Bone-Bioactive Liquid as an Adjunct in Endodontic Surgery

This randomized controlled clinical trial will include patients indicated for endodontic microsurgery due to persistent periapical lesions. Participants will be randomly allocated into two groups. Preoperative CBCT will be taken for each patient, and patients will be scheduled for endodontic microsurgery. Preoperative gingival crevicular fluid samples will be collected. During the surgical procedure the test group will receive application of BBL as a final flush to the bony cavity and surface conditioning of the root end before closure of the surgical site, while the control group will undergo conventional microsurgery without BBL. Standardized surgical procedures will be followed in both groups. Postoperative pain will be assessed using the Visual Analog Scale (VAS) at defined time points following surgery. Inflammatory mediator expressions (e.g., IL-1β and TNF α) will be evaluated using enzyme-linked immunosorbent assay (ELISA) in comparison to preoperative samples to assess the inflammatory response associated with healing at 10th day postsurgical followed by soft tissue healing clinical assessment using Early Healing Score (EHS). Bone healing will be assessed radiographically using cone-beam computed tomography (CBCT) at 6-month follow-ups, with quantitative three-dimensional analysis of lesion volume reduction

Inclusion Criteria: Patients diagnosed with persistent apical periodontitis in maxillary anterior regions require endodontic microsurgery * Lesion diameter 5-8mm Exclusion Criteria: smokers * Diabetic patients * pregnancy * root fracture * Teeth require adjunctive procedures at the time of root-end surgery, such as root amputation, soft tissue grafting, replantation, or perforation repair. * previous apical surgery * immunocompromised patients.