Accuracy of direct insertion of TADs in the anterior palate with respect to a 3D-assisted digital insertion virtual planning

Background Direct and 3D-assisted methods are an available alternative when inserting temporary anchorage devices (TADs) in the anterior palate for orthodontic anchorage. This study aimed to evaluate the differences between a planned insertion versus a direct method on digital models. Settings and sample population Seventy TADs were inserted by the direct insertion method in 35 patients who needed palatal TADs for orthodontic anchorage. For each patient, placement was independently planned by the superimposition of lateral cephalograms and corresponding plaster models. After mini-implant placement, impressions were taken with scanbodies. For the measurement of both linear and angle deviations, virtual planning models and postoperative oral scans were compared using 3D software for automatic surface registration and calculations. Results Comparing TADs positioned by the direct method and the digitally planned method, a mean linear distance was found of 2.54 +/- 1.51 mm in the occlusal view and 2.41 +/- 1.33 mm in the sagittal view. No significant difference has been found between TADs positioned in the right and left palatal sides. A mean distance of 7.65 +/- 2.16 mm was found between the tip of the digitally planned TAD and the central incisors root apex. Conclusions Both direct and 3D-assisted TAD insertion methods are safe and accurate in the anterior palate. However, the use of insertion guides facilitates TAD insertion, allowing less-experienced clinicians to use palatal implants.