{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T06:06:50Z","timestamp":1778998010575,"version":"3.51.4"},"reference-count":23,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Preoperative anxiety is prevalent in children undergoing supernumerary tooth extraction and can exacerbate physiological stress responses. Nonpharmacological interventions like immersive gaming interventions (IGI) offer potential anxiolytic benefits, but robust evidence in pediatric dentistry is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this prospective RCT, 102 children aged 4\u201312\u2009years scheduled for supernumerary tooth extraction under general anesthesia were randomized to IGI (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200950) or standard care (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200952). The IGI group received a multicomponent framework comprising structured therapeutic play, role\u2010reversal simulation, and environmental modification. Anxiety\u2010related emotional distress and somatic symptoms were assessed using the SCARED scale, heart rate (HR), and heart rate variability (LF\/HF ratio) at baseline (T0), post\u2010intervention (T1), and preoperatively (T2). Treatment compliance (Frankl scale) and parental satisfaction (100\u2010point questionnaire) were secondary outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>IGI demonstrated substantial reduction in emotional distress across all measures, with large interaction effect sizes (partial eta squared range: 0.14\u20130.26). At the preoperative stage (T2), SCARED scores in the IGI group were significantly lower than controls (Mean Difference [MD]: 18.5, 95% CI: 16.3\u201320.7; Cohen's d\u2009=\u20093.42). Heart rate and LF\/HF ratio also showed clinically meaningful improvements in the IGI group compared to controls (HR MD: 17.5\u2009bpm, 95% CI: 13.9\u201321.1; LF\/HF MD: 1.33, 95% CI: 1.03\u20131.63). IGI attenuated anxiety\u2010physiology correlations, including a 65% reduction in the SCARED\u2010LF\/HF slope at T2 (unstandardized beta\u2010intervention\u2009=\u20090.029 vs. beta\u2010control\u2009=\u20090.082). The intervention group exhibited superior active cooperation (Risk Difference [RD]: 70.2%, 95% CI: 57.0%\u201383.4%) and higher \u201cvery satisfied\u201d parental ratings (RD: 78.6%, 95% CI: 66.8%\u201390.4%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>IGI effectively alleviates perioperative emotional distress, decouples psychological\u2013physiological stress responses, and improves cooperation in children undergoing supernumerary tooth extraction. It represents a robust nonpharmacological strategy to enhance the pediatric perioperative experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.clinicaltrials.gov\/\">ClinicalTrials.gov<\/jats:ext-link>\n                      identifier: NCT07149727\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pan.70165","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T10:12:46Z","timestamp":1773051166000},"page":"657-666","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Immersive Gaming Intervention Reduces Preoperative Anxiety and Improves Compliance in Children Undergoing Supernumerary Tooth Extraction: A Randomized Controlled Trial"],"prefix":"10.1002","volume":"36","author":[{"given":"Yihong","family":"Shao","sequence":"first","affiliation":[{"name":"Head and Neck Surgery Jiaxing University Affiliated Hospital\/Jiaxing First Hospital  Jiaxing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Neurology Jiaxing University Affiliated Hospital\/Jiaxing First Hospital  Jiaxing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7454-287X","authenticated-orcid":false,"given":"Liang","family":"Chen","sequence":"additional","affiliation":[{"name":"Head and Neck Surgery Jiaxing University Affiliated Hospital\/Jiaxing First Hospital  Jiaxing China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.4103\/jehp.jehp_455_21"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.4103\/jpbs.JPBS_154_17"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.4103\/jpcdoh.jpcdoh"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1590\/1981\u201086372022002420200208"},{"key":"e_1_2_13_6_1","first-page":"71","article-title":"Non\u2010Syndromic Multiple Supernumerary Teeth: A Case Report","volume":"2","author":"G\u00fcler D.","year":"2019","journal-title":"Case Reports in Dentistry"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.30953\/thmt.v9.533"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13193\u2010022\u201001571\u20101"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.16227"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jspn.12272"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.2196\/25504"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.2196\/12431"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000003947"},{"issue":"4","key":"e_1_2_13_14_1","first-page":"407","article-title":"Analysis of Influencing Factors of Anxiety Disorders in Children and Adolescents Under Home Quarantine During COVID\u201019 Epidemic","volume":"28","author":"Li S.","year":"2020","journal-title":"Chinese Journal of Child Health Care"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2017.00258"},{"issue":"18","key":"e_1_2_13_16_1","first-page":"10","article-title":"Analysis of Influencing Factors of Compliance With Inhaled Corticosteroid Therapy in Children With Bronchial Asthma","volume":"16","author":"Hu S.","year":"2019","journal-title":"Nursing Practice Research"},{"issue":"6","key":"e_1_2_13_17_1","first-page":"432","article-title":"A Screening Device: Children at Risk for Dental Fears and Management Problems","volume":"49","author":"Cuthbert M. 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