Objective: To investigate the clinical efficacy of cone-beam computed tomography (CBCT) three-dimensional reconstruction and digital guide-assisted extraction of palatally impacted teeth. Methods:STo investigate the application of Cone Beam Computed Tomography (CBCT) three-dimensional reconstruction technology and digital guides in assisting the extraction of palatally impacted teeth, providing technical support for the precise treatment of complex palatally impacted and embedded teeth.Methods:SFifty patients with palatally impacted teeth treated in the Department of Stomatology of our hospital from February 2023 to August 2025 were selected and randomly divided into a study group and a control group, with 25 patients in each group. Local or general anesthesia was administered based on the specific conditions of the patients. The study group underwent CBCT scanning to obtain imaging data. After three-dimensional reconstruction, the spatial relationship between the palatally impacted tooth and important anatomical structures was precisely located. A personalized surgical plan with a palatal approach was designed, and specialized digital positioning guides and tooth segmentation guides for palatal surgery were fabricated using 3D printing technology. During surgery, these guides were used to assist in palatal flap reflection, precise bone removal, and tooth segmentation. The control group underwent traditional palatal approach surgery. The operative time, degree of palatal soft tissue injury, postoperative pain level, palatal wound healing time, and incidence of complications were compared between the two groups.Results:SThe operative time in the study group was significantly shorter than that in the control group, and intraoperative blood loss was significantly reduced. The study group showed significantly better outcomes than the control group in terms of the degree of palatal soft tissue injury and postoperative pain scores. No perioperative complications occurred in either group.Conclusion:SDigital guide-assisted technology based on CBCT three-dimensional reconstruction for the extraction of palatally impacted teeth may significantly improve surgical precision and minimally invasive outcomes, reduce palatal soft tissue injury, shorten operative time and wound healing time, and decrease postoperative pain levels, providing a reference for the treatment of palatally impacted teeth.