Virtual reality (VR) for Anxiety and Pain Management during Periodontal procedures: A Systematic Review and Meta-analysis.

Background: Dental anxiety (DA) is a major barrier to oral healthcare, often causing treatment avoidance and worsening oral health. DA is associated with increased pain perception, and although opioid-based analgesia is commonly used, non-pharmacological strategies such as virtual reality (VR) have emerged as promising adjuncts for reducing anxiety and discomfort during dental and periodontal procedures. Objectives: To evaluate the effectiveness of VR in reducing anxiety and pain during periodontal treatment. Materials and Methods: A systematic literature search across five databases was conducted. Eligible studies were selected using the PICOS framework. Data extraction was performed independently by two reviewers, and risk of bias was assessed using the Cochrane Risk of Bias 2 tool. A meta-analysis was carried out with Review Manager (RevMan) 5.1 to examine the impact of VR on systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and pain measured via Visual Analogue Scale (VAS). The certainty of evidence was evaluated using the GRADE approach. Results: Nine studies met the inclusion criteria. Pooled analysis showed a modest but statistically significant reduction in DBP with VR (SMD -0.51; 95% CI: -0.88 to -0.14; P = 0.006). No significant differences were found for SBP (SMD 0.26; P = 0.16), HR (SMD 0.13; P = 0.49), or VAS pain scores (SMD 0.34; P = 0.12). Conclusion: VR represents a safe, non-invasive adjunct for managing dental anxiety during periodontal therapy, with modest benefits for DBP. Its impact on pain and other physiological outcomes appears limited, warranting furtherrefinement of VR protocols and larger clinical trials.