Temporary anchorage devices (TADs) provide maximum anchorage in orthodontic therapy. Surgical guides can be used to accurately achieve pre-planned TAD positions. The objective of this study was to assess the accuracy of guided TAD insertion in the anterior palate, comparing two 3D printed surgical guide designs. Patients were randomized in two groups. TADs were inserted using either a surgical guide with a skeletonized design or full arch design. The primary outcome was translational and rotational deviations from the virtually planned TAD positions. Secondary outcomes included the dependence of deviations on age and gender and TAD success rate after a follow-up period of three months. In total 40 patients were included in this RCT and 80 TADs were inserted. During the follow-up period, no TAD loss was observed. The skeletonized design showed significantly higher deviations between the planned TAD position and the actual TAD position in all, but two spatial dimensions (translational and rotational) compared to the full arch design. The right TAD showed higher deviations compared to the left TAD for the skeletonized design. The full arch design showed significantly higher accuracy compared to the skeletonized design. During virtual planning of TAD positions, a safety distance should be considered to account for possible deviations using 3D printed surgical guides for TAD insertion in the anterior palate.