Immersive virtual reality for classification of complex maxillofacial fractures: effects on accuracy, usability, and cognitive workload in a randomized educational study

Accurate classification of complex maxillofacial fractures requires advanced spatial understanding. Virtual reality (VR) may improve three-dimensional anatomical perception compared with conventional two-dimensional (2D) imaging; however, its effectiveness for AO Craniomaxillofacial (AOCMF) fracture classification remains unclear. Of 50 eligible dental residents approached for participation, 46 were randomized in a 1:1 ratio to either a VR group ( n = 23) or a conventional 2D imaging group ( n = 23) in this prospective, parallel-group randomized educational study. Each participant evaluated one anonymized complex maxillofacial fracture case and completed an AOCMF classification. The primary outcome was overall classification accuracy compared with an expert reference standard. Secondary outcomes included evaluation time, usability, and satisfaction assessed using a Computer System Usability Questionnaire (CSUQ)-based instrument, and perceived workload assessed using the NASA Task Load Index (NASA-TLX). All 46 randomized participants completed the study and were included in the analysis. Mean AOCMF classification accuracy was significantly higher in the VR group than in the 2D group (61.93 ± 9.56% vs. 52.52 ± 10.88%; mean difference, 9.42 percentage points; 95% CI 3.33–15.50; p = 0.003). Evaluation time did not differ significantly between groups. CSUQ system usefulness, information quality, interface quality, and overall satisfaction scores were comparable between groups. NASA-TLX scores were significantly higher in the VR group, indicating greater perceived workload ( p = 0.003). VR-based assessment improved AOCMF classification accuracy with no statistically significant difference in evaluation time compared with conventional 2D imaging. Although VR was associated with higher perceived workload, usability and satisfaction were similar between methods. VR may serve as a complementary educational tool for training in the assessment and classification of complex maxillofacial fractures.