Abstract: Objective: To explore the application value of the combined use of different keV virtual monoenergetic images (VMI) and metal artifact reduction (O-MAR) technologies to optimize the image quality of oropharyngeal computed tomography (CT) in patients with oral metal implants. Methods: Phantom study based on the clinical oropharyngeal scanning protocol for spectral CT; the CTP528 module of the Catphan600 phantom was scanned. Images at 66 keV and 80−160 keV (20 keV intervals) were reconstructed with and without the O-MAR, and the modulation transfer function (MTF) was measured. Clinical study: A retrospective analysis was conducted on 55 oropharyngeal CT examinations performed using Philips IQon Spectral CT, including 25 cases with high-density artifacts and 30 cases with low-density artifacts. Conventional images (CI), 66keV, and 80−160 keV (20 keV intervals) VMI were reconstructed with and without the O-MAR. The layer with the most severe artifacts was selected as the artifact layer, and the adjacent layer without artifact interference was selected as the reference layer. The artifact index (AI) of the region of interest (ROI) in the artifact layer, CT value deviation of the ROI between the artifact and reference layers, absolute contrast (AC), and contrast-to-noise ratio (CNR) of the ROI in the reference layer were measured. The images were subjectively evaluated in three dimensions using a three-point Likert scale: artifact removal ability, new artifact formation, and tissue credibility in the artifact removal area. Results: Phantom study: Enabling the O-MAR had no effect on MTF values. The MTF values of the VMI images were approximately 3% lower than those of the CI images. When the O-MAR and VMI (VMIMAR) were used together, the artifact coefficient of high/low-density artifacts and the CT value deviation of high-density artifacts decreased with increasing energy levels. The average values decreased from 125.89/192.47 and 166.04 HU in CI images to 27.61/18.30 and 10.36 HU at 160 keV. The CT value deviation of low-density artifacts was the smallest at 100 keV, with an average of −4.35 HU. When VMI was used alone, the average artifact coefficient of high/low-density artifacts was the lowest at 120/160 keV (65.16/125.31), and the average CT value deviation was the smallest at 160 (12.87/−46.11 HU. The AC/CNR ratio of the images decreased with increasing energy levels. When the O-MAR and VMI were used together, the subjective score reached 3 points in all three dimensions when the energy level reached 120 keV. When VMI was used alone, the highest subjective score was 2 points. Conclusion: The combined use of VMI and O-MAR can effectively reduce the impact of oral metal implant artifacts on the observation of surrounding tissues. Selecting VMIMAR images with a virtual energy level around 120 keV balances the artifact removal effect and image contrast.