Augmented and Virtual Reality in Dental Medicine Updated: A Systematic Review and Meta-Analysis

Abstract

Aim: This updated systematic review aimed to synthesize and evaluate the available evidence on the use of augmented reality (AR), mixed reality (MR), and virtual reality (VR) technologies in dental medicine and education. Both qualitative synthesis and quantitative analysis through pairwise meta-analysis, where applicable, were performed to assess their effectiveness and potential applications in clinical and educational settings. Methods: A systematic electronic search was conducted, incorporating an updated search strategy from the original publication to reflect updated terminology, for articles published between January 1, 2019, and July 14, 2025. Articles reporting the use of AR, MR, or VR in clinical treatment or dental education were eligible for inclusion. Data on study characteristics, target population, dental discipline, application concept, type of reality, primary and secondary outcomes were extracted. Pairwise frequentist meta-analysis was conducted on randomized controlled trials (RCTs) assessing VR and objective stress-related clinical parameters such as heart rate. Study quality was appraised using the corresponding scale according to the study design. Results: A total of 110 studies, reporting the use of AR, MR or VR, encompassing 8573 participants, were included. VR was the most frequently investigated technology (n = 94), followed by AR (n = 11) and MR (n = 2). Most studies evaluated multiple applications: clinical or patient-centered applications were evaluated in 71 trials, operator- or clinician-orientated applications in 33, and educational applications in 132 studies. Among primary outcomes, patient-reported (n = 30) and educational outcomes (n = 57) predominated, whereas clinical, clinician-, and operator-related outcomes were less frequently assessed. Results from the pairwise meta-analyses of RCTs showed that VR significantly reduced anxiety levels in children patients when compared to tell-show-do techniques (SMD = −1.32, 95% CI −1.93 to −0.72); meanwhile, there was a borderline significant reduction in heart rate levels of children patients under the VR technique compared to tell-show-do technique (MD = −3.26, 95% CI −6.51 to −0.00). On the other hand, no significant differences were found in terms of physiological and reported outcomes in adult patients. Conclusion: AR, MR and VR are increasingly used in dental medicine and education, mainly in undergraduate and postgraduate training. Current evidence supports the effectiveness of immersive technologies, particularly VR, in enhancing learning outcomes for students and improving patient experience, especially in anxiety and pain management. However, conclusions are limited by heterogeneity and a small number of high-quality studies, with overall low to moderate certainty of evidence. Trial Registration: PROSPERO number: CDR42023403360 and date of registration 10/03/2023. Start date of systematic review 13/03/2023.