Cryotherapy as an adjunct in root canal therapy: a systematic review and meta-analysis

This meta-analysis aimed to evaluate the efficacy of intracanal cryotherapy in alleviating postoperative pain following root canal treatment. A systematic search of PubMed, Web of Science, the Cochrane Library, and Embase was conducted for studies published in in English or Chinese up to March 10, 2025. Included studies compared intracanal cryotherapy with conventional irrigation protocols at room temperature. Cochrane Risk of Bias tool was used for quality assessment. Postoperative pain was measured using either the Visual Analog Scale (VAS) or the Numerical Rating Scale (NRS). Combined effect sizes were expressed as risk ratios (RR) or standardized mean differences (SMD), accompanied by corresponding 95% confidence intervals (CI). Sixteen randomized controlled trial involving 1,479 participants were included. The findings demonstrated a significant reduction in postoperative pain occurrence with cryotherapy (RR = 0.72; 95% CI: 0.62-0.84). Moreover, cryotherapy was associated with significantly lower pain intensity at 6 h (SMD = - 0.75; 95% CI: - 1.15 to - 0.35), 24 h (SMD = - 0.58; 95% CI: - 0.89 to - 0.27), and 48 h (SMD = - 0.53; 95% CI: - 0.72 to - 0.34) after treatment, when compared with control groups receiving standard irrigation. However, its effect at 72 h post-treatment appeared to be less pronounced. The findings suggest that intracanal cryotherapy may represent an effective adjuvant approach for mitigating early postoperative pain, potentially may reduce the need for analgesics. Its integration into standard endodontic protocols may improve postoperative comfort.