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

Abstract

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.

The influence of intraoral cryotherapy on postoperative pain and substance P in symptomatic apical periodontitis: randomized clinical study

“…www.nature.com/scientificreports/ Following our root canal treatment, all patients in this research experienced considerable pain relief and did not require post-operative analgesics. This outcome lends credence to the findings that single-visit root canal therapy is an effective pain management technique for teeth with irreversible pulpitis 27 . The two groups did not differ in terms of gender, age, or preoperative pain demographics.…”

“…Regarding cryotherapy and methods of cold application in Endodontics, many tactics were addressed in the literature starting from intracanal cryotherapy (i.e. using cold saline as a final irrigant) [13][14][15][16]27 , Intraoral (using a wrapped ice cube in the oral vestibule) 28 and extraoral cold pack application 11,28 . Their results were not final, and the protocol was different in each but all are aligned in their findings that cold application decreases the level of POP.…”