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The secondary outcome was to compare the need for supplemental intraligamentary injection (ILI).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>The study was designed as a randomized clinical trial including 152 participants aged from 10 to 17\u00a0years who were randomly assigned to two equal groups; cryotherapy plus IANB (intervention group) and the control group (conventional INAB). Both groups received 3.6\u00a0mL of 4% articaine. For the intervention group, ice packs were applied in the buccal vestibule of the mandibular first permanent molar for 5\u00a0min. Endodontic procedures started after 20\u00a0min for efficiently anesthetized teeth. The intraoperative pain intensity was measured using the visual analogue scale (VAS). The Mann\u2013Whitney (<jats:italic>U<\/jats:italic>) and chi-square tests were applied to analyze data. The significance level was set to 0.05.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>There was a significant reduction in the overall intraoperative VAS mean in the cryotherapy group compared to that in the control group (<jats:italic>p<\/jats:italic>\u2009=\u20090.004). The success rate was significantly higher in the cryotherapy group (59.2%) compared to the control group (40.8%). The frequency of extra ILI was 50% and 67.1% in the cryotherapy and control groups, respectively (<jats:italic>p<\/jats:italic>\u2009=\u20090.032).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The cryotherapy application boosted the efficacy of pulpal anesthesia of the mandibular first permanent molars with SIP in patients below the age of 18\u00a0years. Additional anesthesia was still necessary for optimal control over pain.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Clinical relevance<\/jats:title>\n                <jats:p>Pain control during endodontic treatment of primary molars with irreversible pulpitis (IP) is a significant factor in a child\u2019s behavior in the dental office. Although the inferior alveolar nerve block (IANB) is the most commonly used technique to anaesthetize mandibular dentition, we found its success rate to be relatively low during endodontic treatment of primary molars with IP. Cryotherapy is a new approach that significantly improves the efficacy of IANB.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Clinical trial registration<\/jats:title>\n                <jats:p>The trial was registered at ClinicalTrials.gov (reference no. NCT05267847).<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00784-023-05084-1","type":"journal-article","created":{"date-parts":[[2023,6,3]],"date-time":"2023-06-03T03:29:13Z","timestamp":1685762953000},"page":"4585-4593","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Cryotherapy and pain intensity during endodontic treatment of mandibular first permanent molars with symptomatic irreversible pulpitis: A randomized controlled trial"],"prefix":"10.1007","volume":"27","author":[{"given":"Ahmad Abdel Hamid","family":"Elheeny","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dania Ibrahem","family":"Sermani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esteer Azer","family":"Saliab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Turky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,6,3]]},"reference":[{"key":"5084_CR1","unstructured":"Malamed S (2014) Handbook of local anesthesia. 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