Positional Accuracy and Safety of Digitally Guided Orthodontic Mini-Implant Placement: A Systematic Review and Exploratory Meta-Analysis

Abstract

This systematic review evaluated the positional accuracy, safety, and clinical performance of digitally guided orthodontic mini-implant placement. English full-text studies published from 2015 to July 2026 evaluating digitally guided TAD placement and reporting accuracy, safety, or procedural outcomes were eligible; reviews, editorials, abstracts, non-TAD studies, and reports with insufficient relevant data were excluded. PubMed/MEDLINE, Scopus, ScienceDirect, and the Cochrane Library were searched to 30 July 2026; ScienceDirect was re-searched 7 September, ClinicalTrials.gov 9 September, and Web of Science, DOSS, CENTRAL, and WHO ICTRP 10 September 2026. Risk of bias was assessed with RoB 2 and design-specific JBI checklists. Random-effects meta-analyses used REML with Hartung–Knapp 95% CIs. Fifty-three independent studies (56 reports; 41 clinical, 11 preclinical, one computational) were included; a single participant total was not aggregable because analytical units varied. Pooled deviations were 0.97 mm coronally (95% CI 0.56–1.38; 10 datasets, 162 participants), 1.35 mm apically (0.88–1.81; 9 datasets, 151 participants), and 4.72° angularly (2.15–7.28; 7 datasets, 122 participants), with I2 = 94.2–95.0%. Risk-of-bias concerns, high heterogeneity, predominantly palatal evidence, and sparse safety data limited interpretation; clinically meaningful safety or survival benefits remain uncertain. Funded by CESPU (MLIA_REAB-GI2-CESPU-2025); PROSPERO CRD420251164975.