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Persistent Cold-Sensitivity in Root Canal Treated Teeth: Mechanisms, Cracked Roots, and Clinical Implications.

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|April 27, 2026
PubMed
Summary

Persistent cold sensitivity after root canal treatment (RCT) can occur due to various factors. This review explores potential causes like residual nerves, cracks, or leakage, aiding diagnosis and management.

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Area of Science:

  • Dentistry
  • Endodontics
  • Oral Surgery

Background:

  • Root canal treatment (RCT) aims to resolve tooth pain and sensitivity by removing infected pulp.
  • Persistent cold sensitivity post-RCT presents a diagnostic challenge, as it seems counterintuitive.
  • Understanding the causes of this residual symptom is crucial for effective patient care.

Purpose of the Study:

  • To review the current knowledge on persistent cold sensitivity following root canal treatment.
  • To identify potential etiological factors contributing to this symptom.
  • To discuss diagnostic and clinical management strategies for teeth with post-RCT cold sensitivity.

Main Methods:

  • A narrative review of existing literature was conducted.
  • The review focused on identifying causes of persistent cold sensitivity after root canal treatment.
  • Diagnostic and clinical management considerations were synthesized from the literature.

Main Results:

  • Persistent cold sensitivity may stem from residual neural tissue or periodontal/periapical innervation.
  • Altered sensations, cracked roots, and restoration marginal leakage are also identified as potential causes.
  • Cracked roots are specifically highlighted as a possible cause of "cold-only" sensitivity.

Conclusions:

  • Persistent cold sensitivity after RCT is multifactorial and requires careful diagnosis.
  • Potential causes include neural issues, innervation changes, cracks, and leakage.
  • A thorough diagnostic approach and appropriate clinical management are essential for addressing this challenging symptom.