Effect of intracanal cryotherapy on postendodontic pain: a systematic review and meta-analysis of randomized controlled trials

Gupta, Alpa; Aggarwal, Vivek; Gurawa, Alka; Mehta, Namrata; Abraham, Dax; Singh, Arundeep; Jala, Sucheta; Chauhan, Nishant Kumar

doi:10.17245/jdapm.2021.21.1.15

Cited by 10 publications

(8 citation statements)

References 32 publications

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“…After seven days, there was a reduction in the postoperative pain scores in the intracanal cryotherapy group (experimental group) compared with the room temperature group (control group) but this reduction could not be proven statistically due to inestimable MD and CI values. Our results were in contrast with those reported by Gupta et al in their systematic review and meta-analysis where they showed that intracanal cryotherapy did not play a significant role in minimizing postendodontic pain [62]. Pain reduction after cryotherapy application is due to several mechanisms including changes in the nerve conduction velocity, inhibition of nociceptors, and a reduction in the metabolic enzyme activity level [67][68][69].…”

Section: Discussioncontrasting

confidence: 99%

Is Intracanal Cryotherapy Effective in Reducing Postoperative Endodontic Pain? An Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials

Almohaimede

Al‐Madi

2021

IJERPH

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This research aimed to assess the potency of intracanal cold therapy in diminishing postoperative endodontic pain. PubMed, Scopus, the Cochrane Library, EMBASE, the Web of Science, grey literature, and endodontic journals were used to identify randomized controlled clinical trials evaluating postoperative pain after a final irrigation with a cold irrigant (as an experimental group) and a room temperature irrigant (as a control group). The risk of bias was rated according to the Cochrane Collaboration’s tool and the Grading Recommendation Assessment, Development, and Evaluation (GRADE) system was used to estimate the evidence quality. For the meta-analysis, a random effects model was utilized. The qualitative analysis contained 16 studies and the quantitative analysis contained 9 studies. The experimental groups showed a reduction in postoperative pain at 6 h (mean difference (MD) = −1.11; p = 0.0004; I2 = 72%; low quality evidence), 24 h (MD = −1.08; p = 0.003; I2 = 92%; low quality evidence), 48 h (MD = −0.38; p = 0.04; I2 = 81%; low quality evidence), and 72 h (MD = −0.69; p = 0.04; I2 = 90%; low quality evidence). A higher quality of evidence from more clinical trials is needed.

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Section: Discussioncontrasting

confidence: 99%

Is Intracanal Cryotherapy Effective in Reducing Postoperative Endodontic Pain? An Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials

Almohaimede

Al‐Madi

2021

IJERPH

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“…Few studies evaluated the effect of cryotherapy on limited biomarkers with different clinical trials, and several studies showed that the cryotherapy decreased post‐operative endodontic pain in different clinical scenarios (Emad et al, 2021; Mourad et al, 2021). However, the recent systematic reviews and meta‐analyses have emphasized the requirement of standardized randomized clinical trials adhering to more clear and strict criteria, randomisation and blinding to clearly define the efficacy of cryotherapy in the management of post‐operative pain (Almohaimede & Al‐Madi, 2021; Gupta et al, 2021; Monteiro et al, 2021). In this randomized controlled trial, intracanal cryotherapy significantly decreased interappointment pain scores and caused different concentration of tested biomarkers.…”

Section: Discussionmentioning

confidence: 99%

“…However, recent systematic reviews and meta‐analyses emphasized further randomized controlled clinical investigations are required to evaluate the efficacy of the technique (Almohaimede & Al‐Madi, 2021; Gupta et al, 2021; Monteiro et al, 2021). This randomized controlled study aimed to investigate the effect of intracanal cryotherapy on the IL‐1β, IL‐2, IL‐6, IL‐8, PGE 2 , TNF‐α and MMP‐8 levels in the periapical exudate of mandibular pre‐molar teeth with asymptomatic apical periodontitis, to compare cryotherapy and control groups in terms of interappointment and post‐operative pain level and analgesic intake, and investigate a possible the correlation between biomarker levels and interappointment endodontic pain.…”

Section: Introductionmentioning

confidence: 99%

Effect of intracanal cryotherapy on the inflammatory cytokine, proteolytic enzyme levels and post‐operative pain in teeth with asymptomatic apical periodontitis: A randomized clinical trial

Keskin,

Aksoy,

Kalyoncuoğlu

et al. 2023

Int Endodontic J

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Aim To investigate the changes in the biomarker levels related to inflammation and tissue destruction in the periapical exudate of mandibular pre‐molar teeth with asymptomatic apical periodontitis after receiving intracanal cryotherapy, to compare cryotherapy and control groups in terms of analgesic intake, interappointment, and post‐operative pain and evaluate the correlation between biomarker levels and interappointment pain. Methodology Mandibular pre‐molar teeth of 44 patients aged 18–35 years, diagnosed with asymptomatic apical periodontitis, were root canal treated in two visits (registered as NCT04798144). Baseline periapical exudate samples were obtained, and the patients were assigned to either control or intracanal cryotherapy group according to the final irrigation with distilled water either at room temperature or 2.5°C. The canals were dressed with calcium hydroxide. In the second visit, the calcium hydroxide was removed with passive ultrasonic irrigation, and the periapical exudate was sampled again. IL‐1β, IL‐2, IL‐6, IL‐8, TNF‐α, PGE2 and MMP‐8 levels were determined with ELISA. Post‐operative pain levels were recorded for 6 days following both visits using a visual analogue scale. Data were analysed using t‐test, the Mann–Whitney U test and correlation tests. Results There was a significant correlation between the pain scores reported after first visit and IL‐1β and PGE2 levels (p < .05). IL‐1β, IL‐2 and IL‐6 levels showed no significant difference in the cryotherapy group (p > .05), while they significantly increased in the control group (p < .05). There was a decrease in IL‐8, TNF‐α, PGE2 and MMP‐8 levels, however, the difference was not significant (p > .05). Pain scores were significantly lower in the cryotherapy group for the first 3 days (p < .05), except for 24th hours (p > .05). Conclusions The positive correlation between interappointment pain and IL‐1β and PGE2 levels might indicate that these biomarker levels can be used to predict the severity of post‐operative pain. Intracanal cryotherapy was effective in reducing post‐operative pain in the short term in teeth with asymptomatic apical periodontitis. Cryotherapy prevented an increase in IL‐1β, IL‐2 and IL‐6 levels compared with the control group.

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“…Regarding the effects of cryotherapy in endodontics, recent systematic reviews with meta-analyses have produced contradictory results. This discrepancy is likely due to the inclusion of randomized controlled trials with methodological deficiencies [ 24 ] or those deemed to provide low-quality evidence [ 25 ]. According to quantitative analysis, intracanal cryotherapy does not seem to significantly reduce post-endodontic pain [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of cryotherapy duration on experimentally induced connective tissue inflammationin vivo

Vera,

Castro-Nuñez,

Troncoso-Cibrian

et al. 2023

Restor Dent Endod

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Objectives This study tested the hypothesis that cryotherapy duration influences lipopolysaccharide (LPS)-induced inflammation in a rat model. Materials and Methods Six Wistar rats ( Rattus norvegicus albinus ) were used. Five sites were selected per animal and divided into 5 groups: a negative control group (NC), 2 positive control groups (PC1 and PC2), and 2 experimental groups (E1 and E2). Cryotherapy was applied for 1 minute (E1) or 5 minutes (E2). An acute inflammatory response was induced in the PC and E groups via subcutaneous administration of 0.5 mL/kg. In the PC2 group, a catheter was inserted without additional treatment. For the E1 and E2 groups, 2.5°C saline solution was administered through the implanted catheters for 1 and 5 minutes, respectively. The rats were sacrificed, and samples were obtained and processed for histological analysis, specifically examining the presence of polymorphonuclear neutrophils and hemorrhage. The χ 2 test was used to compare the presence of acute inflammation across groups. Dependent variables were compared using the linear-by-linear association test. Results Inflammation and hemorrhage varied significantly among the groups ( p = 0.001). A significantly higher degree of acute inflammation was detected ( p = 0.0002) in the PC and E1 samples than in the E2 group, in which cryotherapy was administered for 5 minutes. The PC and E1 groups also exhibited significantly greater numbers of neutrophils ( p = 0.007), which were essentially absent in both the NC and E2 groups. Conclusions Cryotherapy administration for 5 minutes reduced the acute inflammation associated with LPS and catheter implantation.

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Effect of intracanal cryotherapy on postendodontic pain: a systematic review and meta-analysis of randomized controlled trials

Cited by 10 publications

References 32 publications

Is Intracanal Cryotherapy Effective in Reducing Postoperative Endodontic Pain? An Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials

Is Intracanal Cryotherapy Effective in Reducing Postoperative Endodontic Pain? An Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials

Effect of intracanal cryotherapy on the inflammatory cytokine, proteolytic enzyme levels and post‐operative pain in teeth with asymptomatic apical periodontitis: A randomized clinical trial

Effect of cryotherapy duration on experimentally induced connective tissue inflammationin vivo

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