A randomized clinical trial was conducted with 98 participants with borderline intellectual functioning (BIF) and moderate dental anxiety (DAS: 9-12). Participants were assigned in a 1:1 ratio to either the Virtual reality (VR) or sensory adapted dentist environment (SADE) group (49 per group). The primary outcome was treatment success, defined as completing a dental restoration under local anesthesia within 30 minutes.

Inclusion Criteria:

• age of participants between 10 and 13 years
• Diagnosis of Borderline Intellectual Func-tioning (BIF) confirmed by experienced neuropsychiatrists according to DSM-5 criteria
• Moderate dental anxiety, defined by a DAS score between 9 and 12
• Presence of at least one tooth with a Class I carious lesion requiring restorative treatment

Exclusion Criteria:

• absence of dental anxiety (DAS score = 4)
• the presence of mild anxiety (DAS score = 5-8)
• high or severe anxiety (DAS score ≥ 13)