Impact of intracanal cryotherapy on postoperative pain and antimicrobial efficacy in primary teeth: A randomized clinical trial

CONTEXT: Postoperative pain and persistent microbial contamination remain significant challenges in pediatric endodontics following pulpectomy. Intracanal cryotherapy has emerged as a promising adjunct because of its anti-inflammatory, analgesic, and antimicrobial properties. However, its effectiveness requires further clinical evaluation. AIM: The aim of the study was to compare the effect of intracanal cryotherapy using cold saline (2°C-4°C) with room temperature saline (25°C-30°C) on postoperative pain and antimicrobial efficacy during the pulpectomy procedure in primary teeth. SETTINGS AND DESIGN: A randomized clinical trial was conducted involving 30 children (3-7 years) requiring pulpectomy in primary teeth. MATERIALS AND METHODS: Participants were randomly allocated into two groups: Group I (room temperature saline) and Group II (cryotherapy with cold saline). Postoperative pain was assessed using the Wong-Baker Faces Pain Rating Scale at 6, 24, 48, and 72 h posttreatment. Antimicrobial efficacy was evaluated by comparing colony-forming units (CFUs) before and after irrigation via microbiological analysis. STATISTICAL ANALYSIS: Data were analyzed using SPSS v26.0. Paired t - tests/Wilcoxon for intragroup; independent t -test/Mann-Whitney for intergroup were applied. RESULTS: Both groups showed significant intragroup pain reduction over 6, 24, 48, and 72 h ( P < 0.05), with cryotherapy exhibiting lower mean scores but no intergroup differences ( P > 0.05). Microbial counts decreased significantly within groups ( P = 0.001: Group I: 4.23-2.21 and Group II: 3.69-0.68), with cryotherapy superior postintervention ( P < 0.001). No baseline differences were existed. CONCLUSIONS: Intracanal cryotherapy with cold saline is an effective, simple, and cost-efficient method for reducing postoperative pain and enhancing antimicrobial efficacy in primary teeth pulpectomy.