Non-Cochrane · intervention · PM42031860
Effectiveness of intracanal cryotherapy in reducing post-endodontic pain in irreversible pulpitis: a systematic review and meta-analysis.
Mohamed Maged, Abdelmajeed Asmaa, Salah-Uddin Anwar Laithy Muhammad, et al. · Scientific reports · 2026 · PubMed · doi:10.1038/s41598-026-47860-5
Findings
Population Patients undergoing root canal treatment (irreversible pulpitis)
8 findings
| Intracanal cryotherapy (cold irrigant) | Conventional irrigation (room-temperature irrigant) | Postoperative pain intensity (VAS/NRS) 6 h · Clinical endodontic treatment · Sensitivity analysis (leave-one-out) excluding Abuhelal et al. | SMD -0.4 [-0.72, -0.07] GRADE not reported 3 studies · 174 participants |
| Intracanal cryotherapy (cold irrigant) | Conventional irrigation (room-temperature irrigant) | Postoperative pain intensity (VAS/NRS) 72 h · Clinical endodontic treatment | SMD 0.01 [-0.26, 0.28] GRADE not reported 3 studies · 214 participants |
| Intracanal cryotherapy (cold irrigant) | Conventional irrigation (room-temperature irrigant) | Postoperative pain intensity (VAS/NRS) 6 h · Clinical endodontic treatment | SMD -0.88 [-1.83, 0.08] GRADE not reported 4 studies · 198 participants |
| Intracanal cryotherapy (cold irrigant) | Conventional irrigation (room-temperature irrigant) | Postoperative pain intensity (VAS/NRS) 24 h · Clinical endodontic treatment | SMD -0.09 [-0.33, 0.16] GRADE not reported 7 studies · 412 participants |
| Intracanal cryotherapy (cold irrigant) | Conventional irrigation (room-temperature irrigant) | Postoperative pain intensity (VAS/NRS) 12 h · Clinical endodontic treatment | SMD -0.57 [-1.12, -0.02] GRADE not reported 3 studies · 128 participants |
| Intracanal cryotherapy (cold irrigant) | Conventional irrigation (room-temperature irrigant) | Postoperative pain intensity (VAS/NRS) 24 h · Clinical endodontic treatment · Sensitivity analysis (leave-one-out) excluding Alharthi et al. | SMD -0.18 [-0.39, 0.03] GRADE not reported 6 studies · 366 participants |
| Intracanal cryotherapy (cold irrigant) | Conventional irrigation (room-temperature irrigant) | Postoperative pain intensity (VAS/NRS) 48 h · Clinical endodontic treatment | SMD -0.01 [-0.21, 0.19] GRADE not reported 6 studies · 368 participants |
| Intracanal cryotherapy (cold irrigant) | Conventional irrigation (room-temperature irrigant) | Postoperative pain intensity (VAS/NRS) 12 h · Clinical endodontic treatment · Sensitivity analysis (leave-one-out) excluding Iparraguirre Nuñovero et al. | SMD -0.85 [-1.35, -0.35] GRADE not reported 2 studies · 68 participants |
Included primary studies 11
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Mokhtari 2023 The effect of different concentrations and temperatures of sodium hypochlorite irrigation on pain intensity following endodontic treatment… PMID:37345724 | 2023 | 2 other reviews | not stated | not extracted yet |
| Alharthi 2019 Effect of intra-canal cryotherapy on post-endodontic pain in single-visit RCT: A randomized controlled trial. PMID:31337936 | 2019 | 1 other review | not stated | not extracted yet |
| Karatas 2021 Effect of final irrigation with sodium hypochlorite at different temperatures on postoperative pain level and antibacterial activity: a… PMID:33624688 | 2021 | 1 other review | not stated | not extracted yet |
| Keskin 2023 Effect of intracanal cryotherapy on the inflammatory cytokine, proteolytic enzyme levels and post-operative pain in teeth with… PMID:37222468 | 2023 | 1 other review | not stated | not extracted yet |
| Vieyra 2019 Reduction of postendodontic pain after one-visit root canal treatment using three irrigating regimens with different temperature. PMID:30666017 | 2019 | 1 other review | not stated | not extracted yet |
| Abuhelal 2025 EVALUATION OF THE EFFECT OF CRYOTHERAPY VERSUS POST-OPERATIVE IBUPROFEN MEDICATION ON POST-OPERATIVE PAIN IN MANDIBULAR MOLAR TEETH WITH… DOI:10.21608/adjc.2024.278506.1508 | 2025 | this review only | not stated | not extracted yet |
| Al-Nahlawi 2016 Effect of Intracanal Cryotherapy and Negative Irrigation Technique on Postendodontic Pain. PMID:27965485 | 2016 | this review only | not stated | not extracted yet |
| Ingale 2024 Efficacy of Endodontic Cryotherapy in Alleviating Post-Treatment Pain after Single-Visit RCT: A Randomized Study. PMID:39927052 | 2024 | this review only | not stated | not extracted yet |
| Iparraguirre Nunovero 2024 The effect of intracanal cryotherapy with and without foraminal enlargement on pain prevention after endodontic treatment: a randomized… PMID:39191915 | 2024 | this review only | not stated | not extracted yet |
| Junaid 2023 Frequency of pain in Teeth with irreversible pulpitis after single visit root canal treatment using cryotherapy DOI:10.51253/pafmj.v72i6.4295 | 2023 | this review only | not stated | not extracted yet |
| Mitra 2024 Effect of Intracanal Cryotherapy and Curcuma Longa as a Final Irrigant in Reducing Post Operative Pain: An In-Vivo Study. PMID:39346349 | 2024 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Human patients undergoing endodontic treatment (irreversible pulpitis) | Patients undergoing root canal treatment: irreversible pulpitis, vital teeth, asymptomatic apical periodontitis (11 RCTs; 8 meta-analyzed) |
| Intervention | Intracanal cryotherapy (cold saline or cold irrigant delivered intracanal) | Intracanal cryotherapy with cold saline, EDTA, distilled water or NaOCl (about 2 to 4 C) |
| Comparison | Conventional endodontic treatment (conventional irrigation or no cryotherapy) | Room-temperature or warm irrigation, no additional irrigation, ibuprofen |
| Outcomes | Post-endodontic pain (VAS/NRS) at 6, 12, 24, 48 and 72 h; secondary: later time points and analgesic consumption | Postoperative pain SMD at 6 h (4 studies), 12 h (3), 24 h (7), 48 h (6), 72 h (3) |
| Study designs | RCTs | 11 RCTs |
| Timing | 6, 12, 24, 48 and 72 h | 3 h to 7 days; pooled at 6, 12, 24, 48, 72 h |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Yes | Partial Yes | no |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | No | Yes | no |
| Overall | Low | Low | yes |