This clinical study aims to evaluate the effect of different root canal irrigation techniques on postoperative pain levels and periapical healing in premolar and molar teeth diagnosed with apical periodontitis (Periapical Index (PAI) score 4-5). A total of 162 patients are randomly assigned to one of three groups: (1) sonic irrigation activation using EDDY, (2) ultrasonic irrigation activation using VDW Ultra, and (3) conventional syringe irrigation as the control. Postoperative pain will be recorded using the Visual Analog Scale (VAS) and Visual Analog Scale (VRS) at multiple time points up to one month. Periapical healing will be assessed using periapical imaging performed with the parallel technique one year after treatment. The study aims to determine whether enhanced irrigation techniques provide superior clinical outcomes compared to traditional methods.
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Inclusion Criteria: * Age between 18 and 60 years * Premolar and molar teeth with radiographically confirmed periapical lesions classified as Periapical Index (PAI) scores of 4 or 5 will be included in the analysis * Systemically healthy individuals * To be able to read and sign the informed consent form * Physical and mental fitness to undergo treatment * Willingness to attend all follow-up sessions Exclusion Criteria: * Patients with systemic diseases classified as ASA III or higher * Presence of severe periodontal disease (probing depth \>4 mm) * Use of analgesics within the last 12 hours or antibiotics within the past month before the treatment