Garlic gel will be used as an intracanal medicament

Patients will receive informed consent, clinical exam, and preoperative radiographs. After anesthesia and rubber dam isolation, access, cleaning, and shaping of canals will be performed using standard endodontic techniques. Calcium hydroxide (control) will be placed as intracanal medicament, followed by temporary restoration of Cavit and Glass Ionomer cement. After 14 days, if clinical symptoms of pain, tenderness to palpation and percussion resolve, the medicament will be removed, and the canal will be obturated and permanently restored. However, if the patient remains clinically symptomatic, then another dressing of calcium hydroxide will be placed. Finally, clinical outcomes will be recorded after a month and obturation will be delayed until the complete resolution of clinical signs and symptoms. Patients will return after 6 months for clinical and radiographic evaluation, with pre- and postoperative radiographs compared by two endodontists.

Patients will receive informed consent, clinical exam, and preoperative radiographs. After anesthesia and rubber dam isolation, access, cleaning, and shaping of canals will be performed using standard endodontic techniques. A sterile paper point will be placed in the canal for pH evaluation, followed by placement of garlic gel with lentulo spiral and temporary restoration of MD Temp and GC Gold Label 2 GIC. Patients will return after 14 days; if symptoms persist, the medicament will be replaced, and the patient will be reviewed again after 14 days and then after one month. Final obturation will only be done once all symptoms have resolved. If the experimental group continues to show symptoms after three dressings, the case will be considered a failure and treated conventionally. When asymptomatic, the medicament will be removed, canals will be irrigated, dried, obturated with gutta-percha and Endoplus sealer. Radiographic outcomes will be evaluated after 6 months by 2 endodontists.

Clinical success will be based on the absence of the following clinical signs and symptoms:

Pain Tenderness to palpation of adjacent soft tissues Tenderness to percussion of involved tooth Radiographic outcomes will be measured in terms of size of Periapical radiolucency. The Periapical status will be assessed using the periapical index (PAI) scoring system by Orstavik. Each tooth will be assigned one of the Periapical index scores for 5 categories within the scale.

SCORE POSSIBLE OUTCOME

1. Normal periapical structure
2. Small changes in bone structures
3. Change in bone structure with mineral loss
4. Periodontitis with well-defined radiolucency
5. Severe periodontitis with exacerbating features

Periapical radiolucency will be classified as resolved if the Periapical index score is less than or equal to score of 2.