Virtual reality (VR)–based simulation has emerged as a technology-driven approach to improve procedural training in dentistry and oral healthcare. By enabling repeated, risk-free practice with objective feedback, VR simulation may enhance psychomotor control, procedural accuracy, and clinical readiness. However, the extent to which VR training translates into measurable performance advantages over conventional training remains uncertain. This systematic review aimed to evaluate the clinical impact of VR-based simulation on procedural skill acquisition in dental training, based exclusively on randomized controlled trials (RCTs).

Following PRISMA 2020 guidelines (PROSPERO ID: CRD420251161065), a comprehensive search was conducted in PubMed, ScienceDirect, and the Cochrane Library (January 2000–September 2025). Eligible studies included RCTs comparing VR-based interventions with traditional teaching among dental students. Data were extracted on participants, intervention type, outcomes, and study quality. The Cochrane Risk of Bias 2.0 tool was used to assess methodological quality.

The included RCTs encompassed approximately 2100 dental students across 19 countries. Domains included operative dentistry ( n = 13), endodontics ( n = 5), implantology/oral surgery ( n = 4), prosthodontics ( n = 2), orthodontics ( n = 2), pediatric dentistry ( n = 2), radiology ( n = 2), multidisciplinary skills ( n = 2), and single studies in periodontology, local anesthesia, and dental materials. Overall, 26 of 35 RCTs (74.3%) demonstrated statistically significant improvement in at least one prespecified educational or performance outcome compared with conventional instruction. Benefits were most consistently observed in early-stage psychomotor development, spatial understanding, and learner engagement. However, conventional simulation occasionally demonstrates superior performance in complex or transfer-based procedural tasks. Most studies presented some concerns regarding allocation concealment or reporting transparency, although objective outcome measurement reduced major bias risk.

VR-based simulation represents effective adjunctive tools in dental education, particularly within blended training models. While evidence supports their role in early skill acquisition and spatial training, they should complement rather than fully replace conventional simulation for advanced procedural competency.