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

Abstract

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.

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

“…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.…”

“…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.…”

Effect of cryotherapy duration on experimentally induced connective tissue inflammationin vivo

“…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 ]. However, another systematic review found that intracanal cryotherapy effectively reduced postoperative pain in teeth with symptomatic apical periodontitis [ 27 ].…”

Use of Intracanal Cryotherapy in Endodontics as an Adjuvant in Postoperative Analgesia

“…Com isso, desde a década de 1960, tem sido utilizada na medicina para aliviar a dor de lesões derivados dos esportes, lesões musculares e esqueléticas, tal como: tendinites e estiramentos. Além disso, tem sido usada em procedimentos cirúrgicos abdominais, ortopédicos e ginecológicos (ALMOHAIMEDE & AL-MADI., 2021;HESPANHOL et al, 2022).…”