Effect of Cryotherapy on Anesthetic Success and Pain in Irreversible Pulpitis

Inclusion criteria

• Systemically healthy patients classified as ASA I or II, aged between 18 and 60 years,
• Presence of a restorable mandibular premolar tooth diagnosed with symptomatic irreversible pulpitis,
• History of spontaneous pain or lingering pain elicited by thermal stimuli,
• Positive response with lingering pain to cold testing (Endo Ice; Coltene, Altstätten, Switzerland),
• Positive response at low current levels to electric pulp testing (Parkell Inc., USA),
• Teeth with closed apex and no radiographic evidence of periapical pathology (intact periodontal ligament space and absence of periapical radiolucency),
• Patients presenting with moderate or severe preoperative pain, as assessed using the visual analogue scale (VAS).

Exclusion criteria

• Patients who had taken analgesic, anti-inflammatory, or opioid medication within the last 12 hours before treatment,
• Patients with systemic conditions that may affect pain perception, inflammatory response, or healing,
• History of antibiotic use within the previous month or requirement for antibiotic prophylaxis,
• Teeth presenting with clinical or radiographic signs of pulp necrosis or apical periodontitis (Pain on percussion or palpation, presence of sinus tract or swelling, presence of periapical radiolucency),
• Teeth with root resorption, immature apices, severe coronal destruction preventing proper isolation, or calcified canals,
• Teeth that had undergone previous endodontic treatment, including pulpotomy or root canal filling,
• Patients with neurological or psychiatric conditions that could interfere with pain perception or accurate pain reporting,
• Inability to achieve adequate isolation with a rubberdam.