Comparison of Postoperative Pain After Double Antibiotic Paste vs Calcium Hydroxide in Teeth With Symptomatic Apical Periodontitis

This randomized controlled trial aims to compare the mean postoperative pain after using double antibiotic paste (DAP) versus calcium hydroxide (CH) as an intracanal medicament in teeth with symptomatic apical periodontitis. Symptomatic apical periodontitis is a painful dental condition caused by inflammation and destruction of the tissues around the root apex of a tooth. It is diagnosed clinically by a painful response to biting, percussion, or palpation, and radiographically by widening of the periodontal ligament space. Patients aged 16 to 50 years with a single tooth diagnosed with symptomatic apical periodontitis will be randomly divided into two groups. Group A will receive calcium hydroxide as an intracanal medicament, and Group B will receive double antibiotic paste (a mixture of metronidazole and ciprofloxacin). Postoperative pain will be measured using a 10-point Visual Analog Scale (VAS) at 1 hour and 24 hours after treatment. Patients will be contacted by telephone to record their pain scores. The hypothesis is that there is a difference between the mean postoperative pain after using double antibiotic paste versus calcium hydroxide in teeth with symptomatic apical periodontitis.

Inclusion Criteria:1. Patients with ages ranging from 16 to 50 years. 2. Teeth diagnosed with symptomatic apical periodontitis clinically by percussion and radiographically by the presence of radiolucency around the tooth apex. 3\. Patients with good general health (no medical condition). \- Exclusion Criteria: * 1\. Pregnant women. 2. Patients who had received antibiotic treatment during the last 3 months. 3. Patients having more than one tooth requiring root canal treatment. 4. Teeth with periodontal probing depth \>4 mm measured with W.H.O probe. 5. Teeth that couldn't be isolated with a rubber dam. 6. Teeth with previous root canal treatment, or teeth with fluctuant facial swelling where emergency management should include incision and drainage.