Accuracy of palatal orthodontic miniscrew placement: Static vs dynamic computer-guided techniques in a randomized clinical trial

Objectives: This randomized clinical trial compared the accuracy of palatal paramedian miniscrew placement using static computer-assisted surgery (s-CAS) and dynamic computer-assisted surgery (d-CAS). Materials and methods: Forty subjects (11–17 years) requiring palatal paramedian miniscrew insertion were randomized into two groups to receive two miniscrews placed with s-CAS (Group A; n = 20 subjects, 40 miniscrews) and d-CAS (Group B; n = 20 subjects, 40 miniscrews). Preoperative digital intraoral scans and CBCT images were used for virtual planning. Group A procedures employed patient-specific surgical guides, while group B procedures were performed with real-time navigation. Immediate postoperative CBCT scans were superimposed to measure four accuracy parameters: coronal, apical, depth, and angular deviation from the planned position. Statistical analysis included the mixed-effect model analysis. Results: Eighty miniscrews were analyzed. Mean coronal (p < 0.001), apical (p < 0.001) and angular deviations (p = 0.001) were significantly lower in the s-CAS group compared to the d-CAS group. No significant difference was observed for depth deviation (p = 0.065). The s-CAS technique also exhibited smaller standard deviations and lower maximum deviations across all parameters. Conclusions: Static computer-assisted surgery achieved greater linear and angular accuracy than dynamic navigation for palatal miniscrew insertion, while vertical control was comparable between the two approaches. Clinical relevance: In the present study, static computer-assisted surgery offered superior consistency and accuracy in palatal miniscrew placement, supporting its use in anatomical areas where spatial accuracy is critical to avoid adjacent anatomical structures. Dynamic navigation remains a viable alternative when flexibility, visibility, or same-day digital workflows are prioritized. Clinical trial registration: The trial was registered in clinicaltrials.gov; reference number. NCT07378618.