Is Intracanal Cryotherapy Effective in Reducing Postoperative Endodontic Pain? An Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Protocol
2.2. PICOS Eligibility Criteria
2.3. Database Sources and Search Strategy
2.4. Selection of Studies and Data Collection
3. Results
3.1. Postoperative Pain at 6 h
3.2. Postoperative Pain at 24 h
3.3. Postoperative Pain at 48 h
3.4. Postoperative Pain at 72 h
3.5. Postoperative Pain at 7 Days
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Author and Year | Sample Size | Age | Pulpal and Periapical Diagnosis | Type of Teeth | Pain Assessment Tool | Mean and SD of Preoperative Pain in the Cryotherapy Group | Mean and SD of Preoperative Pain in the Control Group | Final Irrigation in the Cryotherapy Group | Final Irrigation in the Control Group | Pain Assessment Times | Treat ment Visits | Conclusion |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Nahlawi et al., 2016 R [43] | 75 | 20–46 | Irreversible pulpitis | Single-rooted single canal teeth | VAS (0–10 cm) | 2.0 ± 0.9 | 2.5 ± 0.78 | 20 mL of 2–4 °C saline for 5 min with needle syringe + EndoVac negative irrigation | 20 mL room temperature saline for 5 min with needle syringe + EndoVac negative irrigation | 6, 12, 24, 48 h, and 7 days | Single visit | Intracanal cryotherapy eliminated postendodontic pain significantly compared with the control group at 6, 12, 24, and 48 h postoperatively but no significant difference after 1 week |
Keskin et al., 2017 R [44] | 170 | 19–63 | Irreversible pulpitis with normal apical tissues or symptomatic apical periodontitis | Maxillary or mandibular incisors/premolars/molars | VAS (0–10 cm) | 2.3 ± 0.8 | 2.0 ± 0.6 | 5 mL of 2.5 °C saline for 5 min + needle syringe | 5 mL room temperature saline for 5 min + needle syringe | 24 and 48 h | Single visit | Cryotherapy reduced postoperative pain significantly after 24 h compared with the control group but no significant difference after 48 h |
Jain et al., 2018 [45] | 60 | 18–25 | Symptomatic irreversible pulpitis with normal apical tissues or apical periodontitis | Mandibular 1st molars | VAS (0–10 cm) | 8.12 ± 0.67 | 8.52 ± 0.75 | 2.5 °C saline for 1 min + needle syringe | Room temperature saline for 1 min + needle syringe | 6, 24, and 48 h | Multi visits | Intracanal cryotherapy was effective in significantly reducing pain during and after endodontic treatment compared with the control group in symptomatic irreversible pulpitis with symptomatic apical periodontitis at 6, 24, and 48 h |
Gundogdu and Arslan, 2018 R [46] | 84 | ≥18 | Symptomatic irreversible pulpitis with symptomatic apical periodontitis | Maxillary or mandibular molars | VAS (0–100 cm) | 91.32 ± 8.214 | 94.86 ± 4.293 | 20 mL of 2.5 °C saline for 5 min + needle syringe | 20 mL room temperature saline for 5 min + needle syringe | 24, 72 h, 5, and 7 days | Single visit | Intracanal cryotherapy reduced postoperative pain levels and reduced the VAS scores of pain on percussion compared with the levels in the control group after 24 h, 3, 5, and 7 days |
Bazaid and Kenawi, 2018 [47] | 36 | 18–40 | Irreversible pulpitis with normal apical tissues or apical periodontitis | Molars and premolars | VAS (0–10 cm) | NR | NR | 2.5 °C saline for 2 min + side-vented needle | Room temperature saline for 2 min + side-vented needle | 24 and 48 h | Multi visits | Using cold normal saline reduced the postoperative pain degree in patients with irreversible pulpitis with apical periodontitis but it did not affect patients with irreversible pulpitis without apical periodontitis after 24 and 48 h postoperatively |
Vera et al., 2018 R [48] | 210 | 18–60 | Necrotic pulp with symptomatic apical periodontitis | Single canal teeth | VAS (0–10 cm) | 8.847 ± 0.769 | 8.96 ± 0.789 | 20 mL of 2.5 °C saline for 5 min | 20 mL room temperature saline for 5 min | 6, 24, and 72 h | Multi visits | Intracanal cryotherapy reduced the incidence of postoperative pain and the need for medication in patients with necrotic pulp and symptomatic apical periodontitis after 6, 24, and 72 h compared with the control group |
Nandhini, 2018 [57] | 40 | 20–50 | Symptomatic irreversible pulpitis with normal apical tissues or apical periodontitis | Mandibular premolars | Heft–Parker scale (0–170 mm) | 80.35 ± 52.652 | 85.2 ± 47.32 | Cold saline at 2.5 °C + EndoVac microcannula | Saline at room temperature + EndoVac microcannula | 6, 12, 24, 48 h, 4, and 7 days | Single visit | Comparison of the control and experimental group values showed significant differences at 6, 12, 24, 48 h, and 4 days and without any significant difference at the end of the 7th day. Use of normal saline as an irrigant reduced the pain intensity slowly whereas the use of cold saline totally abolished pain by the end of the 4th day |
Alharthi et al., 2019 R [49] | 105 | 18–50 | Asymptomatic irreversible pulpitis with normal apical tissues | Single canal teeth | VAS (0–10 cm) | 0 ± 0 | 0 ± 0 | 10 mL of cold (1.5–2.5 °C) saline for 5 min + side-vented needle | 10 mL room temperature saline for 5 min + side-vented needle | 6, 24, and 48 h | Single visit | Room temperature saline showed comparable results to intracanal cryotherapy in pain reduction at 6, 24, and 48 h postoperatively |
Sudheer et al., 2019 [50] | 60 | 18–45 | Symptomatic irreversible pulpitis | Single-rooted teeth | VAS (0–10 cm) | NR | NR | 10 mL of 2.5 °C saline | 10 mL room temperature saline | 6, 24, and 48 h | Single visit | Intracanal cryotherapy significantly reduced postoperative pain compared with the control group at 6, 24, and 48 h postoperatively |
Vieyra et al., 2019 R [51] | 240 | 18–65 | Vital pulp | Maxillary or mandibular molars, premolar, anteriors | VAS (0–10 cm) | 0 ± 0 | 0 ± 0 | 10 mL of cold (4 °C + 2.5 °C) saline with cold (4 °C + 2.5 °C) EndoVac microcannula for 1 min | 10 mL room temperature saline + EndoVac microcannula for 1 min | 24, 48, and 72 h | Single visit | No statistically significant difference between the cold and room temperature saline was found regarding the degree or duration of pain at 24, 48, and 72 h postoperatively |
Al-Abdullah et al., 2020 [52] | 60 | >20 | Irreversible pulpitis | Single-rooted with single canal teeth | VAS (0–10 cm) | NR | NR | 20 mL of 2–4 °C cold saline for 5 min + needle syringe | 20 mL room temperature saline for 5 min + needle syringe | 6, 12, 24, 48 h, and 7 days | Single visit | Intracanal cryotherapy eliminated postendodontic pain compared with the control group at 6, 12, 24, and 48 h but the difference was not significant after 7 days |
Nandakumar and Nasim, 2020 [53] | 64 | 18–70 | Symptomatic irreversible pulpitis with apical periodontitis | Molars and premolars | VAS (0–10 cm) | 4.72 ± 1.373 | 4.66 ± 1.096 | 20 mL of 2–4 °C NaOCl for 5 min + needle syringe | 20 mL room temperature NaOCl for 5 min + needle syringe | 6, 24, and 48 h | Single visit | Intracanal cryotherapy significantly reduced analgesic consumption and postoperative pain at 6, 24, and 48 h compared with the control group |
Jaiswal et al., 2020 [54] | 30 | NR | Necrotic pulp with symptomatic apical periodontitis | NR | VAS (0–10 cm) | NR | NR | 20 mL of 2.5 °C saline for 5 min + needle syringe | 20 mL room temperature saline for 5 min + needle syringe | 6 and 24 h | Multi visits | No statistically significant difference between the cold and room temperature saline in reducing postoperative pain and analgesic consumption at 6 and 24 h |
Akpinar and Kaya, 2021 R [55] | 94 | 18–65 | Irreversible pulpitis with symptomatic apical periodontitis | Mandibular molars | VAS (0–100 cm) | NR | NR | 20 mL of 2.5 °C saline for 5 min + 30 gauge side-hole special irrigation tip | 5 mL of distilled water + 30 gauge side-hole special irrigation tip | 4, 8, 12, 24, 48, and 72 h | Multi visits | Intracanal cryotherapy significantly reduced postoperative pain compared with the control group at 4, 8, 12, 24, 48, and 72 h |
Emad et al., 2021 [56] | 48 | 20–50 | Symptomatic apical periodontitis | Single-rooted teeth | VAS (0–10 cm) | NR | NR | 20 mL of 5% 2.5 °C NaOCl for 5 min + side-vented (30G) needle | 20 mL of 5% room temperature NaOCl for 5 min + side-vented (30G) needle | 12, 24, 48, 72 h, and 7 days | Multi visits | The cryotherapy irrigation protocol showed lower levels of postoperative pain compared with the control group at 12, 24, 48, 72 h, and 7 days |
Karataş et al., 2021 R [58] | 45 | Mean = 27 | Necrotic pulp with asymptomatic apical periodontitis | Incisors, canines, premolars | VAS (0–100 cm) | NR | NR | 5 mL of 1% 2 °C NaOCl for 1 min + syringe | 5 mL of 1% 25 °C NaOCl for 1 min + syringe | 24, 48, 72 h, 5, and 7 days | NR | No statistically significant difference between the cold and room temperature NaOCl in postoperative pain reduction and in postoperative analgesic intake |
Certainty Assessment | Number of Patients | Effect | Certainty § | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Number of Studies | Study Design | Risk of Bias | Inconsistency | Indirectness | Imprecision | Other Considerations | Intracanal Cryotherapy | Room Temperature Irrigant (Control) | Mean Difference (95% CI *) | |
Postoperative pain at 6 h | ||||||||||
6 | Randomized clinical trials | Serious a | Serious b | Not serious c | Not serious d | None | 225 | 225 | −1.11 (−1.72 to −0.5) | ⨁⨁◯◯ LOW |
Postoperative pain at 24 h | ||||||||||
9 | Randomized clinical trials | Serious a | Serious b | Not serious c | Not serious d | None | 422 | 341 | −1.08 (−1.79 to −0.38) | ⨁⨁◯◯ LOW |
Postoperative pain at 48 h | ||||||||||
5 | Randomized clinical trials | Serious a | Serious b | Not serious c | Not serious d | None | 260 | 180 | −0.38 (−0.73 to −0.02) | ⨁⨁◯◯ LOW |
Postoperative pain at 72 h | ||||||||||
5 | Randomized clinical trials | Serious a | Serious b | Not serious c | Not serious d | None | 290 | 209 | −0.69 (−1.34 to −0.05) | ⨁⨁◯◯ LOW |
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Almohaimede, A.; Al-Madi, E. Is Intracanal Cryotherapy Effective in Reducing Postoperative Endodontic Pain? An Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials. Int. J. Environ. Res. Public Health 2021, 18, 11750. https://doi.org/10.3390/ijerph182211750
Almohaimede A, Al-Madi E. Is Intracanal Cryotherapy Effective in Reducing Postoperative Endodontic Pain? An Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials. International Journal of Environmental Research and Public Health. 2021; 18(22):11750. https://doi.org/10.3390/ijerph182211750
Chicago/Turabian StyleAlmohaimede, Amal, and Ebtissam Al-Madi. 2021. "Is Intracanal Cryotherapy Effective in Reducing Postoperative Endodontic Pain? An Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials" International Journal of Environmental Research and Public Health 18, no. 22: 11750. https://doi.org/10.3390/ijerph182211750