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VOLUME 17 , ISSUE 12 ( December, 2016 ) > List of Articles


Effect of Intracanal Cryotherapy and Negative Irrigation Technique on Postendodontic Pain

Talal Al-Nahlawi, Talaat Abo Hatab, Mahmoud Abd Alrazak, Ahmad Al-Abdullah

Citation Information : Al-Nahlawi T, Hatab TA, Alrazak MA, Al-Abdullah A. Effect of Intracanal Cryotherapy and Negative Irrigation Technique on Postendodontic Pain. J Contemp Dent Pract 2016; 17 (12):990-996.

DOI: 10.5005/jp-journals-10024-1969

Published Online: 01-05-2017

Copyright Statement:  Copyright © 2016; The Author(s).



To evaluate the effect of intracanal cryotherapy with negative pressure irrigation (EndoVac) on postendodontic pain after vital single-visit root canal treatment (RCT).

Materials and methods

A total of 75 single-rooted teeth with single root canal were treated endodontically. After root canal preparation with Protaper Universal rotary system and irrigation, teeth were divided randomly into three groups (n = 25) according to additional irrigation protocol as follows: Group I: No additional irrigation was applied (control); group II: A 20 mL of room temperature saline was irrigated during 5 minutes using EndoVac, and group III: A 20 mL of 2 to 4°C cold saline was irrigated during 5 minutes using EndoVac. Pain levels were assessed by visual analog scale (VAS) and verbal evaluation of pain questionnaire after 6, 12, 24, 48 hours, and 7 days of canal obturation. The data were then analyzed using Statistical Package for the Social Sciences (SPSS) 13.0 using Kruskal–Wallis and Mann–Whitney U tests at p-value of 0.05.


The results showed that pain levels were high in groups I and II after 6 hours that decreased with time to almost diminish after 1 week, and on the other hand, group III showed no pain among different monitoring periods. Also pain levels in groups II were lower compared with group I after only 6 hours, with significance p < 0.05.


Postendodontic pain presented with highest values after 6 hours of treatment and reduced to almost nil after 1 week. Intracanal cryotherapy eliminated postendodontic pain clinically. Negative pressure reduced postendodontic pain after 6 hours of treatment.

Clinical significance

The outcome of this study indicates that the use of intracanal cryotherapy technique with negative pressure irrigation eliminates postendodontic pain after single-visit RCTs.

How to cite this article

Al-Nahlawi T, Abo Hatab T, Abd Alrazak M, Al-Abdullah A. Effect of Intracanal Cryotherapy and Negative Irrigation Technique on Postendodontic Pain. J Contemp Dent Pract 2016;17(12):990-996.

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  1. Interappointment pain: mechanisms, diagnosis, and treatment. Endod Topics 2004 Mar;7(1):93-109.
  2. Post-operative pain and use of analgesic agents following various dental procedures. Am J Dent 2006 Aug;19(4):245-247.
  3. Factors associated with endodontic flare-ups: a prospective study. Int Endod J 1995 Sep;28(5):261-265.
  4. Postoperative pain after root canal treatment: a prospective cohort study. Int J Dent 2012 Mar 15;2012:310467.
  5. Endodontic flare-ups: a prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010 Nov;110(5):e68-e72.
  6. Incidence of pain associated with clinical factors during and after root canal therapy. Part 2. Postobturation pain. J Endod 1983 Oct;9(10):434-438.
  7. Microbial causes of endodontic flare-ups. Int Endod J 2003 Jul;36(7):453-463.
  8. Postobturation pain after single- and multiple-visit endodontic therapy. A prospective study. J Dent 1998 Mar;26(3):227-232.
  9. Irrigation in endodontics. Dental Clin North Am 2010 Apr 30;54(2):291-312.
  10. Comparison of 2% chlorhexidine and 5.25% sodium hypochlorite irrigating solutions on postoperative pain: a randomized clinical trial. Indian J Dent Res 2010 Oct-Dec;21(4):523-527.
  11. Postoperative pain after the application of two different irrigation devices. J Ended 2010 Aug;36:1295-1301.
  12. Advanced endodontics for clinicians. 1st ed. Bangalore: J&J Publication; 1998. p. 202-208.
  13. The antibacterial action of sodium hypochlorite and EDTA in 60 cases of endodontic therapy. Int Endod J 1985 Jan;18(1):35-40.
  14. Microscopes in endodontics. Dent Clin North Am 1997;41:29-40.
  15. Liquid nitrogen cryosurgery and immediate bone grafting in the management of aggressive primary jaw lesions. J Oral Maxillofac Surg 1995 Jul;53(7):784-790.
  16. Postoperative cryotherapy after total knee arthroplasty: a prospective study of 86 patients. J Arthroplasty 2006 Dec;21(8):1175-1179.
  17. A preliminary examination of cryotherapy and secondary injury in skeletal muscle. Med Sci Sports Exerc 1999 Nov;31(11):1516-1521.
  18. Cryotherapy–an Inevitable part of sports medicine and it's benefits for sports injury. Int J Adv Res 2015;1(4):324-327.
  19. The influence of cryotherapy on reduction of swelling, pain and trismus after third-molar extraction: a preliminary study. J Am Dent Assoc 2005 Jun;136(6):774-778.
  20. An in vitro evaluation of the effect of deep dry cryotreatment on the cutting efficiency of three rotary nickel titanium instruments. J Conserv Dent 2011 Apr;14(2):169-172.
  21. The EndoVac method of endodontic irrigation, part 2—efficacy. Dent Today 2008 Jan;27(1):48-51.
  22. Effect of Intracanal Cryotherapy on Reducing Root Surface Temperature. J Endod 2015 Nov;41(11):1884-1887.
  23. Measurement of pain. Lancet 1974 Nov;2(7889):1127-1131.
  24. Effects of cold application on maximal isometric contraction. Phys Ther 1967 Mar;47(3):185-192.
  25. A randomized prospective study to assess the efficacy of two cold therapy treatments following carpal tunnel release. J Hand Ther 2001 Sep;14(3):208-215.
  26. Smear layer removal and canal cleanliness using different irrigation systems (EndoActivator, EndoVac, and passive ultrasonic irrigation): field emission scanning electron microscopic evaluation in an in vitro study. J Endod 2013 Nov;39(11):1456-1460.
  27. Postoperative pain after the application of two different irrigation devices in a prospective randomized clinical trial. J Endod 2010 Aug;36(8):1295-1301.
  28. Comparative safety of various intracanal irrigation systems. J Endod 2009 Nov;35(11):545-549.
  29. Comparison of apical extrusion of NaOCl using the EndoVac or needle irrigation of root canals. J Endod 2010 Feb;36(2):338-341.
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