Artificial intelligence (AI) continues to significantly transform digital dentistry. In aligner therapy, AI-driven systems now assist with tooth segmentation, treatment set-up proposals, movement staging, attachment placement and even predictions of treatment outcomes. For many clinicians, this development is both exciting and unsettling. On the one hand, AI has considerably improved efficiency in digital workflows. Treatment simulations can be generated within minutes, visualising tooth movement in ways that were unimaginable only a decade ago. On the other hand, a growing number of clinicians are encountering an uncomfortable reality: digital simulations that look perfect do not always translate into predictable clinical outcomes. Understanding why this happens is becoming increasingly important as aligner therapy continues to expand worldwide.