Accuracy of Pterygoid Implant Placement With Augmented and Mixed Reality Navigation: An In Vitro Study

OBJECTIVES: To evaluate the accuracy of augmented reality (AR) and mixed reality (MR)-assisted technologies for pterygoid implant trajectory guidance under anatomically challenging posterior maxillary conditions in the in vitro experimental model. MATERIALS AND METHODS: Cone beam computed tomography datasets from eight patients were used to reconstruct three-dimensional (3D) models of the pterygoid-maxillary complex. Virtual implant placement was performed in planning software, and the corresponding standard tessellation language (STL) files were exported as the preoperative reference. For each patient, four resin models were fabricated and randomly assigned within the patient to the four implant placement techniques (free hand [FH]; static guide [SG]; AR; MR), resulting in 32 models in total. A surgeon placed 36 implants in all models according to group designs. Following implant placement, each model was digitized, and STL datasets were generated. These were superimposed with the preoperative reference STL in 3D analysis software, allowing calculation of angular and linear deviation. One-way repeated measures ANOVA was applied to compare deviations among groups, with significance set at p < 0.05. RESULTS: The SG group demonstrated the highest accuracy (coronal deviation 0.86 ± 0.73 mm; apical deviation 1.26 ± 0.60 mm; angular deviation 3.77° ± 1.84°). In contrast, the FH, AR, and MR groups exhibited greater deviations in all parameters, with the MR group showing the largest errors-particularly in apical deviation (3.81 ± 1.47 mm) and angular deviation (12.37 ± 5.05). CONCLUSIONS: Within the limitations of the in vitro model, the AR and MR-assisted technologies tested in this study demonstrated limited accuracy for pterygoid implant placement.