Clinical Research Directory

Inclusion Criteria: * Candidates received a comprehensive explanation of the study, provided written informed consent, and agreed to complete the full trial. * Patients having lower molars with vital pulp \& irreversible pulpitis. * Patients with apical periodontitis were selected based on severe preoperative and percussion pain, defined as a visual analogue scale (VAS) score greater than 7. * The absence of periapical radiolucency on radiographs. Exclusion Criteria: * History of systemic disease. * Vulnerable population: prisoners, pregnant women, mentally ill people, etc. * Patients took analgesics before treatment * A radiographically calcified canal * A previous endodontic treatment * Sinus tracts * Local gingival inflammation around the offended tooth * Severe periodontal disease * Presence of periodontal pockets \>3 mm in the affected tooth * No bleeding observed upon access cavity preparation * Inaccurate working length determination * Separated instruments, over instrumentation, and overfilling or under filling * Resorption * Periapical radiolucency * Anatomical variations as, excessively curved root or Prescence radix, excessively long or short roots,teeth with open apices