AI-Based Immersive Virtual Environment as a Behavioral Conditioning Tool in Pediatric Oral Rehabilitation: A Case Report

Background: Behavioral management remains a major challenge in pediatric dentistry, particularly in patients with early childhood caries and severe dental anxiety. While virtual reality has been explored as a distraction tool, its integration as part of a structured behavioral conditioning protocol supported by artificial intelligence (AI)-based immersive environments remains limited. Case Presentation: A 5-year-old female patient with early childhood caries and negative behavior (Frankl I) presented with multiple carious lesions requiring comprehensive oral rehabilitation, including pulpectomies. The patient exhibited persistent crying, treatment refusal, and a history of negative dental experiences. Intervention: A structured non-pharmacological behavioral management protocol was implemented, including gradual desensitization, tell-show-do, positive reinforcement, and modeling techniques. This approach was complemented by an AI-supported immersive virtual environment developed using FrameVR, enabling experiential reconstruction of the dental process and controlled exposure to anxiety-triggering stimuli. Results: The patient demonstrated a progressive behavioral improvement, transitioning from Frankl I to cooperative behavior. This allowed the successful completion of multiple pulpectomies and restorative procedures without pharmacological intervention. The immersive environment enhanced emotional regulation, reduced anticipatory anxiety, and improved understanding of clinical procedures. Conclusion: The integration of AI-based immersive virtual environments as an adjunct to behavioral conditioning may represent an effective strategy to improve cooperation and reduce anxiety in pediatric dental patients. This approach has the potential to shift behavioral management from passive distraction to active cognitive-emotional conditioning. This approach may represent a clinically applicable strategy to improve cooperation and reduce anxiety in pediatric dental patients