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Modified Cryotherapy During Final Irrigation Reduces Postoperative Pain and Anxiety in Pediatric Primary Molar Root Canal Therapy

Clin Exp Dent Res. 2026 Apr;12(2):e70369. doi: 10.1002/cre2.70369.

ABSTRACT

OBJECTIVES: Postoperative pain and dental anxiety are significant barriers to effective pediatric endodontic treatment. Improving patient comfort and cooperation remains a critical clinical objective in school-age children undergoing primary molar root canal therapy (RCTP). Conventional pharmacologic strategies have limitations in acceptability, safety, and efficacy, prompting the exploration of non-invasive alternatives. The aim of this study is to evaluate the effect of modified cryotherapy using 0°C saline as the final irrigation protocol on postoperative pain levels and anxiety control in school-age children undergoing RCTP.

MATERIAL AND METHODS: This single-center, randomized, controlled clinical trial enrolled 104 school-age patients diagnosed with pulp or periapical disease in deciduous molars. Patients were randomly allocated to either a modified cryotherapy group or a control group. Pain levels were assessed using the Wong-Baker FACES Pain Rating Scale (WB Scale) at baseline, 6, 24, 48 h, and 7 days postoperatively. Anxiety and cooperation were evaluated at baseline and 7-day follow-up using the Venham Scale. Statistical analyses included Chi-square and Mann-Whitney U tests, with significance at p < 0.05.

RESULTS: Baseline characteristics were comparable between groups. The cryotherapy group showed significantly lower pain scores at 6 h,24 h, and 48 h (p < 0.001) post-treatment compared to controls. At 7 days, pain levels converged with no significant difference. The cryotherapy group also demonstrated significantly improved anxiety scores (p = 0.005) and clinical cooperation (p = 0.012) at follow-up compared to the control group.

CONCLUSION: Modified cryotherapy applied during final root canal irrigation significantly reduces short-term postoperative pain and enhances clinical cooperation in school-age children.

PMID:42046866 | DOI:10.1002/cre2.70369