The treatment procedure and the exact steps were explained to the child verbally, after which all the tools and equipment required for the treatment were shown to the child before the extraction was performed.

The planned tooth extraction had been explained to the children using the Tell-Show-Do (TSD) technique, and each child had been asked to select a preferred song. During the procedure, the selected songs were played on a screen mounted in the dental unit. The duration of the therapy had been standardized to 10 minutes in order to relax the children's physiological and psychological state.

For the TSD and therapeutic play therapy groups, a play therapy-certified researcher demonstrated the procedure on a model using a plush Pink Panther toy (Youya Dental Supply Store, China) and a toy dentist set (Heroes Toys, Turkey). Children were allotted 10 minutes to roleplay the procedure, interact with the toys to facilitate emotional expression related to the procedure, and ask any questions.

Standard behavioral management technique where the dental procedure is explained to the child, demonstrated, and then performed.

The primary outcomes of this study were assessed through physiological measurements (blood pressure).

Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded at multiple time points during the procedure: before the procedure, after the administration of local anesthesia, after pulpotomy, and at the end of the procedure.

Each patient had rested for 15 minutes prior to the blood pressure measurement. Measurements were taken from the right wrist with the child in an upright position using an automatic wrist blood pressure device (Wohler, Türkiye).

Systolic (SBP) and diastolic blood pressure (DBP) values, expressed in centimeters of mercury (cmHg), were recorded.

The primary outcomes of this study were assessed through physiological measurements (heart rate).

Heart rate (HR) was measured while the child was in a seated position using a finger-type portable pulse oximeter (Oncomed, USA) attached to the child's right finger. HR values displayed on the digital monitor were recorded as beats per minute.

The primary outcomes of this study were assessed through physiological measurements (hemoglobin oxygen saturation).

Hemoglobin oxygen saturation (SpO₂) was measured while the child was in a seated position using a finger-type portable pulse oximeter (Oncomed, USA) attached to the child's right finger. SpO₂ values displayed on the digital monitor were recorded as a percentage.

The primary outcomes of this study were assessed through psychometric measurements (The Faces Version of the Modified Child Dental Anxiety Scale).

The Faces Version of the Modified Child Dental Anxiety Scale (MCDASf) was used to measure the level of anxiety experienced by the children throughout the procedure.

This scale included five possible responses consisting of smiling or sad faces, appropriate for each answer given by the child. A happy face corresponded to 1 point, whereas a very sad face corresponded to 5 points.

After the dental treatment, the children in all three groups were asked the questions. The scores corresponding to the selected facial expressions were chosen by the children and recorded by the pediatric dentist.

The total score was calculated with a minimum of 8 and a maximum of 40, with higher scores indicating greater levels of anxiety.