Effectiveness of Intracanal Cryotherapy on Postoperative Pain in Teeth with Symptomatic Apical Periodontitis.

Abstract

Objective: To assess the impact of intracanal cryotherapy in patients with pulp necrosis and symptomatic apical periodontitis at 12, 24, and 72 hours after single-visit root canal therapy using cold saline (2.5°c) as a final irrigant. study design: Randomized Clinical Trial. setting: Operative Dentistry & Endodontics, Institute of Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan. Period: May to October 2025. methods: Group a (intracanal cryotherapy: 20 ml of 2.5°c normal saline) and group b (control: 20 ml of room-temperature saline) were randomly assigned 1:1 to 196 systemically healthy adults (aged 18–60 years) with pulp necrosis and symptomatic apical periodontitis. every tooth received a single-visit root canal treatment. visual analog scale (vas) was used to measure postoperative pain at 12, 24, and 72 hours. the chi-square test (p < 0.05), general linear model, and mann-whitney u test were used to evaluate between-group differences. results: All 196 participants completed the study. the groups were comparable at baseline for age and sex (p > 0.05). no significant between-group differences in pain scores were observed at 12 hours (5.07 ± 0.646 vs. 5.01 ± 0.634; p = 0.668) or 24 hours (3.97 ± 1.000 vs. 3.99 ± 1.108; p = 0.749). at 72 hours, the cryotherapy group demonstrated significantly lower mean pain scores than the control group (1.31 ± 1.304 vs. 2.08 ± 1.843; p = 0.008), with a significantly greater proportion achieving no or mild pain (vas 0–3: 89.8% vs. 70.4%; χ² = 10.371, p = 0.001). male participants and anterior teeth in the cryotherapy group demonstrated greater analgesic benefit at 72 hours. no adverse events were recorded in either group. conclusion: Intracanal cryotherapy using 20 ml of 2.5°c saline significantly reduced postoperative pain intensity and improved clinical success rates at 72 hours compared with room-temperature saline in patients with symptomatic apical periodontitis.