Table 3. Characteristics of the selected studies in maxillofacial surgery and oral pain.

S. no	Author, Year, Country	VR system	Participants	Study design	Tool of assessment	Tested outcome	Results
Abbreviations: AR, augmented reality; CT, comparative trial; CST, cross sectional trial; IVR, immersive virtual reality; MCQs, multiple choice questions; RCT, randomized controlled trial; VP, virtual patients.
1	Clark et al 2012, United States 47	Autonomous virtual patient (AVP)	(26) 4th year DS, (10) board experts	CT	Examination of four VP with orofacial pain or oral medicine problem	Examination time, number of diagnostic tests, number of medications	Significant differences in the final total score, the number of diagnostic tests ordered, and the number of medications selected
2	Pulijala et al 2018, India 54	IVR surgery to train Le Fort-1 surgery	(95) Surgical residents	RCT	1. Pre- and post-training self-assessment of perceived confidence 2. Objective cognitive skills assessment	1. Self-confidence 2. Change in knowledge of surgical residents	Study group showed significantly greater perceived self-confidence but insignificant differences in knowledge scores
3	Seifert et al 2019, Germany 48	VP on e-learning platform “Lernbar”	(57) 4th year DS	RCT	Theoretical tests; pre, immediately after T1, and 6-wk T2 Self-assessment questionnaire	MCQs for structured facial examination and placing a venous catheter and Ernst ligature Self-assessment of knowledge and competency	VP group scored better than control group at T1 and no difference at T2. Both interventions led to a significant growth in self-assessed competence
4	Mladenovic et al 2019, Serbia 51	AR simulator on mobiles	(41) 4th and 5th year DS	RCT	Application of local anesthesia Post-clinical knowledge questionnaire	Knowledge and skills. Measurement of heartbeat during anesthesia administration	The experimental group had higher average score, less time of administration, and higher success rate. Both groups had a statistically significant increase in heart rate
5	Mardani et al 2020, Iran 49	Web-based VP in clinical decision-making ability	(76) DS	Quasi experiment	Knowledge pre-, post- (1 wk), and post-training (1 mo) Questionnaire on procedural knowledge	Procedural knowledge Problem-solving ability	Clinical decision-making score of VP group was significant more than the control group in post-test 1 but control group scores rose significantly more in post-test 2
7	Mladenovic et al 2020, Serbia 52	Mobile AR simulator	(11) 4th year DS	CST	Simulated local anesthesia (infiltrations and nerve block) then electronic satisfaction survey	Student satisfaction	All respondents (100%) believe (agree and strongly agree) that the application helped them to better understand the techniques of local anesthesia
6	Sakowitz et al 2020, United States 53	VP of complex orthognathic cases	(30) 3rd year DS	RCT	Knowledge pre- (T0), post- (T1), and follow-up test (T2) Written case analysis of two cases	MCQs score Case analysis score	No significant difference between the groups in MCQs examinations and the written case analysis
8	Collaço et al 2020, Brazil 55	IVR in inferior alveolar nerve block anesthesia	(163) DS	CT	Technical skills Participants’ subjective experience with syringe handling and simulator sickness	Task execution time, insertion accuracy, insertion point coordinates, needle angle, and needle depth	IVRs were significantly more accurate and confident and took less time. No significant differences in needle angle and needle depth. Participants perceived a high sense of realism with the haptic feedback when handling the syringe
9	McAlpin et al 2020, United States 50	Web-based patient simulator (Web-Sim)	(221) DS	RCT	Cognitive, psychomotor, and professional interpersonal skills in local anesthesia and nonsurgical extraction	Student-recorded role-paly video MCQs	Web-Sim group scored significantly higher in the role-play videos but insignificant MCQs scores