Persistent Cold-Sensitivity in Root Canal Treated Teeth: Mechanisms, Cracked Roots, and Clinical Implications

Abstract: Root canal treatment (RCT) removes necrotic and inflamed pulp tissue with the objective of eliminating pain and sensitivity. Nonetheless, some treated teeth may have persistent sensitivity to cold. This symptom is counterintuitive and poses a diagnostic challenge. This article reviews current knowledge base on how cold sensitivity can persist in RCT teeth. Cold sensitivity may indicate residual neural tissue, periodontal/periapical innervation, altered sensations, cracked roots, and restoration marginal leakage. Cracked roots may indeed induce “cold-only” sensitivity. A narrative review, diagnostic and clinical management considerations are presented as well. Keywords: endodontic, proprioception, sensitivity, post operative pain, dental pulp