Biomarkers in Apical Periodontitis

Aim: To evaluate the effects of three different irrigation activation techniques-conventional syringe irrigation (CSI), ultrasonic irrigation (UI), and SWEEPS (Shock Wave Enhanced Emission Photoacoustic Streaming)-on the levels of proinflammatory cytokines (Tumor Necrosis Factor Alpha (TNF-α), interleukin-1beta (IL-1β)) and proteolytic enzymes matrix metalloproteinase-9 (MMP-9) in teeth with chronic apical periodontitis. Methodology: Sixty-six male patients (aged 18-35) with single-rooted teeth, previous root canal treatment (at least 4 years ago), and periapical lesions (\

Inclusion Criteria: * Male patients aged 18-35 years. * Presence of chronic apical periodontitis in maxillary or mandibular incisors, canines, or single-rooted/single-channeled premolars. * History of root canal treatment performed at least 4 years ago. * Presence of a periapical lesion smaller than 1 cm. * Periapical Index (PAI) score of 3 or 4 according to Orstavik classification. Exclusion Criteria: * Need for antibiotic prophylaxis * Diabetes * Hematological disorders * Use of antibiotics or anti-inflammatory drugs within the last month. * Excessive plaque and tartar * Gum redness or bleeding * Severe gingivitis * Widespread periodontitis * Periodontal pocket depths exceeding 3 mm. * Presence of sinus fistula (bleeding). * Presence of internal or external root resorption. * Pain on palpation of teeth * Swelling * Pregnancy during treatment.