Non-Cochrane · intervention · PM42611134
Cryotherapy as an adjunct in root canal therapy: a systematic review and meta-analysis.
Huang Qifan, Cui Ce, Fan Jifang, et al. · Lasers in medical science · 2026 · PubMed · doi:10.1007/s10103-026-04847-y
Findings
Population Patients with pulp or periapical pathology receiving non-surgical root canal treatment
6 findings
| Intracanal cryotherapy (cold irrigant, 1.5 to 4 C) | Irrigation at room temperature | Incidence of postoperative pain Single-visit and multi-visit endodontic treatment; mostly single-center | RR 0.72 [0.62, 0.84] High 4 studies · 632 participants |
| Intracanal cryotherapy (cold irrigant, 1.5 to 4 C) | Irrigation at room temperature | Postoperative pain intensity (VAS/NRS) 72 h · Single-visit and multi-visit endodontic treatment; mostly single-center | SMD -0.70 [-1.34, -0.07] High 3 studies · 122 participants |
| Intracanal cryotherapy (cold irrigant, 1.5 to 4 C) | Irrigation at room temperature | Postoperative pain intensity (VAS/NRS) 72 h · Single-visit and multi-visit endodontic treatment; mostly single-center · Sensitivity analysis excluding Gundogdu 2018 | SMD -0.38 [-0.83, 0.07] GRADE not reported 2 studies |
| Intracanal cryotherapy (cold irrigant, 1.5 to 4 C) | Irrigation at room temperature | Postoperative pain intensity (VAS/NRS) 48 h · Single-visit and multi-visit endodontic treatment; mostly single-center | SMD -0.53 [-0.72, -0.34] High 6 studies · 440 participants |
| Intracanal cryotherapy (cold irrigant, 1.5 to 4 C) | Irrigation at room temperature | Postoperative pain intensity (VAS/NRS) 24 h · Single-visit and multi-visit endodontic treatment; mostly single-center | SMD -0.58 [-0.89, -0.27] High 11 studies · 700 participants |
| Intracanal cryotherapy (cold irrigant, 1.5 to 4 C) | Irrigation at room temperature | Postoperative pain intensity (VAS/NRS) 6 h · Single-visit and multi-visit endodontic treatment; mostly single-center | SMD -0.75 [-1.15, -0.35] High 9 studies · 621 participants |
Included primary studies 26
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 | Postoperative pain intensity (VAS/NRS) | 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 | Postoperative pain intensity (VAS/NRS) | not extracted yet |
| Jain 2018 matched by author and year (probable) | NR | 1 other review | Postoperative pain intensity (VAS/NRS) | 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 | Postoperative pain intensity (VAS/NRS) | 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 | Postoperative pain intensity (VAS/NRS) | 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 | Incidence of postoperative pain | not extracted yet |
| Ajeesh 2023 Comparative evaluation of the effectiveness of intracanal and intraoral cryotherapy on postendodontic pain in patients with symptomatic… PMID:38292358 | 2023 | this review only | Postoperative pain intensity (VAS/NRS) | not extracted yet |
| Alharthi 2019 Effect of intra-canal cryotherapy on post-endodontic pain in single-visit RCT: A randomized controlled trial DOI:10.1016/j.sdentj.2019.03.004 | 2019 | this review only | not stated | not extracted yet |
| Duaa 2018 matched by author and year (probable) | NR | this review only | Incidence of postoperative pain | not extracted yet |
| Ghabraei 2024 Effect of intracanal cryotherapy on post-operative pain in single-visit endodontic retreatment: a randomized clinical trial DOI:10.1186/s12903-024-05249-8 | 2024 | this review only | not stated | not extracted yet |
| Ghabraei 2024 Effect of intracanal cryotherapy on post-operative pain in single-visit endodontic retreatment: a randomized clinical trial. PMID:39710651 | 2024 | this review only | Postoperative pain intensity (VAS/NRS) | not extracted yet |
| Gundogdu 2018 Effects of Various Cryotherapy Applications on Postoperative Pain in Molar Teeth with Symptomatic Apical Periodontitis: A Preliminary… DOI:10.1016/j.joen.2017.11.002 | 2018 | this review only | not stated | not extracted yet |
| Gundogdu 2018 Effects of Various Cryotherapy Applications on Postoperative Pain in Molar Teeth with Symptomatic Apical Periodontitis: A Preliminary… PMID:29398090 | 2018 | this review only | Postoperative pain intensity (VAS/NRS) | not extracted yet |
| Jaiswal 2020 matched by author and year (probable) | NR | this review only | 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… DOI:10.1590/1678-7757-2020-0502 | 2021 | this review only | not stated | not extracted yet |
| Keskin 2016 Effect of intracanal cryotherapy on pain after single-visit root canal treatment DOI:10.1111/aej.12175 | 2016 | this review only | not stated | not extracted yet |
| Keskin 2016 Effect of intracanal cryotherapy on pain after single-visit root canal treatment. PMID:27699913 | 2017 | this review only | Incidence of postoperative pain | not extracted yet |
| Keskin 2023 Effect of intracanal cryotherapy on the inflammatory cytokine, proteolytic enzyme levels and post‐operative pain in teeth with… DOI:10.1111/iej.13937 | 2023 | this review only | not stated | not extracted yet |
| Kumari 2022 Comparative evaluation of intracanal cryotherapy and curcumin as a final irrigant in reducing post endodontic pain in primary teeth DOI:10.4103/jisppd.jisppd_216_22 | 2022 | this review only | not stated | not extracted yet |
| Kumari 2022 Comparative evaluation of intracanal cryotherapy and curcumin as a final irrigant in reducing post endodontic pain in primary teeth. PMID:36260471 | 2022 | this review only | Postoperative pain intensity (VAS/NRS) | not extracted yet |
| Mokhtari 2023 The effect of different concentrations and temperatures of sodium hypochlorite irrigation on pain intensity following endodontic treatment… DOI:10.1002/cre2.754 | 2023 | this review only | not stated | not extracted yet |
| Nandakumar 2020 Effect of intracanal cryotreated sodium hypochlorite on postoperative pain after root canal treatment - A randomized controlled clinical… PMID:33384483 | 2020 | this review only | Postoperative pain intensity (VAS/NRS) | not extracted yet |
| Solomon 2024 Comparative evaluation of effect of intracanal cryotherapy and corticosteroid solution on post endodontic pain in single visit root canal… PMID:38600937 | 2024 | this review only | Postoperative pain intensity (VAS/NRS) | not extracted yet |
| Vera 2018 Intracanal Cryotherapy Reduces Postoperative Pain in Teeth with Symptomatic Apical Periodontitis: A Randomized Multicenter Clinical Trial DOI:10.1016/j.joen.2017.08.038 | 2018 | this review only | not stated | not extracted yet |
| Vera 2018 Intracanal Cryotherapy Reduces Postoperative Pain in Teeth with Symptomatic Apical Periodontitis: A Randomized Multicenter Clinical Trial. PMID:29079057 | 2018 | this review only | Incidence of postoperative pain; Postoperative pain intensity (VAS/NRS) | not extracted yet |
| Vieyra 2019 Reduction of Postendodontic Pain after One-visit Root Canal Treatment Using Three Irrigating Regimens with Different Temperature DOI:10.4103/njcp.njcp_349_18 | 2019 | 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 | Patients with pulp or periapical pathology receiving non-surgical root canal treatment | Patients having root canal treatment (n=1479), mostly adults 18 to 70 years, one pediatric study |
| Intervention | Cold irrigating solutions (e.g., cold saline or sodium hypochlorite) | Intracanal cryotherapy, 1.5 to 4 C saline or sodium hypochlorite (11 studies used 2.5 C saline) |
| Comparison | Irrigation at ambient (room) temperature | Room temperature irrigant |
| Outcomes | Postoperative pain severity (VAS or NRS) or incidence of pain | Pain incidence (4 studies); pain scores at 6 h (9), 24 h (11), 48 h (6), 72 h (3) |
| Study designs | RCTs, cohort studies or case-control studies | 16 RCTs |
| Timing | Not specified | 6, 24, 48 and 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 | Partial Yes | Partial Yes | yes |
| 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 | No | No | 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 | Yes | Yes | 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 | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Moderate | Moderate | yes |