Objectives <p>This randomized controlled clinical trial aimed to evaluate the effect of intracanal cryotherapy using cold saline (2.5&#xa0;°C) as a final irrigant on postoperative pain and analgesic consumption following single-visit nonsurgical endodontic retreatment of asymptomatic mandibular premolars.</p> Materials and methods <p>Sixty systemically healthy patients with asymptomatic apical periodontitis in previously treated single-rooted mandibular premolars were enrolled and randomly assigned to two groups (<i>n</i> = 30 each). Both groups underwent standardized retreatment protocols, with the cryotherapy group receiving final irrigation with cold saline (2.5&#xa0;°C) and the control group with room-temperature saline, both for 5&#xa0;min. Postoperative pain was assessed using a 10-point Visual Analog Scale (VAS) at 6, 12, 24, 48, 72, and 168&#xa0;h. Analgesic intake was also recorded. Statistical analysis was performed using the Chi-Square and Mann-Whitney tests with a significance level set at 0.05.</p> Results <p>The cryotherapy group exhibited significantly lower pain scores at 6&#xa0;h (<i>p</i> = 0.014) and 12&#xa0;h (<i>p</i> = 0.028) postoperatively compared to the control group. No significant differences were observed at 24, 48, 72, or 168&#xa0;h. Although fewer patients in the cryotherapy group reported analgesic use, this difference was not statistically significant (<i>p</i> = 0.278). No adverse events were reported.</p> Conclusions <p>Intracanal cryotherapy using cold saline effectively reduced short-term postoperative pain following endodontic retreatment but did not significantly influence long-term pain or analgesic intake.</p> Clinical relevance <p>Intracanal cryotherapy offers a simple, low-cost adjunct that may effectively reduce early postoperative pain and improve patient comfort in single-visit retreatment.</p>