الفهرس 
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Abstract
Apical periodontitis is an inflammatory reaction of peri-radicular tissues characterized by an increase in vascular permeability, migration of leukocytes from blood vessels and recruitment of inflammatory cells. Synchronization of immunological and inflammatory cells is regulated by signals released from cytokines.Cytokinesarelow-molecular-weightproteinsreleasedbycellssuchas white blood cells and have a specific effect on modulation of inflammatory responses through their action on immunecells.
Recent work in neuro-immunology suggests that the immunesystemdoes morethansimplyperformsitswell-knownfunctionsofrecognizingand removinginvadingpathogens.Inaddition,theimmunesystemfunctionsasa diffusesenseorganthatsignalsthebrainabouteventsoccurringintheperiphery.
Peripheraleventssuchasinjuryandirritationinducehyperalgesiawhich in turn activate immune cells. The activated immune cellsreleasesoluble signaling molecules; most notably thepro-inflammatory cytokines.These cytokines activate peripheral nerves which either terminates in brainorspinal cord dorsal horn. Similar to other mediators, cytokines may actdirectlyon nociceptorsormorecommonlyindirectlybystimulatingthereleaseofagents suchasprostaglandins.Duringacutephases,cytokinesappeartoinduce sensitizationviareceptor‐associatedkinasesandphosphorylationofionchannels. Painisthemajorreasonforpatients’visitstodentalclinicsinordertogain immediaterelief.Preoperativepainresultingfromapreviousinjurytotheperi- radicular area has been reported to be an indicator of more frequent and
pronounced postoperative pain.
Post-endodontic pain most often occurs during the first 24 to 48 hours following cleaning and shaping and generally recedes in a few hours although it occasionally persists for several days. Pain management during and after root canal treatment is one of the most important aspects of endodontic practice.
Such pain can be relieved by being more careful during the endodontic treatment procedure. Each step of root canal treatment must be done with almost perfection such as accurate working length determination, proper cleaning and shaping with adequate sequencing of instruments, optimum use and judicious selection of irrigants.
Cryotherapy is a relatively new form of treatment in which the body is briefly exposed to very cold temperatures. It will reduce the local blood flow by vasoconstrictionandtherefore,thelocalinflammatoryreaction,swellingandheat experience.Thiswilleventuallyslowtheconductionofnervesignals,potentially reducing paintransmission.
Therefore,thiswasconductedtoevaluatetheeffectofcoldtemperatureof irrigants in reducing post-endodontic pain andinflammation.