Impact of guide design and accuracy of mini-implant placement in the anterior palate: A systematic review

BACKGROUND: Digitally designed insertion guides ensure precise placement of orthodontic mini-implants, offering controlled insertion. However, the transfer accuracy of these guides can vary across different designs, impacting their effectiveness in clinical application. METHODS: A systematic review was conducted using PubMed, Google Scholar, Cochrane and Livivo. The search focused on the impact of insertion guide design on transfer accuracy of orthodontic mini-implants in the anterior palate. In total, 101 records were identified, of which 10 were included. The quality of the included studies was assessed by the JBI critical appraisal tool. A two-step independent review process was implemented. RESULTS: Overall, guided insertion showed small deviations, typically<1mm and<7°. In an in vivo RCT, full-arch guides achieved 0.73±0.47mm (head), 1.47±1.30mm (tip) and 5.55±4.88° vs. skeletonized 1.01±0.55mm, 2.00±1.01mm and 6.44±3.36° (P=0.021; P=0.011). Cadaver data confirmed full-arch superiority: parallelism 5.19°±2.71° vs. 10.41°±7.29° (P=0.03) and vertical deviation -0.17mm vs. +0.65mm (P=0.001). Tooth-borne vs. gingiva-borne guides reduced lateral deviation from 1.65±1.03mm to 0.88±0.46mm (P=0.004) and sagittal angulation from 6.46±5.50° to 3.67±2.25° (P=0.043). CONCLUSION: Palatal TAD placement using insertion guides is highly accurate. The available literature suggests that full-arch guides outperform skeletonized and gingiva-borne guides and are particularly recommended for single-visit protocols and anatomically challenging cases.