Effect of Cryotherapy on Anesthetic Success and Pain in Irreversible Pulpitis

Inclusion Criteria: * Systemically healthy patients classified as ASA I or II, aged between 18 and 60 years, * Presence of a restorable mandibular premolar tooth diagnosed with symptomatic irreversible pulpitis, * History of spontaneous pain or lingering pain elicited by thermal stimuli, * Positive response with lingering pain to cold testing (Endo Ice; Coltene, Altstätten, Switzerland), * Positive response at low current levels to electric pulp testing (Parkell Inc., USA), * Teeth with closed apex and no radiographic evidence of periapical pathology (intact periodontal ligament space and absence of periapical radiolucency), * Patients presenting with moderate or severe preoperative pain, as assessed using the visual analogue scale (VAS). Exclusion Criteria: * Patients who had taken analgesic, anti-inflammatory, or opioid medication within the last 12 hours before treatment, * Patients with systemic conditions that may affect pain perception, inflammatory response, or healing, * History of antibiotic use within the previous month or requirement for antibiotic prophylaxis, * Teeth presenting with clinical or radiographic signs of pulp necrosis or apical periodontitis (Pain on percussion or palpation, presence of sinus tract or swelling, presence of periapical radiolucency), * Teeth with root resorption, immature apices, severe coronal destruction preventing proper isolation, or calcified canals, * Teeth that had undergone previous endodontic treatment, including pulpotomy or root canal filling, * Patients with neurological or psychiatric conditions that could interfere with pain perception or accurate pain reporting, * Inability to achieve adequate isolation with a rubberdam.