospective Pilot Study","volume":"21","author":"Palone","year":"2021","journal-title":"Pesqui. Bras. Odontopediatria Clin. Integrada"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.ajodo.2011.01.020","article-title":"Accuracy in Tooth Positioning with a Fully Customized Lingual Orthodontic Appliance","volume":"140","author":"Grauer","year":"2011","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/S0889-5406(98)70179-9","article-title":"Objective Grading System for Dental Casts and Panoramic Radiographs","volume":"114","author":"Casko","year":"1998","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1016\/j.ajodo.2024.11.006","article-title":"Evaluation of the Reliability of Palatal Rugae as a Reference Area in Digital Superimposition after Slow Maxillary Expansion Treatment","volume":"167","author":"Topsakal","year":"2025","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"497","DOI":"10.2319\/101309-569.1","article-title":"Accuracy and Reliability of Palatal Superimposition of Three-Dimensional Digital Models","volume":"80","author":"Choi","year":"2010","journal-title":"Angle Orthod."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s40510-022-00453-0","article-title":"Predictability of Orthodontic Tooth Movement with Aligners: Effect of Treatment Design","volume":"24","author":"Castroflorio","year":"2023","journal-title":"Prog. Orthod."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.ajodo.2007.05.018","article-title":"How Well Does Invisalign Work? A Prospective Clinical Study Evaluating the Efficacy of Tooth Movement with Invisalign","volume":"135","author":"Kravitz","year":"2009","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.ajodo.2021.02.018","article-title":"Assessment of Simulated vs Actual Orthodontic Tooth Movement with a Customized Fixed Lingual Appliance Using Untreated Posterior Teeth for Registration and Digital Superimposition: A Retrospective Study","volume":"161","author":"Sharp","year":"2022","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1016\/j.joen.2017.01.012","article-title":"Anatomic Comparison of Contralateral Premolars","volume":"43","author":"Johnsen","year":"2017","journal-title":"J. Endod."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1111\/iej.12553","article-title":"A Proposal for Using Contralateral Teeth to Provide Well-Balanced Experimental Groups for Endodontic Studies","volume":"49","author":"Xu","year":"2016","journal-title":"Int. Endod. J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"158","DOI":"10.3390\/ai5010009","article-title":"AI and Face-Driven Orthodontics: A Scoping Review of Digital Advances in Diagnosis and Treatment Planning","volume":"5","author":"Zsoldos","year":"2024","journal-title":"AI"}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/13\/1\/94\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T15:52:12Z","timestamp":1768405932000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/13\/1\/94"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,14]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["bioengineering13010094"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering13010094","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,14]]}}}