###### Abstract  
At present, temporary anchorage devices (TADs) are continuously gaining importance because of their usability and their possibility to broaden clinical force applications; however, how difficult can their placement planning be? Aim: The aim is to evaluate the association between clinical experience, digital knowledge and the capability of virtual planning in palatal orthodontic miniscrew insertion in various types of clinicians, divided by different levels of experience. Methods: A total of 30 participants (10 dental students, 10 orthodontics students and 10 orthodontists) with different levels of clinical and digital experience were randomly recruited in this cross-sectional study. All participants performed a pre-test survey followed by two consecutive digital planning tests and, finally a post-test survey. The digital planning test was made using software BlueSkyBio-BlueSkyPlan, a surgical guide module. The differences in terms of planning execution time, miniscrew insertion and surgical guide realization were evaluated. The Kruskal-Wallis and Mann-Whitney U-tests were performed to determine the effects of independent variables and interactions between groups. Results: The relation between clinical experience and bicorticalism was statistically significant (\(p=0.017\)); in the planning execution time, a significant difference was evident between the dental students and the orthodontics students (T1: \(p=0.015\) and T2: \(p=0.019\)), who, having good digital knowledge, took an average of 4.58 min less in T1 (\(p=0.025\)), while this difference was significantly reduced in T2 (\(p=0.106\)). Conclusion: Clinical experience increased miniscrew placement accuracy and digital knowledge reduced execution planning time but both had a stronger impact in the first test than in the second.  
orthodontics; software; bone screw; maxilla; palate +
Footnote †: journal:  
Skeletal anchorage in the anterior palate is optimal for supporting various treatment mechanics, including distalization [8], rapid maxillary expansion [9], space closure [10], intrusion mechanics [11], canine disimpaction [12; 13; 14] and final incisor position relative to the facial profile esthetics [15; 16]. Furthermore, orthodontists can address more complex clinical situations, such as severe open bite [17], impacted teeth [18] or mixed dentition [19].  
TADs' placement can be accomplished with or without previous digital planning. Both direct and three-dimensional (3D)-assisted TAD insertion methods are safe and accurate in the anterior palate [4].  
The need to increase the predictability in miniscrew insertion brought about the development of techniques that allow the clinician to deepen their case study in order to achieve better results. The introduction of computer-aided design and computer-aided manufacturing (CAD-CAM) software made digital planning available, allowing clinicians to design miniscrew insertion and potential customized devices to handle different issues [20; 21].  
The precision acquired with digital planning has to be then transferred to the oral cavity itself and this can be achieved with a custom-made 3D-printed surgical guide [22]; the use of insertion guides may facilitate TAD insertion, providing the opportunity to use palatal MSI for less-experienced clinicians [4; 23; 24; 25].  
The digital planning of an MSI insertion has to be accomplished by the clinician them-self and may be thus considered operator-dependent. The aim of this study is to evaluate the association between clinical experience and digital knowledge, and the capabilities of virtual planning in palatal orthodontic miniscrew insertion.