Effects of Virtual Reality Content on Anxiety During Third Molar Surgery

NCT07819123 | Completed

• 1 other identifier: 2025/353
• Study Type: interventional
• Target: 75
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized controlled study evaluated whether the content of an immersive virtual reality environment influenced anxiety in adults undergoing surgical removal of an impacted mandibular third molar. A total of 75 patients aged 18-40 years with elevated dental anxiety were randomly assigned in a 1:1:1 ratio to a nature-based virtual reality group, an art-gallery virtual reality group, or a control group receiving conventional care without virtual reality. Participants in the two virtual reality groups wore the same headset and headphones and viewed standardized 360-degree content from the beginning of surgery until completion of the procedure. Anxiety was assessed using the Modified Dental Anxiety Scale, the State-Trait Anxiety Inventory-State subscale, and an 11-point numerical anxiety rating scale. Systolic and diastolic blood pressure, heart rate, and peripheral oxygen saturation were also recorded. Measurements were obtained before local anesthesia, after local anesthesia but before surgery and virtual reality exposure, and immediately after wound closure, as applicable. The study compared changes in anxiety and physiological measures among the three groups and examined whether nature-based and art-gallery virtual reality content produced different responses.

Conditions

Dental Anxiety; Impacted Mandibular Third Molar

Keywords

Virtual Reality; Immersive Virtual Environment; Third Molar Surgery; Oral Surgery; Nature-Based Virtual Reality; Art-Gallery Virtual Reality; Nonpharmacological Anxiety Management

Outcome Measures

Primary Outcomes (2)

• Change in Modified Dental Anxiety Scale Score

  Dental anxiety was assessed using the five-item Modified Dental Anxiety Scale (MDAS). Each item is scored from 1 to 5, producing a total score ranging from 5 to 25, with higher scores indicating greater dental anxiety. The outcome was the change in total MDAS score from T0 to T2, calculated as the T2 score minus the T0 score.

  From before local anesthesia (T0) to immediately after wound closure and completion of the procedure (T2), during a single surgical visit

• Change in State-Trait Anxiety Inventory-State Subscale Score

  State anxiety was assessed using the 20-item State-Trait Anxiety Inventory-State subscale (STAI-S). Each item is scored from 1 to 4, producing a total score ranging from 20 to 80, with higher scores indicating greater state anxiety. The outcome was the change in total STAI-S score from T0 to T2, calculated as the T2 score minus the T0 score.

  From before local anesthesia (T0) to immediately after wound closure and completion of the procedure (T2), during a single surgical visit

Secondary Outcomes (5)

• Change in Anxiety Visual Analog Scale Score

  At three time points during a single surgical visit: before local anesthesia (T0), after local anesthesia but before surgery and virtual reality exposure (T1), and immediately after wound closure and completion of the procedure (T2)

• Change in Systolic Blood Pressure

  At three time points during a single surgical visit: before local anesthesia (T0), after local anesthesia but before surgery and virtual reality exposure (T1), and immediately after wound closure and completion of the procedure (T2)

• Change in Diastolic Blood Pressure

  At three time points during a single surgical visit: before local anesthesia (T0), after local anesthesia but before surgery and virtual reality exposure (T1), and immediately after wound closure and completion of the procedure (T2)

• Change in Heart Rate

  At three time points during a single surgical visit: before local anesthesia (T0), after local anesthesia but before surgery and virtual reality exposure (T1), and immediately after wound closure and completion of the procedure (T2)

• Change in Peripheral Oxygen Saturation

  At three time points during a single surgical visit: before local anesthesia (T0), after local anesthesia but before surgery and virtual reality exposure (T1), and immediately after wound closure and completion of the procedure (T2)

Study Arms (3)

Nature-Based Virtual Reality

EXPERIMENTAL

Participants viewed standardized investigator-developed nature-based 360-degree immersive content using a virtual reality headset and headphones from the beginning of surgery until completion of the procedure. Exposure duration was determined by surgical duration and did not exceed 30 minutes.

Behavioral: Nature-Based Virtual Reality

Art-Gallery Virtual Reality

EXPERIMENTAL

Participants viewed standardized investigator-developed art-gallery 360-degree immersive content using the same virtual reality headset, headphones, audiovisual settings, and exposure period as the nature-based virtual reality group. Exposure continued from the beginning of surgery until completion of the procedure and did not exceed 30 minutes.

Behavioral: Art-Gallery Virtual Reality

Conventional Care Without Virtual Reality

NO INTERVENTION

Participants underwent the same standardized surgical procedure and received conventional clinical care without a virtual reality headset or an alternative audiovisual intervention.

Interventions

Nature-Based Virtual Reality BEHAVIORAL

Participants viewed standardized investigator-developed nature-based 360-degree immersive content using a virtual reality headset and headphones. The intervention began at the start of surgery and continued until completion of the procedure. Exposure duration was determined by surgical duration and did not exceed 30 minutes.

Nature-Based Virtual Reality

Art-Gallery Virtual Reality BEHAVIORAL

Participants viewed standardized investigator-developed art-gallery 360-degree immersive content using the same virtual reality headset, headphones, audiovisual settings, and exposure period as the nature-based virtual reality group. The intervention began at the start of surgery and continued until completion of the procedure. Exposure duration was determined by surgical duration and did not exceed 30 minutes.

Art-Gallery Virtual Reality

Eligibility Criteria

• Age: 18 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Age between 18 and 40 years
• American Society of Anesthesiologists (ASA) physical status I
• Presence of an impacted mandibular third molar for which surgical removal was indicated
• Pell and Gregory Class II, position B impaction
• Vertical or mesioangular impaction according to Winter's classification
• Preoperative Modified Dental Anxiety Scale (MDAS) score of 11 or higher
• Ability to understand the study procedures and complete the questionnaires
• Provision of written informed consent

You may not qualify if:

• A systemic or psychiatric condition considered likely to influence anxiety responses
• Regular use of medication that could alter anxiety or autonomic responses
• Use of antipsychotic or anxiolytic medication
• Smoking 10 or more cigarettes per day
• Previous surgical removal of an impacted tooth
• Acute infection in the operative region
• Pregnancy
• Severe visual or hearing impairment that could prevent adequate virtual reality exposure
• Inability to tolerate or correctly use the virtual reality headset
• Surgical duration exceeding 30 minutes
• Withdrawal of consent at any stage of the study

Sponsors & Collaborators

• Recep Tayyip Erdogan University: lead

Study Sites (1)

Recep Tayyip Erdogan University Faculty of Dentistry

Rize, Rize Province, 53020, Turkey (Türkiye)

Location

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Model Details: Participants were randomly assigned in a 1:1:1 ratio to nature-based virtual reality, art-gallery virtual reality, or conventional care without virtual reality.

Study Record Dates

• First Submitted: September 8, 2026
• First Posted: September 14, 2026
• Study Start: October 1, 2025
• Primary Completion: June 30, 2026
• Study Completion: June 30, 2026
• Last Updated: September 16, 2026

Record last verified: 2026-09

Data Sharing

• IPD Sharing: Will share
• Time Frame: Data will be available beginning after publication of the main study results and will remain available for five years following publication.
• Access Criteria: Requests should be submitted to the corresponding author at ismailburak.halat@erdogan.edu.tr and should include a scientifically sound research proposal. Requests will be evaluated for compatibility with participant consent, ethics approval, and applicable data-protection requirements. Data will be shared with qualified researchers for approved scientific purposes, and a data-use agreement may be required.

Locations

TU (1)