Effectiveness of intracanal cryotherapy in reducing post-endodontic pain in irreversible pulpitis: a systematic review and meta-analysis
Clinical Snapshot
PICO Framework
| P — Population | Patients with irreversible pulpitis requiring endodontic treatment |
| I — Intervention | Intracanal cryotherapy as adjunct to conventional endodontic treatment |
| C — Comparator | Conventional endodontic treatment alone |
| O — Outcomes | Postoperative pain levels at 6, 12, 24, 48, and 72 hours |
Bottom Line
This systematic review provides moderate-quality evidence that intracanal cryotherapy offers a simple, cost-effective adjunct to conventional endodontic treatment for managing early postoperative pain in irreversible pulpitis. The technique demonstrates significant pain reduction within the first 6-12 hours post-treatment but shows no sustained benefit beyond 24 hours. While the intervention appears safe and feasible for routine clinical use, clinicians should counsel patients that pain relief is primarily limited to the immediate postoperative period. The acknowledged heterogeneity between studies and short follow-up periods suggest that while cryotherapy may be a useful adjunct, it should not replace comprehensive pain management strategies. Australian practitioners can consider incorporating this technique as part of a multimodal approach to post-endodontic pain management, particularly for patients at higher risk of immediate postoperative discomfort.
Key Findings
P Value: Significant at 6 and 12 hours, non-significant at later time points
Effect Size: Standardised mean difference (SMD) - specific values not provided in abstract
Primary Outcome: Postoperative pain reduction at multiple time points
Nnt Or Sensitivity: Not calculable from available data - would require individual study data
Confidence Interval: Not specified in abstract
Clinical Application
High feasibility - described as simple and cost-effective technique requiring minimal additional equipment Highly applicable to Australian dental practice - no regulatory barriers, aligns with evidence-based endodontic care principles supported by Australian Dental Association Patients undergoing endodontic treatment for irreversible pulpitis in general dental practice
Abstract
Irreversible pulpitis is characterized by persistent inflammation and moderate to severe pain, often requiring pharmacological or adjunctive strategies for postoperative management. Intracanal cryotherapy has emerged as a simple, cost-effective technique to mitigate this pain by utilizing cold-induced physiological responses. This systematic review and meta-analysis aimed to evaluate the clinical evidence regarding the effectiveness of intracanal cryotherapy in reducing postoperative pain in teeth with irreversible pulpitis. Electronic searches were conducted in PubMed, Web of Science, Cochrane, and Scopus up to October 2025. Randomized controlled trials (RCTs) comparing intracanal cryotherapy to conventional endodontic treatment. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2. Random-effects meta-analysis was performed using SMD for pain levels at 6, 12, 24, 48, and 72 h. Twelve RCTs were included; nine were meta-analyzed. Cryotherapy significantly reduced pain at 6 and 12 h but not later time points. Intracanal cryotherapy appears to be a safe and inexpensive adjunct that is associated with reduced early postoperative pain, with the most consistent effect observed within the first 6-12 h. Heterogeneity and short follow-up periods. Cryotherapy reduces early postoperative pain only.Registration: PROSPERO CRD420261295239.
References
- 1.Mohamed, M., Abdelmajeed, A., Salah-Uddin Anwar Laithy, M., & Abozaid, D. (2026). Effectiveness of intracanal cryotherapy in reducing post-endodontic pain in irreversible pulpitis: a systematic review and meta-analysis. Scientific Reports. https://doi.org/10.1002/cre2.70320
Related Research
JMIR medical informatics
Large Language Models for Endodontic Symptom Assessment and Treatment Planning Using Image-Free Clinical Records: Comparative Evaluation Study
25 July 2026
Clinical oral investigations
Does endodontic treatment modify serum inflammatory markers of cardiovascular risk in individuals with asymptomatic apical periodontitis? a systematic review and meta-analysis.
10 May 2026
This content is for educational purposes for healthcare professionals only and does not constitute clinical advice. Clinical decisions should be based on individual patient assessment, current guidelines, and appropriate specialist consultation. Editorial Standards · Privacy Policy · Terms of Service