Intracanal Cryotherapy and its Effects on the Postoperative Pain in Root Canal Therapy: Systematic Review & Meta-analysis Protocol

Intracanal Cryotherapy and its Effects on the Postoperative Pain in Root Canal Therapy: Systematic Review & Meta-analysis Protocol

Durre Sadaf1 , Muhammad Zubair Ahmad2, Igho Onakpoya3

1Assistant Professor, Department of Conservative Sciences, Qassim University, Buraidah, KSA; Evidence-Based Healthcare, Centre of Evidence-Based Medicine, University of Oxford, UK. 2Assistant Professor, Department of Conservative Sciences, Al Rass, Qassim University, KSA; Evidence-Based Healthcare, Centre of Evidence-Based Medicine, University of Oxford, UK. 3University of Oxford, Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, Woodstock Road, Oxford OX2 6GG

American Journal of Geographical Research and Reviews

Background:  There are many research studies directing in lowering postoperative pain in root canal therapy. The use of intracanal cryotherapy in root canal treatment is recently introduced, and many researchers are inclined towards this techniques.  This systematic review will give an insight into its application in endodontic therapy and its effects on postoperative pain. The aim of this systematic review is to evaluate the effect of intracanal cryotherapy  on the postoperative pain in patients with pulp diseases and with or without peri-radicular infection during root canal therapy. This systematic review will include randomized controlled trials only. The studies should encompass patients with pulpal diseases, i.e. irreversible pulpitis and pulp necrosis in teeth. Previously root treated teeth, immature, and teeth with root resorption will not be included.

Methods: We will conduct a comprehensive search strategy using electronic databases PubMed, EMBASE (Ovid),  Scopus, and Cochrane library. A predefined inclusion and exclusion criteria will be utilized for the selection of studies. The reference list of selected studies will be manually searched. We will extract data from studies on a structured data collection form.  At the same time, the risk of bias assessment of studies using the Cochrane risk of bias assessment tools will be performed by two reviewers independently. Furthermore,  qualitative and quantitative data synthesis will be accomplished. The data will be presented in the form of table of summary of findings.

Discussion: This systematic review will assess the role of intracanal cryotherapy in the form of cold saline irrigation as a final irrigant during root canal therapy. The quality of evidence will ranked as high, moderate low or very low using GRADE approach. Comprehensive search strategy, risk of bias assessment using Cochrane risk of bias assessment tool by two reviewers are the  strength of this systematic review.

Systematic review registration number: The protocol is registered with the International Prospective Register of Systematic Reviews. (PROSPERO CRD  42020163438)

Keywords: canal irrigation; cryotherapy; irreversible pulpitis; postoperative pain; root canal therapy.

Free Full-text PDF

How to cite this article:
Durre Sadaf1 , Muhammad Zubair Ahmad2, Igho Onakpoya3. Intracanal Cryotherapy and its Effects on the Postoperative Pain in Root Canal Therapy: Systematic Review & Meta-analysis Protocol. International Journal of Dental Research and Reviews, 2020, 3:35.


1. Sathorn C, Parashos P, Messer H. The prevalence of postoperative pain and flare-up in single- and multiple-visit endodontic treatment: a systematic review. International endodontic journal. 2008;41(2):91-9.
2. Matusow RJ. The flare-up phenomenon in endodontics: A clinical perspective and review. Oral Surgery, Oral Medicine, Oral Pathology. 1988;65(6):750-3.
3. Ali A, Olivieri JG, Duran-Sindreu F, Abella F, Roig M, Garcia-Font M. Influence of preoperative pain intensity on postoperative pain after root canal treatment: A prospective clinical study. Journal of dentistry. 2016;45:39-42.
4. Ince B, Ercan E, Dalli M, Dulgergil CT, Zorba YO, Colak H. Incidence of postoperative pain after single- and multi-visit endodontic treatment in teeth with vital and non-vital pulp. Eur J Dent. 2009;3(4):273-9.
5. Ng YL, Glennon JP, Setchell DJ, Gulabivala K. Prevalence of and factors affecting post-obturation pain in patients undergoing root canal treatment. International endodontic journal. 2004;37(6):381-91.
6. Attar S, Bowles WR, Baisden MK, Hodges JS, McClanahan SB. Evaluation of Pretreatment Analgesia and Endodontic Treatment for Postoperative Endodontic Pain. Journal of Endodontics. 2008;34(6):652-5.
7. Rowe NH, Shekter MA, Turner JL, Spencer J, Dowson J, Petrick TJ. Control of pain resulting from endodontic therapy: A double-blind, placebo-controlled study. Oral Surgery, Oral Medicine, Oral Pathology. 1980;50(3):257-63.
8. Torabinejad M, Dorn SO, Eleazer PD, Frankson M, Jouhari B, Mullin RK, et al. Effectiveness of various medications on postoperative pain following root canal obturation. Journal of Endodontics. 1994;20(9):427-31.
9. Ryan JL, Jureidini B, Hodges JS, Baisden M, Swift JQ, Bowles WR. Gender Differences in Analgesia for Endodontic Pain. Journal of Endodontics. 2008;34(5):552-6.
10. Gatchel RJ. Dealing with Discomfort Managing Anxiety and Pain During Dental Treatment. The Journal of the American Dental Association. 1992;123(6):37-41.
11. Arslan H, Khalilov R, Do anay E, Karatas E. The effect of various kinematics on postoperative pain after instrumentation: a prospective, randomized clinical study. Journal of Applied Oral Science. 2016;24:503-8.
12. Dehghan M, Farahbod F. The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study. J Clin Diagn Res. 2014;8(9):LC01-LC4.
13. Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. The American journal of sports medicine. 2004;32(1):251-61.
14. Grant AE. MASSAGE WITH ICE (CRYOKINETICS) IN THE TREATMENT OF PAINFUL CONDITIONS OF THE MUSCULOSKELETAL SYSTEM. Archives of physical medicine and rehabilitation. 1964;45:233-8.
15. Diamond S, Freitag FG. Cold as an adjunctive therapy for headache. Postgraduate medicine. 1986;79(1):305-9.
16. Belli E, Rendine G, Mazzone N. Cold therapy in maxillofacial surgery. The Journal of craniofacial surgery. 2009;20(3):878-80.
17. Akan M, Misirlioglu A, Yildirim S, Cakir B, Taylan G, Akoz T. Ice application to minimize pain in the split-thickness skin graft donor site. Aesthetic plastic surgery. 2003;27(4):305-7.
18. Forouzanfar T, Sabelis A, Ausems S, Baart JA, van der Waal I. Effect of ice compression on pain after mandibular third molar surgery: a single-blind, randomized controlled trial. International journal of oral and maxillofacial surgery. 2008;37(9):824-30.
19. Vera J, Ochoa-Rivera J, Vazquez-Carcano M, Romero M, Arias A, Sleiman P. Effect of Intracanal Cryotherapy on Reducing Root Surface Temperature. J Endod. 2015;41(11):1884-7.
20. Nadler SF, Weingand K, Kruse RJ. The physiologic basis and clinical applications of cryotherapy and thermotherapy for the pain practitioner. Pain physician. 2004;7(3):395-9.
21. Lee H, Natsui H, Akimoto T, Yanagi K, Ohshima N, Kono I. Effects of cryotherapy after contusion using real-time intravital microscopy. Medicine and science in sports and exercise. 2005;37(7):1093-8.
22. Dolan MG, Thornton RM, Fish DR, Mendel FC. Effects of cold water immersion on edema formation after blunt injury to the hind limbs of rats. J Athl Train. 1997;32(3):233-7.
23. McLean DA. The use of cold and superficial heat in the treatment of soft tissue injuries. Br J Sports Med. 1989;23(1):53-4.
24. Muldoon J. Skin cooling, pain and chronic wound healing progression. British journal of community nursing. 2006;11(3):S21, s4-5.
25. Forsgren H, Heimdahl A, Johansson B, Krekmanov L. Effect of application of cold dressings on the postoperative course in oral surgery. International journal of oral surgery. 1985;14(3):223-8.
26. Laureano Filho JR, de Oliveira e Silva ED, Batista CI, Gouveia FM. The influence of cryotherapy on reduction of swelling, pain and trismus after third-molar extraction: a preliminary study. Journal of the American Dental Association (1939). 2005;136(6):774-8; quiz 807.
27. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.

Terms of Use/Privacy Policy/ Disclaimer/ Other Policies:
You agree that by using our site, you have read, understood, and agreed to be bound by all of our terms of use/privacy policy/ disclaimer/ other policies (click here for details).

This work and its PDF file(s) are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.