Effect of intracanal cryotherapy application on postoperative endodontic pain: a systematic review and metaanalysis
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REVIEW
Effect of intracanal cryotherapy application on postoperative endodontic pain: a systematic review and metaanalysis Laise Pena Braga Monteiro 1 & Marcella Yasmin Reis Guerreiro 1 & Roberta de Castro Valino 1 Marcela Baraúna Magno 2 & Lucianne Cople Maia 2 & Juliana Melo da Silva Brandão 1
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Received: 29 June 2020 / Accepted: 10 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives To assess the influence of intracanal cryotherapy application on postoperative pain after endodontic treatment. Materials and methods A systematic review (SR) was conducted in seven databases. Articles that were published up to 04 February 2020 were included and randomized clinical trials that used a cold saline solution for final irrigation to manage postoperative endodontic pain were compared with those that used a saline solution at room temperature. Metaanalysis was performed to assess postoperative pain after 6, 24, 48, and 72 h using a random effects model, a confidence interval of 95%, and heterogeneity tested by the I2 index. The certainty of evidence was rated using GRADE. Results Qualitative and quantitative analysis included eight and six studies, respectively. Individuals treated with cryotherapy presented lower means of postendodontic pain than the controls, 6 and 24 h after endodontic treatment (MD − 1.30 [− 2.32, − 0.28] p = 0.01 and SMD − 0.68 [ − 1.21, − 0.16] p = 0.01, respectively, with very low certainty of evidence). After 48 and 72 h, both groups demonstrated similar means of postendodontic pain (MD − 0.06 [− 0.18, 0.07] p = 0.38 and SMD − 0.54 [− 1.18, − 0.11] p = 0.10, with high and low certainty of evidence, respectively). Conclusions Based on the limited quality evidence, intracanal cryotherapy application reduced postoperative endodontic pain after 6 and 24 h. New clinical trials are needed to support the result of this review. Clinical significance This SR provides information about the use of intracanal cryotherapy in clinical practice, guides clinicians to make evidence-based decisions and suggests recommendations for further high-quality studies Keywords Cryotherapy . Root canal treatment . Postoperative pain . Metaanalysis
Introduction Management of postendodontic pain in daily practice is crucial for patients’ well-being, considering the fact that its presence may lead to patient dissatisfaction and affect their quality of life [1]. Root-canal-treatment-associated pain has an incidence of 3–58% [2]. A recent cross-sectional study found that
* Roberta de Castro Valino [email protected] 1
Department of Endodontics, School of Dentistry, Federal University of Pará, Rua Augusto Correa, 1, Guamá, Belém, Pará 66075-110, Brazil
2
Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
approximately one out of 10 adult patients with root filled teeth experienced pain or discomfort [3]. Pain after endodontic treatment may be associated with mechanical and ch
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