Effect of Using Nanochitosan versus Calcium Hydroxide as Intracanal Medications on the Postoperative Pain and Apical Bone Healing

PICO approach P (population): maxillary anterior teeth having necrotic pulp with symptomatic apical periodontitis with evidence of apical radiolucency (minimum size 2 mm x 2 mm).

I (intervention):0.2% nanochitosan as intracanal medication. C (control): calcium hydroxide paste intracanal medication.

O (outcome):

Primary outcome: postoperative pain at time interval 4, 12, 24, 48, 72 hours

Secondary outcome:

1. Postoperative pain, swelling, palpation, percussion and mobility at one week, 3, 6, 12 months
2. Number of analgesic tablets used at 4, 12, 24, 48, 72 hours and one week.
3. healing of apical periodontitis using CBCT at 3, 6, 12 months

Inclusion criteria:

• Patients in good general health.
• Patient's age ranging between 20-40 years with no sex predilection.
• Maxillary anterior teeth with non-vital pulp and symptomatic apical periodontitis.
• Evidence of apical radiolucency (minimum size 2 mm x 2 mm).
• Patients' acceptance to participate in the study.

Exclusion criteria:

• Medically compromised patients with a severe systemic condition.
• Pregnant female patients.
• Patients who had taken any antibiotic or analgesics during the past 24 hours.
• Presence of a swelling because emergency management may include incision and drainage.
• Retreatment cases.
• Generalized periodontitis (calculus, deep pockets).
• Out of normal variations (open apex- severely curved canal- obstructed canal).

participants should be blinded