Evaluating the effect of cryotherapy and low-level laser therapy on postoperative pain and quality of life in patients with symptomatic apical periodontitis- a randomized controlled clinical study

The aim of this randomized controlled clinical study is to compare the effect of intracanal cryotherapy and intraoral Low-Level LASER Therapy (LLLT) applications on postoperative pain and quality of life in patients following endodontic treatment for symptomatic apical periodontitis. After ethical clearance and registering the trial at clinical trial registry of India, a randomized, parallel-controlled clinical study with 2 test arms and 1 control arm was conducted. 90 subjects diagnosed with acute apical periodontitis in molar teeth meeting the inclusion and exclusion criteria, were enrolled in the current trial. After obtaining written informed consent, first researcher randomly allocated the subjects into 3 arms: intracanal cryotherapy, intraoral Low-Level LASER Therapy (LLLT) and control. Preoperative pain scores were marked on the Heft- Parker visual analog scale (HP-VAS) by the second researcher. Preoperative quality of life was marked by the subjects on the Oral Health Impact Profile-17 (OHIP-17) questionnaire. Root canal treatment was performed for all the subjects enrolled in the study and the interventions were performed accordingly, by a single operator. The patients were instructed to record their postoperative pain levels and analgesics intake at 24 h, 48 h, the third day, fifth day, and seventh day. On the seventh day postoperative quality of life questionnaire was recorded by the subjects. The data were tabulated in MS Excel and statistically analyzed using the EPI-INFO software. After 24 h, postoperative pain reduced significantly in the cryotherapy arm when compared with the LLLT arm. However, no statistically significant differences in postoperative pain were found between the two test arms at 48 h, the third day, fifth day, and seventh day. Subjects in the control arm were relieved of postoperative pain after the fifth day. Subjects in the cryotherapy arm required fewer analgesics, with intake limited to the first 24 h postoperatively. Conversely, participants in the LLLT arm needed analgesics for the initial 48 h postoperatively. In contrast, subjects in the control arm had the longest duration of analgesic use, up to the fifth day. The quality of life for all the subjects was found to improve postoperatively after seven days, irrespective of additional interventions. Application of cryotherapy and Low-Level LASER Therapy was found to be effective at 24 h and 48 h respectively, in the management of postoperative endodontic pain. The findings highlight the potential benefits of cryotherapy and LLLT compared to standard postoperative care alone. Henceforth, cryotherapy and Low-Level LASER Therapy could be utilized, as they are simple and innocuous modalities to manage post-endodontic pain.