Effectiveness of intracanal cryotherapy in reducing post-endodontic pain in irreversible pulpitis: a systematic review and meta-analysis.

Irreversible pulpitis is characterized by persistent inflammation and moderate to severe pain, often requiring pharmacological or adjunctive strategies for postoperative management. Intracanal cryotherapy has emerged as a simple, cost-effective technique to mitigate this pain by utilizing cold-induced physiological responses. This systematic review and meta-analysis aimed to evaluate the clinical evidence regarding the effectiveness of intracanal cryotherapy in reducing postoperative pain in teeth with irreversible pulpitis. Electronic searches were conducted in PubMed, Web of Science, Cochrane, and Scopus up to October 2025. Randomized controlled trials (RCTs) comparing intracanal cryotherapy to conventional endodontic treatment. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2. Random-effects meta-analysis was performed using SMD for pain levels at 6, 12, 24, 48, and 72 h. Twelve RCTs were included; nine were meta-analyzed. Cryotherapy significantly reduced pain at 6 and 12 h but not later time points. Intracanal cryotherapy appears to be a safe and inexpensive adjunct that is associated with reduced early postoperative pain, with the most consistent effect observed within the first 6-12 h. Heterogeneity and short follow-up periods. Cryotherapy reduces early postoperative pain only.Registration: PROSPERO CRD420261295239.