Endodontide Kriyoterapi
Özet
Tıp ve diş hekimliğinde uzun süredir enflamasyon, ödem ve sinir iletim hızını azaltmak amacıyla kullanılan kriyoterapi, endodonti alanında ağrı kontrolü, vital pulpa tedavileri ve dezenfeksiyon gibi konularda umut vadeden bir non-farmakolojik yöntemdir. Endodontik prosedürlerde geleneksel farmakolojik ajanların gastrointestinal ve renal yan etkilerinden kaçınmak amacıyla gündeme gelen kanal içi soğuk uygulamaları, yapılan çalışmalar doğrultusunda özellikle pulpa nekrozu ve semptomatik apikal periodontitise sahip dişlerde postoperatif ağrıyı ve analjezik ihtiyacını anlamlı derecede azaltmaktadır; ancak sadece irreversibl pulpitis olgularında kontrol grubuna kıyasla ek bir fayda sağlamadığı görülmüştür. Ağrı yönetiminin yanı sıra kriyoterapinin, vital pulpa tedavilerinde kanama kontrolü sağladığı, intraoral uygulandığında inferior alveolar sinir blokajının anestezi derinliğini artırdığı ve NaOCl irrigasyonu ile kombine edilen kriyo-enstrümantasyon uygulamalarının kök kanalındaki bakteri yükünü sadece NaOCl kullanımına kıyasla daha etkin bir şekilde düşürdüğü raporlanmıştır. Buna karşın, in vitro çalışmalar termal streslerin diş yapısında deformasyona yol açarak kırılma direncini önemli ölçüde azaltabileceğini gösterdiğinden, kanal içi soğutma yerine ekstraoral soğuk uygulaması alternatif bir teknik olarak önerilmekte; yöntemin klinik standartları ve optimal uygulama süresi için daha fazla araştırmaya ihtiyaç duyulmaktadır.
The treatment modality of cryotherapy, which has long been utilized in medicine and dentistry to reduce inflammation, edema, and nerve conduction velocity, has emerged as a promising non-pharmacological approach in endodontics for pain management, vital pulp therapies, and disinfection. Intracanal cold applications, introduced to avoid the gastrointestinal and renal side effects associated with traditional pharmacological agents, have been shown in various studies to significantly decrease postoperative pain and the need for analgesics, particularly in teeth with pulp necrosis and symptomatic apical periodontitis, whereas they offer no additional benefit in cases presenting with irreversible pulpitis alone. Beyond pain reduction, recent data indicates that cryotherapy facilitates bleeding control in vital pulp therapies, enhances the depth of anesthesia in inferior alveolar nerve blocks when applied intraorally, and significantly lowers the bacterial load within the root canal system when combined with NaOCl irrigation compared to the use of NaOCl alone. Conversely, since in vitro investigations demonstrate that thermal stresses can induce structural deformation and substantially reduce the fracture resistance of endodontically treated teeth, extraoral cold application is suggested as an alternative technique to intracanal cooling, and further research remains necessary to establish definitive clinical standards and optimal application durations.
Referanslar
Belitsky RB, Odam SJ, Hubley-Kozey C. Evaluation of the effectiveness of wet ice, dry ice, and cryogen packs in reducing skin temperature. Physical Therapy. 1987;67(7): 1080-4. doi:10.1093/ptj/67.7.1080
Nayeema S, Subha D. Cryotherapy–a novel treatment modality in oral lesions. Int J Pharm Pharm Sci. 2013; 5: 4-5.
Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. British journal of sports medicine. 2007;41(6): 365-9. doi:10.1136/bjsm.2006.031237
Peres D, Sagawa Jr Y, Dugue B, Domenech SC, Tordi N, Prati C. The practice ofphysical activity and cryotherapy in rheumatoid arthritis: systematic review. European journal of physical and rehabilitation medicine. 2017;53(5): 775-87. doi:10.23736/S1973-9087.16.04534-2
Olson JE, Stravino VD. A review of cryotherapy. Physical Therapy. 1972;52(8): 840-53.
Weeks V, Travell J. How to Give Painless Injections. New York, NY, Grune & Stratton. Inc; 1957.
Gomez SL, Cheng I, Shariff-Marco S. Incidence and Mortality Annual Review, 1988-2018.
Santesso N, Mustafa RA, Wiercioch W, Kehar R, Gandhi S, Chen Y, et al. Systematic reviews and meta-analyses of benefits and harms of cryotherapy, LEEP, and cold knife conization to treat cervical intraepithelial neoplasia. International Journal of Gynecology & Obstetrics. 2016;132(3): 266-71. doi:10.1016/j.ijgo.2015.07.026
Laureano Filho JR, e SILVA EDdO, CAMARGO IB, Gouveia FM. The influence of cryotherapy on reduction of swelling, pain and trismus after third-molar extraction: a preliminary study. The Journal of the American Dental Association. 2005;136(6): 774-8. doi:10.14219/jada.archive.2005.0261
do Nascimento-Júnior EM, Dos Santos GMS, Mendes MLT, Cenci M, Correa MB, Pereira-Cenci T, et al. Cryotherapy in reducing pain, trismus, and facial swelling after third-molar surgery: Systematic review and meta-analysis of randomized clinical trials. The Journal of the American Dental Association. 2019;150(4): 269-77. e1. doi:10.1016/j.adaj.2018.11.008
Greenstein G. Therapeutic efficacy of cold therapy after intraoral surgical procedures: a literature review. Journal of periodontology. 2007;78(5): 790-800.
Yu C-H, Lin H-P, Cheng S-J, Sun A, Chen H-M. Cryotherapy for oral precancers and cancers. Journal of the Formosan Medical Association. 2014;113(5): 272-7. doi:10.1016/j.jfma.2014.01.014
Kuflik EG. Cryosurgery updated. Journal of the American Academy of Dermatology. 1994;31(6): 925-44. doi:10.1016/s0190-9622(94)70261-6
O'Keefe EM. Pain in endodontic therapy: preliminary study. Journal of endodontics. 1976;2(10): 315-9.
Parirokh M, Rekabi AR, Ashouri R, Nakhaee N, Abbott PV, Gorjestani H. Effect of occlusal reduction on postoperative pain in teeth with irreversible pulpitis and mild tenderness to percussion. Journal of endodontics. 2013;39(1): 1-5. doi:10.1016/j.joen.2012.08.008
Peuhkuri K, Nevala R, Vapaatalo H, Moilanen E, Korpela R. Ibuprofen augments gastrointestinal symptoms in lactose maldigesters during a lactose tolerance test. Alimentary Pharmacology and Therapeutics. 1999;13(9): 1227-34. doi:10.1046/j.1365-2036.1999.00608.x
Etienney I, Beaugerie L, Viboud C, Flahault A. Non-steroidal anti-inflammatory drugs as a risk factor for acute diarrhoea: a case crossover study. Gut. 2003;52(2): 260-3. doi:10.1136/gut.52.2.260
Püspök A, Kiener H-P, Oberhuber G. Clinical, endoscopic, and histologic spectrum of nonsteroidal anti-inflammatory drug-induced lesions in the colon. Diseases of the Colon & Rectum. 2000;43(5): 685-91. doi:10.1007/BF02235589
Fernandes IA, Armond ACV, Falci SGM. The effectiveness of the cold therapy (cryotherapy) in the management of inflammatory parameters after removal of mandibular third molars: a meta-analysis. International archives of otorhinolaryngology. 2019;23: 221-8. doi:10.1055/s-0039-1677755
Bazaid DS, Kenawi LM. The effect of intracanal cryotherapy in reducing postoperative pain in patients with irreversible pulpitis: a randomized control trial. Int J Health Sci. 2018;8: 83-8. doi:10.1016/j.joen.2020.08.022
Bahcall J, Johnson B, Xie Q. Introduction to vital pulp cryotherapy. Endod Pract US. 2019;1: 14.
Topçuoğlu HS, Arslan H, Topçuoğlu G, Demirbuga S. The effect of cryotherapy application on the success rate of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis. Journal of endodontics. 2019;45(8): 965-9. doi:10.1016/j.joen.2019.05.001
Cattabriga I, Pacini D, Lamazza G, Talarico F, Di Bartolomeo R, Grillone G, et al. Intravenous paracetamol as adjunctive treatment for postoperative pain after cardiac surgery: a double blind randomized controlled trial. European Journal of Cardio-thoracic surgery. 2007;32(3): 527-31. doi:10.1016/j.ejcts.2007.05.017
Law A, Nixdorf D, Aguirre A, Reams G, Tortomasi A, Manne B, et al. Predicting severe pain after root canal therapy in the National Dental PBRN. Journal of dental research. 2015;94(3_suppl): 37S-43S. doi:10.1177/0022034514555144
Richards J, Hubbert AO. Experiences of expert nurses in caring for patients with postoperative pain. Pain Management Nursing. 2007;8(1): 17-24. doi:10.1016/j.pmn.2006.12.003
Khan AA, Dionne RA. COX‐2 inhibitors for endodontic pain. Endodontic Topics. 2002;3(1): 31-40.
Işik B, Yaman S, Aktuna S, Turan A. Analgesic efficacy of prophylactic gabapentin and lornoxicam in preventing postendodontic pain. Pain Medicine. 2014;15(12): 2150-5. doi:10.1111/pme.12536
Fein A. Nociceptors and the perception of pain. University of Connecticut Health Center. 2012;4: 61-7.
Yandım T. Yara yeri infiltrasyon kateteri yerleştirilen olgularda lokal anestezik infüzyon ve bolus dozlarının postoperatif analjezi üzerine etkileri. 2009.
Fehrenbacher JC, Sun XX, Locke EE, Henry MA, Hargreaves KM. Capsaicin-evoked iCGRP release from human dental pulp: a model system for the study of peripheral neuropeptide secretion in normal healthy tissue. PAIN®. 2009;144(3): 253-61. doi:10.1016/j.pain.2009.03.027
Keiser K, Hargreaves KM. Building effective strategies for the management of endodontic pain. Endodontic topics. 2002;3(1): 93-105.
Hargreaves KM. Cohen's pathways of the pulp: Elsevier; 2016.
Berman LH, Hargreaves KM. Cohen's Pathways of the Pulp Expert Consult-E-Book: Elsevier Health Sciences; 2015.
Kaya F. Semptomatik apikal periodontitise sahip daimi alt büyük azı dişlerde farklı klinik yaklaşımların postoperatif ağrıya etkisi: Randomize kontrollü klinik çalışma. 2019.
Wang C, Xu P, Ren L, Dong G, Ye L. Comparison of post‐obturation pain experience following one‐visit and two‐visit root canal treatment on teeth with vital pulps: a randomized controlled trial. International endodontic journal. 2010;43(8): 692-7. doi:10.1111/j.1365-2591.2010.01748.x
Hargreaves K. Endodontic pharmacology. Pathways of pulp. 2001: 665-82.
Fayyad DM, Abdelsalam N, Hashem N. Cryotherapy: a new paradigm of treatment in endodontics. Journal of endodontics. 2020;46(7): 936-42. doi:10.1016/j.joen.2020.03.019
Walton RE. Interappointment flare‐ups: incidence, related factors, prevention, and management. Endodontic Topics. 2002;3(1): 67-76.
Abramson DI, Chu LS, Tuck S, Lee SW, Richardson G, Levin M. Effect of tissue temperatures and blood flow on motor nerve conduction velocity. Jama. 1966;198(10): 1082-8.
Siqueira Jr JF, Rôças IN, Favieri A, Machado AG, Gahyva SM, Oliveira JC, et al. Incidence of postoperative pain after intracanal procedures based on an antimicrobial strategy. Journal of endodontics. 2002;28(6): 457-60. doi:10.1097/00004770-200206000-00010
Saygili G. Farklı irrigasyon aktivasyon teknikleri ile endodontik postoperatif ağrı arasındaki ilişkinin değerlendirilmesi. 2015.
Harrison JW, Baumgartner JC, Svec TA. Incidence of pain associated with clinical factors during and after root canal therapy. Part 1. Interappointment pain. Journal of endodontics. 1983;9(9): 384-7.
Siqueira Jr JF, de Uzeda M. Intracanal medicaments: evaluation of the antibacterial effects of chlorhexidine, metronidazole, and calcium hydroxide associated with three vehicles. Journal of endodontics. 1997;23(3): 167-9. doi:10.1016/S0099-2399(97)80268-3
Ng YL, Glennon J, Setchell D, Gulabivala K. Prevalence of and factors affecting post‐obturation pain in patients undergoing root canal treatment. International endodontic journal. 2004;37(6): 381-91. doi:10.1111/j.1365-2591.2004.00820.x
Siqueira Jr JF. Microbial causes of endodontic flare‐ups. International endodontic journal. 2003;36(7): 453-63. doi:10.1046/j.1365-2591.2003.00671.x
Tinaz AC, Alacam T, Uzun O, Maden M, Kayaoglu G. The effect of disruption of apical constriction on periapical extrusion. Journal of endodontics. 2005;31(7): 533-5. doi:10.1097/01.don.0000152294.35507.35
Gotler M, Bar-Gil B, Ashkenazi M. Postoperative pain after root canal treatment: a prospective cohort study. International journal of dentistry. 2012;2012. doi:10.1155/2012/310467
Azim AA, Azim KA, Abbott PV. Prevalence of inter-appointment endodontic flare-ups and host-related factors. Clinical oral investigations. 2017;21(3): 889-94. doi:10.1007/s00784-016-1839-7
Genet J, Hart A, Wesselink P, Thoden van Velzen S. Preoperative and operative factors associated with pain after the first endodontic visit. International Endodontic Journal. 1987;20(2): 53-64. doi:10.1111/j.1365-2591.1987.tb00590.x
Alí A, Olivieri JG, Duran-Sindreu F, Abella F, Roig M, García-Font M. Influence of preoperative pain intensity on postoperative pain after root canal treatment: A prospective clinical study. Journal of dentistry. 2016;45: 39-42. doi:10.1016/j.jdent.2015.12.002
Segura‐Egea JJ, Cisneros‐Cabello R, Llamas‐Carreras JM, Velasco‐Ortega E. Pain associated with root canal treatment. International endodontic journal. 2009;42(7): 614-20. doi:10.1111/j.1365-2591.2009.01562.x
Shresha R, Shrestha D, Kayastha R. Post-operative pain and associated factors in patients undergoing single visit root canal treatment on teeth with vital pulp. Kathmandu Univ Med J. 2018;62(2): 120-3.
Abbott PV. Medicaments: aids to success in endodontics. Part 1. A review of the literature. Australian dental journal. 1990;35(5): 438-48. doi:10.1111/j.1834-7819.1990.tb05427.x
Modabber A, Rana M, Ghassemi A, Gerressen M, Gellrich N-C, Hölzle F, et al. Three-dimensional evaluation of postoperative swelling in treatment of zygomatic bone fractures using two different cooling therapy methods: a randomized, observer-blind, prospective study. Trials. 2013;14(1): 1-10. doi:10.1186/1745-6215-14-238
Watkins AA, Johnson TV, Shrewsberry AB, Nourparvar P, Madni T, Watkins CJ, et al. Ice packs reduce postoperative midline incision pain and narcotic use: a randomized controlled trial. Journal of the American College of Surgeons. 2014;219(3): 511-7. doi:10.1016/j.jamcollsurg.2014.03.057
Herrera E, Sandoval MC, Camargo DM, Salvini TF. Motor and sensory nerve conduction are affected differently by ice pack, ice massage, and cold water immersion. Physical therapy. 2010;90(4): 581-91. doi:10.2522/ptj.20090131
Ernst E, Fialka V. Ice freezes pain ?A review of the clinical effectiveness of analgesic cold therapy. Journal of pain and symptom management. 1994;9(1): 56-9. doi:10.1016/0885-3924(94)90150-3
Fields HL, Basbaum AI. Brainstem control of spinal pain-transmission neurons. Annual review of physiology. 1978;40(1): 217-48. doi:10.1146/annurev.ph.40.030178.001245
Nadler SF, Weingand K, Kruse RJ. The physiologic basis and clinical applications of cryotherapy and thermotherapy for the pain practitioner. Pain physician. 2004;7(3): 395-400.
Ho SS, Coel MN, Kagawa R, Richardson AB. The effects of ice on blood flow and bone metabolism in knees. The American journal of sports medicine. 1994;22(4): 537-40. doi:10.1177/036354659402200417
Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate medicine. 2015;127(1): 57-65. doi:10.1080/00325481.2015.992719
Paine R, DeLee J, Drez D, Miller M. Rehabilitation and therapeutic modalities. Language of exercise and rehabilitation. DeLee and Drez’s Orthopaedic Sports Medicine Principles and Practice 3rd edition Elsevier. 2010: 221-331.
Gregson W, Black MA, Jones H, Milson J, Morton J, Dawson B, et al. Influence of cold water immersion on limb and cutaneous blood flow at rest. The American journal of sports medicine. 2011;39(6): 1316-23. doi:10.1177/0363546510395497
Taber C, Contryman K, Fahrenbruch J, Lacount K, Cornwall MW. Measurement of reactive vasodilation during cold gel pack application to nontraumatized ankles. Physical therapy. 1992;72(4): 294-9. doi:10.1093/ptj/72.4.294
Weston M, Taber C, Casagranda L, Cornwall M. Changes in local blood volume during cold gel pack application to traumatized ankles. Journal of Orthopaedic & Sports Physical Therapy. 1994;19(4): 197-9. doi:10.2519/jospt.1994.19.4.197
Vera J, Ochoa-Rivera J, Vazquez-Carcaño M, Romero M, Arias A, Sleiman P. Effect of intracanal cryotherapy on reducing root surface temperature. Journal of endodontics. 2015;41(11): 1884-7. doi:10.1016/j.joen.2015.08.009
Al-Nahlawi T, Hatab TA, Alrazak M, Al-Abdullah A. Effect of Intracanal Cryotherapy and Negative Irrigation Technique on Postendodontic Pain. The journal of contemporary dental practice. 2016;17(12): 990-6.
Kherlakian D, Cunha RS, Ehrhardt IC, Zuolo ML, Kishen A, da Silveira Bueno CE. Comparison of the incidence of postoperative pain after using 2 reciprocating systems and a continuous rotary system: a prospective randomized clinical trial. Journal of Endodontics. 2016;42(2): 171-6. doi:10.1016/j.joen.2015.10.011
Gundogdu EC, Arslan H. Effects of various cryotherapy applications on postoperative pain in molar teeth with symptomatic apical periodontitis: a preliminary randomized prospective clinical trial. Journal of endodontics. 2018;44(3): 349-54. doi:10.1016/j.joen.2017.11.002
Jain A, Davis D, Bahuguna R, Agrawal A, Singh S, Ramachandran R, et al. Role of cryotherapy in reducing postoperative pain in patients with irreversible pulpitis; an in-vivo study. Int J Dent Med Sci Res. 2018;2: 43-9.
Vera J, Ochoa J, Romero M, Vazquez-Carcano M, Ramos-Gregorio CO, Aguilar RR, et al. Intracanal cryotherapy reduces postoperative pain in teeth with symptomatic apical periodontitis: a randomized multicenter clinical trial. Journal of endodontics. 2018;44(1): 4-8. doi:10.1016/j.joen.2017.08.038
Shri Nandhini Devi R. Effect of cold saline solution as final irrigant on post operative pain after single visit root canal treatment: An Invivo study: Ragas Dental College and Hospital, Chennai; 2018.
Alharthi AA, Aljoudi MH, Almaliki MN, Almalki MA, Sunbul MA. Effect of intra-canal cryotherapy on post-endodontic pain in single-visit RCT: A randomized controlled trial. The Saudi dental journal. 2019;31(3): 330-5. doi:10.1016/j.sdentj.2019.03.004
Bazaid DS, Kenawi LM. The effect of intracanal cryotherapy in reducing postoperative pain in patients with irreversible pulpitis: a randomized control trial. Int J Health Sci. 2018;8: 83-8.
Keskin C, Sariyilmaz E, Keleş A, Güler DH. Effect of intracanal cryotherapy on the fracture resistance of endodontically treated teeth. Acta Odontologica Scandinavica. 2019;77(2): 164-7. doi:10.1080/00016357.2018.1549748
Lloyd B, McGinley M, Brown W. Thermal stress in teeth. Journal of dental research. 1978;57(4): 571-82. doi:10.1177/00220345780570040701
Barker Jr RE, Rafoth RF, Ward RW. Thermally induced stresses and rapid temperature changes in teeth. Journal of Biomedical Materials Research. 1972;6(5): 305-25. doi:10.1002/jbm.820060503
Kho P, Baumgartner JC. A comparison of the antimicrobial efficacy of NaOCl/Biopure MTAD versus NaOCl/EDTA against Enterococcus faecalis. Journal of endodontics. 2006;32(7): 652-5. doi:10.1016/j.joen.2005.11.004
Dewsnup N, Pileggi R, Haddix J, Nair U, Walker C, Varella CH. Comparison of bacterial reduction in straight and curved canals using erbium, chromium: yttrium-scandium-gallium-garnet laser treatment versus a traditional irrigation technique with sodium hypochlorite. Journal of endodontics. 2010;36(4): 725-8. doi:10.1016/j.joen.2009.11.017
Mandras N, Allizond V, Bianco A, Banche G, Roana J, Piazza L, et al. Antimicrobial efficacy of cryotreatment against E nterococcus faecalis in root canals. Letters in applied microbiology. 2013;56(2): 95-8. doi:10.1111/lam.12017
