AJMAN, UAE: For clinicians aiming to improve patient comfort and manage postoperative pain more effectively, recent research highlights two promising strategies: cryotherapy and occlusal reduction. These methods may help alleviate discomfort after endodontic treatment, particularly in patients with symptomatic irreversible pulpitis and symptomatic periapical periodontitis. It is crucial to reduce the need for systemic pain medications, since these often have side effects, by offering alternative, less invasive methods for managing postoperative pain.
Through a randomised controlled trial with a double-blinded design and involving 60 patients, the researchers, from Gulf Medical University in Ajman, evaluated the effectiveness of these two methods in reducing postoperative pain. Patients with symptomatic periapical periodontitis affecting mandibular first molars underwent single-visit root canal treatment and were divided into three intervention groups: a control group, in whom final irrigation was done with room-temperature saline; a cryotherapy group, with cold saline irrigation; and an occlusal reduction group, with room-temperature saline. This third group also underwent occlusal reduction after restoration. The postoperative pain intensity reported by the patients was gathered at 6, 24, 48 and 72 hours, as well as on the seventh day.
The study found that cryotherapy resulted in a statistically significant reduction in pain scores compared with the control group but only at the 24-hour interval. Beyond this, both cryotherapy and occlusal reduction showed comparable effectiveness to the control group, and there were no significant differences in pain scores at the other time points. By the seventh day, all patients in all the groups reported a zero pain score, indicating the transient nature of postoperative endodontic pain.
The patients in the cryotherapy group reported the lowest pain levels at 24 hours. This outcome is attributed to the vasoconstrictive properties of cold temperatures, which reduce blood flow, oedema and inflammatory responses, thus relieving pain. The researchers suggest that this effect likely arises from cryotherapy’s ability to decrease pain signal transmission and reduce the release of inflammatory cytokines, such as tumour necrosis factor-α and interleukins that contribute to pain perception. These physiological responses to cryotherapy are especially beneficial for patients who are at risk of adverse effects from analgesics.
The occlusal reduction group also experienced a reduction in pain, although the difference was not statistically significant. Occlusal reduction is thought to alleviate pain by diminishing mechanical stimulation of nociceptors sensitised by inflammatory mediators that heighten pain sensitivity. Occlusal reduction may be additionally useful for reducing pain, particularly for patients who experience sensitivity to the mechanical stimulation of occlusal forces.
In sum, this study highlights cryotherapy as a promising conservative method to alleviate pain in the early stages after treatment. Although occlusal reduction also showed potential benefits, cryotherapy’s minimal invasiveness and efficacy make it a valuable addition to existing pain management protocols. Given the absence of adverse effects and the convenience of application, cryotherapy could serve as an alternative or complement to systemic analgesics, reducing the likelihood of medication-related complications.
The study, titled “Effect of cryotherapy and occlusal reduction on postoperative endodontic pain in mandibular first molars with symptomatic apical periodontitis: A prospective, parallel, double-blinded randomized controlled trial”, was published online on 7 November 2024 in the European Journal of Dentistry, ahead of inclusion in an issue.
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