Guided insertion of temporary anchorage device in form of orthodontic titanium miniscrews with customized 3D templates—A systematic review with meta-analysis of clinical studies

Abstract: (1) Background: Miniscrew insertion, using a surgical guide, aims to avoid possible adverse effects or complications. With the higher availability of both 3D imaging and printing, 3D surgical guides have been used more frequently in orthodontics. The aim of the present systematic review was to find scientific clinical evidence concerning the precision of the 3D guided insertion of miniscrews for temporary orthodontic anchorage. (2) Methods: Literature searches were performed in the following five search engines: Pubmed (Medline), Pubmed Central, Scopus, Web of Science and Embase on 10 September 2021 (articles from 1950 to 10 September 2021). A meta-analysis was performed using the random-effect model, with Standardized Mean Differences (SMD) and 95% confidence intervals (95% CI) calculated as effect estimates. The heterogeneity was assessed quantitatively. (3) Results: The search strategy identified 671 potential articles. After the removal of duplicates, 530 articles were analyzed. Subsequently, 487 papers were excluded, because they were not associated with the subject of the study. Of the remaining 43 papers, 34 were excluded because they did not meet the methodological criteria. Finally, only nine papers were subjected to a qualitative analysis. (4) Conclusions: The current literature concerning guided miniscrew insertion reveals, for the most part, a low methodological level. High-quality clinical trials are in the minority. The use of surgical guides increases insertion accuracy, stability and reduces the failure rate of orthodontic miniscrews. Tooth-borne insertion guides supported on the edges of the teeth ensure a higher insertion precision compared to mucosa-borne ones. The study protocol was registered in PROSPERO under the number CRD42021267248.