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

• Guided insertion of palatal TADs is highly accurate overall, with mean deviations typically < 1 mm and < 7° across clinical, cadaveric, and in vitro studies. • Full-arch guides demonstrate superior transfer accuracy compared to skeletonized and gingiva-borne designs, particularly regarding angular error, lateral deviation, and vertical control. • Full-arch designs are especially advantageous for single-visit workflows and anatomically demanding cases, where minimal deviation is critical for appliance fit and safe distance to anatomical structures. • Skeletonized guides still achieve clinically acceptable accuracy but show larger deviations, particularly at the screw tip and in depth. 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. 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. Overall, guided insertion showed small deviations, typically < 1 mm and < 7°. In an in vivo RCT, full-arch guides achieved 0.73 ± 0.47 mm (head), 1.47 ± 1.30 mm (tip) and 5.55 ± 4.88° vs. skeletonized 1.01 ± 0.55 mm, 2.00 ± 1.01 mm 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 −0.17 mm vs. +0.65 mm ( P = 0.001). Tooth-borne vs. gingiva-borne guides reduced lateral deviation from 1.65 ± 1.03 mm to 0.88 ± 0.46 mm ( P = 0.004) and sagittal angulation from 6.46 ± 5.50° to 3.67 ± 2.25° ( P = 0.043). 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.