The application of cryotherapy effectively enhances pulpal anesthesia in mandibular first permanent molars affected by symptomatic irreversible pulpitis among patients under 18 years of age. Nonetheless, supplementary anesthesia remains necessary for optimal pain management.

The main goal of this study was to examine the effectiveness of applying cryotherapy following the administration of an inferior alveolar nerve block (IANB) in treating symptomatic irreversible pulpitis in mandibular first permanent molars among adolescents. Additionally, the study compared the requirement for supplemental intraligamentary injection between the two treatment approaches.

Conducted as a randomized clinical trial, the study enrolled 152 subjects aged 10 to 17 years, randomly assigned to two equal groups: an intervention group receiving cryotherapy along with IANB, and a control group receiving conventional IANB. Both the study groups were administered 3.6 mL of 4% Articaine.

In the intervention group, ice packs were applied to the buccal vestibule of the affected molar for a duration of 5 minutes. Endodontic procedures were commenced 20 minutes after ensuring effective anesthesia. Using visual analogue scale (VAS), intraoperative pain intensity was gauged. Data analysis employed the Mann–Whitney U and chi-square tests, with a significance level of 0.05.

In adolescents, cryotherapy boosted IANB effectiveness in anesthetizing molars having pulpitis and remarkably minimized the intraoperative pain scores during endodontic therapy of molars. A remarkable reduction in average intraoperative VAS scores was observed in the cryotherapy group in comparison with the control group. The cryotherapy group also demonstrated a notably greater success rate when compared to the control group. The occurrence of additional intraligamentary injection was lower in the cryotherapy group in comparison with the control group (Table 1).

In a dental setting, effectively managing pain during endodontic therapy of primary molars having irreversible pulpitis profoundly influences a child’s behavior. While IANB is a commonly utilized method for anesthetizing mandibular teeth, its success rate was relatively limited during the endodontic treatment of primary molars with pulpitis. Cryotherapy introduces a novel approach that substantially enhances IANB effectiveness.