Department of Endodontics, School of Dentistry, Federal University of Pará, Rua Augusto Correa, 1, Guamá, Belém, Pará, 66075-110, Brazil.
Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
Clin Oral Investig. 2021 Jan;25(1):23-35. doi: 10.1007/s00784-020-03693-8. Epub 2020 Nov 21.
To assess the influence of intracanal cryotherapy application on postoperative pain after endodontic treatment.
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 I index. The certainty of evidence was rated using GRADE.
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).
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.
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.
评估根管内冷冻疗法应用对根管治疗术后疼痛的影响。
系统综述（SR）在七个数据库中进行。纳入截至 2020 年 2 月 4 日发表的文章，并比较了使用冷盐水溶液进行最终冲洗以管理术后根管疼痛的随机临床试验与使用室温盐水溶液的研究。使用随机效应模型、置信区间为 95%、通过 I 指数检验异质性，对术后 6、24、48 和 72 h 的术后疼痛进行 meta 分析。使用 GRADE 对证据确定性进行评级。
定性和定量分析分别包括 8 项和 6 项研究。与对照组相比，冷冻治疗组在根管治疗后 6 和 24 h 的术后疼痛平均值较低（MD-1.30[-2.32，-0.28]p=0.01 和 SMD-0.68[-1.21，-0.16]p=0.01，证据确定性极低）。在 48 和 72 h 时，两组的术后疼痛平均值相似（MD-0.06[-0.18，0.07]p=0.38 和 SMD-0.54[-1.18，-0.11]p=0.10，证据确定性分别为高和低）。
基于有限的高质量证据，根管内冷冻疗法应用可减少根管治疗后 6 和 24 h 的术后根管疼痛。需要新的临床试验来支持本综述的结果。
本 SR 提供了关于在临床实践中使用根管内冷冻疗法的信息，指导临床医生做出基于证据的决策，并提出进一步开展高质量研究的建议。
