IP Indian Journal of Orthodontics and Dentofacial Research 2022;8(3):156–160

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IP Indian Journal of Orthodontics and Dentofacial Research

Journal homepage: https://www.ijodr.com/

Original Research Article

Effectiveness of Virtual Reality (VR) technology towards pain management during
initial fixed orthodontic procedures: A case-control study
Bikash Ranjan Bindhani1 , Pritam Mohanty1 , Ashish Kamboj2, *, Subhas Seth3 ,
Debapreeti Mohanty1 , PV Samir1
1 Kalinga Institute of Dental Sciences,KIIT-DU, Bhubaneswar, Odisha, India
2 Dept. of Orthodontics, Government Dental Centre, Leh (UT of Ladakh), India
3 Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal, India

ARTICLE INFO ABSTRACT

Article history: Aim: The goal of this research is to see how effective virtual reality (VR) is in reducing discomfort during
Received 03-08-2022 early fixed orthodontic operations.
Accepted 12-08-2022 Materials and Methods: The research comprised 70 individuals, all of whom were between the ages of
Available online 27-10-2022 15 to 18 years randomly divided into two groups- research group (n=35) and the control group (n=35).
Patients in the experimental group received a virtual reality headset and watched interesting movies during
orthodontic procedures, while those in the control group received regular care. The VR headgear was placed
Keywords: over the patient’s eyes as the dental procedure began in the study group, whereas the controls group’s eyes
Virtual reality
were kept open as they viewed the clinic and dental procedures going on around them.
Orthodontic pain
Result: After adopting virtual reality movies before and after dental treatments, there was a statistically
Anxiety significant difference in pain levels between the control and study groups. The mean pain ratings during
orthodontic treatment were 8.6 and 6.3 in the control and study groups, respectively. Following orthodontic
treatment, the control and study groups reported mean pain levels of 7.4 and 6.7, respectively.
Conclusion: VR is found to be an effective method in pain alleviation during initial fixed orthodontic
procedures.

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1. Introduction treatment. 1 Tension, pressure, tooth sensitivity, and pain

are all symptoms of orthodontic discomfort, which is
One of the main issues that may deter a patient from
caused by immediate or delayed noxious stimuli of the
getting orthodontic treatment is their fear of chronic
periodontal ligament. 2–4 Pain is a multifaceted idiosyncratic
pain. Orthodontic patients are typically advised that the
sensory perception that gets impacted by a variety of bio-
insertion of separators and first arch-wires, as well as
physiological and psychosocial variables in addition to
frequent orthodontic appliance adjustments, may cause
the underlying condition. 5,6 91% of orthodontic patients
varying degrees of pain and discomfort. It is a significant
experience discomfort, with 39% reporting pain at every
clinical issue that has a detrimental impact on their
phase of treatment. 7
compliance, cooperation, and motivation to continue the
treatment. Despite functional and aesthetic requirements, The most often prescribed medicines for the therapy
people have been observed to deliberately defer orthodontic of orthodontic pain are nonsteroidal anti-inflammatory
* Corresponding author. drugs (NSAIDs) and acetaminophen. Because NSAIDs
E-mail address: aashishkamboj@ymail.com (A. Kamboj). block prostaglandin production, they have been shown

https://doi.org/10.18231/j.ijodr.2022.027
2581-9356/© 2022 Innovative Publication, All rights reserved. 156
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to prevent orthodontic tooth movement. According to the 2.2. Sample size

available evidence, acetaminophen is the drug of choice for
treating pain during orthodontic treatment inhibiting 70 adolescents between the ages of 15 and 18 were assessed
cyclooxygenase-3 in the brain reducing peripheral in an orthodontic department, by an orthodontist for fixed
prostaglandin production. 8–10 To alleviate pain, a variety orthodontic treatment. As a result, the sampling for each
of psychological techniques are also commonly used, group was determined to be 35 individuals (95% confidence
including cognitive-behavioral and hypnotic techniques. interval and 80% strength). The participants were chosen
Distraction is a psychological technique for managing the through convenience sampling. The control and therapeutic
pain and anxiety imposed on by medical procedures. The groups were allocated to patients on a random basis.
effectiveness of this strategy has already been confirmed by
a growing body of studies. Breathing exercises, soothing 2.3. Randomization
music, and watching a favorite show have all become All of the participants were initially numbered from 1 to
popular distraction strategies. 11,12 70. Then using software, 35 random integers were generated
VR has been widely employed in a variety of sectors from 1 to 70. The study group was made up of 35 patients.
in recent years, and it is intended to become a part of The study and control groups were then tallied for age and
people’s daily life. In a virtual reality scenario, there are gender.
three fundamental elements: participation, somatosensory,
and interactivity in all aspects of the virtual world. Virtual 2.4. Methodology
reality shows a set of items in a 360◦ actual world and
During orthodontic treatments, patients in the study group
establishes the connections that govern them. A computer
wore a virtual reality headset and watched interesting
is usually used to create the virtual environment in virtual
movies, while those in the control group received standard
reality. 11 This technology has also made its way into
care. When the dental operation began in the study
the healthcare business. It’s utilized as an interactive
group, the VR headgear was put over the patient’s eyes.
tool, teaching and therapy as a simulation. In healthcare
Because the patients in this group couldn’t view the clinic
system, virtual reality shows various applicability, including
environment throughout the dental operation, they were
screening patients, counseling, and recuperation, as well as
intensely engaged in audiovisual communication with the
facility construction. 13
VR device while experiencing a 360◦ motion picture. The
The current study aims to appraise the effectiveness controlled group’s eyes were kept open as they observed
of virtual reality (VR) on discomfort during initial fixed the clinic and dental procedures going on around them.
orthodontic procedures. The major concern was a comparison of the two group’s
pain levels during and after the orthodontic therapy. Visual
Analog Scale (VAS) was used to record the participant’s
2. Materials and Methods anxiety level. 14

The 2010 CONSORT- consolidated standards of reporting 2.5. Statistical analysis

trials criteria were used to conduct this parallel randomized
controlled trial. There were 70 participants included in the Statistical data were interpreted using the SPSS software
study within the age group of 15-18 years, and they were all (Version 22). At the 0.05 significance level (=0.05),
referred to the Department of Orthodontics and Dentofacial a variety of statistical tests were applied, including
Orthopaedics, KIIT Deemed to be University, Bhubaneswar. Spearman correlation coefficients, Mann-Whitney and
The research group (n=35) and the control group (n=35) Wilcoxon. The Kolmogorov-Smirnov statistical test was
were then assigned to the participants at random. performed to determine the data’s normality. The data
were described as standard deviation and frequency in
percentage. Furthermore, the alpha coefficient (internal
2.1. Eligibility criteria consistency coefficient) was 0.92. With a one-week retest
procedure, its validity varies by 0.75, and the correlation of
The inclusion criteria for the study were patients of 15- its materials ranges from 0.30 to 0.76.
18 years age group, without any visibility or hearing All participants, along with their parents, were informed
impairment and ability to understand and respond to the about the research protocol. The patients gave their
questionnaire. Patients with visual or auditory problems, as informed consent after being convinced that their
well as those who had trouble filling out the questionnaire, participation was completely voluntary. During the
were thus eliminated. Hypersensitivity to the materials, as therapy, participants in the study group were not allowed
well as any fear of using the VR system, were also reasons to remove the VR-headset at any point. However, these
for disqualification. individuals were later removed from the research. The
158 Bindhani et al. / IP Indian Journal of Orthodontics and Dentofacial Research 2022;8(3):156–160

patient in figure 1 gave their informed consent for their intervention (P=0.207) groups.
photograph to be published.
Before starting orthodontic treatment, all patients had
visited twice or thrice for clinical assessment and study of
their diagnostic data. Patients were asked to come to the
clinic once a month for the duration of their orthodontic
procedure, which usually lasts 18 to 24 months. Because
most patients are confronted with new and old procedures,
the initial session of an active phase of treatment in
orthodontics can be regarded as the most painful. Patients
often experience less discomfort after monthly visits since
they are in a known atmosphere and are exposed to well-
known techniques to some extent. The method was well
described to the participants, and steps were taken to ensure
their comfort. The study group wore a virtual reality headset
(IRUSU MONSTER VR headset) (Figure 2), whereas the
control group got standard care.
While the patients were reclining in the dental chair Fig. 1: Patient wearing VR headset during dental procedure
for orthodontic treatment, an engaging VR movie clip was
played over the headset. There was no possibility for user
engagement in the video, which was an amazing 30-minute
360-degree amazing video. During orthodontic treatment,
participants in the study group were all shown the same
VR film, and those in the comparison group were able to
see the orthodontist and the clinical environment. The VAS
score was determined by monitoring the range in between
"no pain" attachment point and the participant’s notation on
a 10-cm line that used a ruler, includes a range of 0–100
mm. The pain is said to be more acute if the score is higher.
Minimal pain (0–4 mm), sharp pain (5–44 mm), intense pain
(45–74 mm), and extreme pain (75–100 mm) are the four
pain VAS ratings. 15

3. Results
According to descriptive data, the mean ages of the patients
in the control and study groups were 15.85±2.20 years
and 15.15±2.17 years, respectively. In the study group,
there were 18.0 (51.4%) male patients and 16.0 (46.0%) Fig. 2: IRUSU MONSTER VR headset used for the research
in the control group (Table-1). The results showed that
there was no statistically significant difference between
the two groups in terms of age and gender (P>0.05). The
4. Discussion
Mann Whitney U test revealed a statistically significant
difference in pain levels between the control and study The present study aimed to determine how patients’ anxiety
groups after using virtual reality videos during and after levels were changed by seeing VR movies during dental
dental procedures. In the control and study groups, the operations. According to the findings, there had been a
mean pain ratings throughout orthodontic treatment were significance difference in pain levels in the intervention
8.6 and 6.3, respectively. The control and study groups had and control groups before and after orthodontic therapy.
mean pain levels of 7.4 and 6.7, respectively, following The intervention group’s pain levels dropped after the
orthodontic treatment. Both the control (P=0.034) and intervention, proving that virtual reality technology (i.e.,
research (P=0.004) groups had statistically significant the use of VR entertainment movies) is beneficial in
differences in pain levels during and after orthodontic reducing patient discomfort during orthodontic operations.
treatment (Table 2). Furthermore, the Mann-Whitney U test The outcome of the present investigation confirm those of
revealed no statistically significant change in gender Ram et al., who discovered that, VR glasses might help
rating following intervention in the control (0.203) and in visual distraction among the youngsters during dental
 Bindhani et al. / IP Indian Journal of Orthodontics and Dentofacial Research 2022;8(3):156–160 159

Table 1: Age and gender comparison of participants in the study and control groups during the orthodontic treatment.
Variable Groups Z- Value P value
Control 15.85±2.20 yrs 0.23
Age
Study 15.15±2.17 yrs
Male 16 (45.8%)
Control
Female 19 (54.2%)
Gender 0.44
Male 18 (51.4%)
Study
Female 17 (48.6%)

Table 2: The comparison of the patient’s pain levels in the study and control groups during and after orthodontic treatment
Group Median VAS score (in cm) Average
Mid-treatment 8.6 86.0% P= 0.034
Control
Post-treatment 7.4 74.0% Z= 0.07
Mid-treatment 6.3 63.0% P= 0.004
Study
Post-treatment 6.7 67.0% Z= 2.89

treatment. 16 Furthermore, Hua et al. shown that using and in pain following VR therapy. 25 In terms of the pain
virtual reality to treat burn patients may lower pain, anxiety, component, the results of this study matched those of
and treatment time. 17 They claimed that employing a virtual Wiederhold et al. Our study has the advantage of focusing
reality system might help youngsters feel less discomfort specifically on the effectiveness of video clips on VR in
and be more calm and obedient. Garrett et al. discovered that reducing pain experience in teens who usually tend to
using virtual reality environment to alleviate and manage worry while dental operations. VR is a novel type of non-
pain in people suffering from chronic diseases can help them pharmaceutical pain relief and diversion. The success of VR
feel better. 18 Aliakbari et al. also looked at the impact of VR approaches in lowering treatment-related pain and anxiety
on psychological symptoms such as melancholy in patients can be ascribed to a number of factors. 17
suffering from cancer, and concluded with a difference Patients who are anxious with dental procedures might
between the experimental and control groups significantly. find that, using distraction VR system is a helpful
In the experimental group, pain in particular, were much alternative. This technology might be used in dental clinics
decreased. 19 to assist minimise anxiety suffering, monotony, and the
This study’s findings are similar to those of earlier amount of time it takes to complete common dental
research. A scoping review by Ahmadpour et al. concluded operations. The present study found that participants who
that, VR can be a viable choice for managing pain and received VR-based amusing video clips had lower anxiety
anxiety in various procedures of medicine. 20 According to levels. This study suggests that VR-based strategies can
a previous research, the type of equipment or virtual reality help children and adolescents cope with the anxiety and
devices used, maturity, anxiousness, and psychosocial suffering associated with dental procedures. As a result, the
outcomes of the patient, and the type of medic care provided use of virtual reality technology in dental care may be more
has an influence on the management of discomfort, tension, convenient for this age group. Because dentistry anxiety
and melancholy brought on by medicine therapy. 17,21 is a multifaceted issue with behavioural, intellectual, and
A research conducted by Al-Khotani et al. looked at emotional elements, pain following treatment might impact
how audiovisual diversion influences child’s behaviour the development of this complication. As a result, all factors
throughout medical attention, which found a statistical should be examined while assessing it. Patients’ positive
differences in average anxiousness and behaviour self-perceptions develop stronger as a result of using this
evaluations between the control and intervention groups technology throughout therapy, making them more robust
(watching Virtual videos) showing lower average scores to discomfort and suffering. Psychologically, it aids patients
of the study group than those of the control group. 22 in developing optimal physiological responses to stress,
Audio-visual and bimodal stimulus congruence can sadness, and anxiety. It’s possible that increasing a patient’s
alter the subjective perception of emotions, according to VR engagement does not make them think about their
Mitrakul et al. 23 Likewise, according to the findings of health, concerns, or suffering more, which might be a crucial
a study conducted by Prabhakar et al., visual distraction element in reducing anxiety in patients.
was more effective than auditory distraction during dental
treatment. 24 5. Conclusion
Wiederhold et al. examined the effect of virtual reality
systems on reducing anxiety and discomfort during dental VR is found to be an effective method in pain alleviation
procedures, and discovered that patients were less anxious during initial fixed orthodontic procedures.
160 Bindhani et al. / IP Indian Journal of Orthodontics and Dentofacial Research 2022;8(3):156–160

6. Source of Funding 16. Ram D, Shapira J, Holan G, Magora F, Cohen S, Davidovich E,

et al. Audiovisual video eyeglass distraction during dental treatment
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Virtual Reality Distraction on Pain Relief During Dressing Changes in
7. Conflict of Interest Children with Chronic Wounds on Lower Limbs. Pain Manag Nurs.
2015;16(5):685–91.
None.
18. Garrett B, Taverner T, Mcdade P. Virtual Reality as an Adjunct Home
Therapy in Chronic Pain Management: An Exploratory Study. JMIR
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