Alenezi Abdulwahab T, Alkandari Mohammed, Alkandari Meshari, Alhallaq Rashed, Alobaidan Abdullah, Alobaidan Mubarak, Almutairi Mohammad, Alajmi Mubarak, Alajmi Yousef, Alsaleh Sayed A
Department of Dentistry, Saad Al-Abdullah Health Center Block 2, Al Jahra, KWT.
Department of Dentistry, Rumaithiya Polyclinic, Kuwait City, KWT.
Cureus. 2025 May 13;17(5):e84046. doi: 10.7759/cureus.84046. eCollection 2025 May.
The inferior alveolar nerve block (IANB) is routinely employed to achieve pulpal anesthesia during endodontic procedures. Cryotherapy is a well-established method for managing postoperative pain; however, evidence regarding its efficacy in enhancing IANB outcomes remains limited. This systematic review and meta-analysis aimed to evaluate the efficacy of cryotherapy application following IANB in patients with symptomatic irreversible pulpitis. A comprehensive search was conducted in PubMed, Scopus, Web of Science (WOS), and Cochrane Central from inception to February 2025 for randomized controlled trials (RCTs) assessing cryotherapy application after IANB. The primary outcomes included success rates, pain intensity measured using the Visual Analogue Scale (VAS), and anxiety levels assessed by the Dental Anxiety Scale-Revised (DAS-R). Dichotomous data were analyzed using odds ratios (ORs) with 95% confidence intervals (CIs), while continuous data were analyzed using mean differences (MDs) with 95% CIs under a random-effects model. All statistical analyses were performed using STATA version 18MP (www.stata.com). Six RCTs involving 506 patients were included. Ice pack application following IANB significantly improved success rates compared to no cryotherapy (OR: 1.44; 95% CI: 1.04-2.00; p = 0.03), whereas no significant difference was observed with Endo Ice. Cryotherapy also resulted in significantly greater pain reduction intraoperatively and at one hour postoperatively compared to control (MD = -0.83; 95% CI: -1.61 to -0.05; p = 0.04 and MD = -3.08; 95% CI: -5.56 to -0.60; p = 0.01, respectively). In conclusion, cryotherapy application following IANB enhances anesthetic efficacy and reduces pain in patients with irreversible pulpitis. Further high-quality trials with longer follow-up durations are recommended.
下牙槽神经阻滞（IANB）在牙髓治疗过程中常用于实现牙髓麻醉。冷冻疗法是一种成熟的术后疼痛管理方法；然而，关于其增强IANB效果的有效性的证据仍然有限。本系统评价和荟萃分析旨在评估在有症状的不可逆性牙髓炎患者中，IANB后应用冷冻疗法的有效性。从数据库建立到2025年2月，在PubMed、Scopus、科学网（WOS）和考克兰中心进行了全面检索，以查找评估IANB后应用冷冻疗法的随机对照试验（RCT）。主要结局包括成功率、使用视觉模拟量表（VAS）测量的疼痛强度以及通过修订的牙科焦虑量表（DAS-R）评估的焦虑水平。二分数据使用比值比（OR）和95%置信区间（CI）进行分析，连续数据在随机效应模型下使用平均差（MD）和95%CI进行分析。所有统计分析均使用STATA 18MP版本（www.stata.com）进行。纳入了6项涉及506例患者的RCT。与不进行冷冻疗法相比，IANB后应用冰袋显著提高了成功率（OR：1.44；95%CI：1.04 - 2.00；p = 0.03），而使用Endo Ice未观察到显著差异。与对照组相比，冷冻疗法在术中及术后1小时也导致疼痛显著减轻（MD = -0.83；95%CI：-1.61至-0.05；p = 0.04和MD = -3.08；95%CI：-5.56至-0.60；p = 0.01）。总之，IANB后应用冷冻疗法可提高不可逆性牙髓炎患者的麻醉效果并减轻疼痛。建议进行进一步的高质量、随访时间更长的试验。
