A Segmentation-Assisted Three-Dimensional Planning Workflow for Static-Guided Pterygoid Implant Placement: A...

Background/Objectives: Pterygoid implant placement represents a valuable alternative to conventional bone grafting procedures in the rehabilitation of the atrophic posterior maxilla; however, the procedure remains technically demanding because of limited visibility, difficult access, complex pterygomaxillary anatomy, and the need for precise angulation and distal bicortical anchorage. Although digital guidance has increasingly been applied in implant dentistry, a clearly described workflow integrating automatic segmentation, selective virtual trimming of the posterior maxillary anatomy, and direct three-dimensional planning for static-guided pterygoid implant placement remains insufficiently detailed in the literature. The aim of this report was to describe and illustrate such a workflow in a proof-of-concept clinical application. Methods: This work was designed as a methodological proof-of-concept with a single clinical illustration. A CBCT dataset was imported into BlueSkyPlan, where automatic segmentation was used to generate three-dimensional models of the maxilla, teeth, and pterygoid process. The segmented volumes were then selectively trimmed to expose the relevant pterygomaxillary anatomy and to support direct three-dimensional planning of the implant axis in the rendered model. A static surgical guide with combined tooth and mucosal support was subsequently designed, positioned on a printed jaw model derived from the intraoral scan, and assessed by CBCT-based internal verification. Results: In this proof-of-concept application, the workflow enabled three-dimensional visualization of the pterygomaxillary trajectory, supported implant axis planning in the rendered model, and facilitated guide design and radiographic verification of the planned trajectory. The verification step provided an internal methodological consistency check between the planned implant axis and the drill-guided direction visible on CBCT. Conclusions: The present report describes a segmentation-assisted three-dimensional planning workflow for static-guided pterygoid implant placement in a single proof-of-concept clinical application. The workflow should be interpreted as a methodological illustration rather than a quantitative validation study. Further investigations are required to evaluate accuracy, inter-operator reproducibility, and broader clinical applicability.