Insertion guide for palatal TADs: Advantages and disadvantages from the clinical point of view

In recent years, there has been a growing trend in orthodontics to use the anterior palatal vault as an insertion site for temporary anchorage devices (TADs), to expand orthodontic possibilities and limit the collateral and unwanted dental effects. To improve accessibility and facilitate the procedure for clinicians, a guided approach for TAD insertion in the palatal vault, using insertion guides, has become increasingly prevalent. The manuscript primarily focuses on the real advantages and possible disadvantages that clinicians can expect when using insertion guides during TAD insertion into the palatal vault. Safety, precise evaluation of insertion depth, and the potential to execute a "one-visit protocol" are examined. Indeed, both direct and indirect palatal insertion protocols result to be efficient and safe in daily practice. The use of insertion guides result to be particularly beneficial for less experienced clinicians as well as for more complex patients and impacted teeth cases. Insertion guides can be created overlapping intraoral scanning to cbct or also to lateral teleradiograph, with sufficient accuracy and lower radiation exposure. However this method is limited in achieving bicortical evaluation, as well as relations to incisive canal and nasal floor. Finally a case report is presented, describing a full digital orthodontic treatment of a young adult patient presenting narrow maxilla. Slow maxillary expansion and fixed orthodontic treatment are described.