Efficacy of Cryotherapy After Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

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.