Clinical Evaluation of the Postoperative Pain and Substance P levels Following the use of Bioceramic verses Calcium Hydroxide Intracanal Medicaments in Permanent Mandibular molars with Symptomatic Apical Periodontitis

This study aims to evaluate postoperative pain levels and Substance P expression following the use of two different intracanal medicaments: bioceramic materials and calcium hydroxide in permanent mandibular molars diagnosed with symptomatic apical periodontitis.

A total of 28 patients will be included in this study and randomly allocated into two equal groups (n=14 each). Group I will receive calcium hydroxide (Ca(OH)₂) as an intracanal medicament, while Group II will receive a bioceramic intracanal medicament.

Standardized endodontic procedures will be performed for all participants. Postoperative pain will be assessed using a visual analog scale (VAS) at different time intervals following treatment.

In addition, samples will be collected to evaluate Substance P levels as a biochemical marker associated with pain and inflammation.

The comparison between the two groups will help determine the effectiveness of each intracanal medicament in reducing postoperative pain and inflammatory response. The results of this study may contribute to improving clinical decision-making in endodontic therapy.

Inclusion Criteria:

• - Patients aged 18-45 years with no sex predilection
• Medically free Patients with no systemic conditions that can affect post operative pain response.
• Patients should not be taking any pain medications 24 hours before intervention
• Positive patients' acceptance for participating in the study
• Patient able to sign informed consent
• Permanent mandibular molars diagnosis with Symptomatic Apical Periodontitis
• Permanent molars without any anatomical variations or severe curvatures

Exclusion Criteria:

• - Medically compromised patients
• Patients who have received antibiotic therapy within the last 2 weeks.
• Pregnant or lactating women.
• Patients with known allergy to any of the irrigants used.
• Patients with swelling or acute peri-apical abscess or fistulous tract.
• Teeth that have:
• Wide or open apex .
• Vital pulp tissue .
• Periodontally affected with grade 2or 3 mobility.
• Non restorable teeth .
• Abnormal anatomy and calcified canals .
• Pervious root canal treatment.
• severe curved canal
• Buccolingual and mesiodistal radiographs were taken to evaluate the root canal anatomy

No individual participant data will be shared.