Correlation Between the Clinical Presentation of Pulp and the Biological Mediators in Gingival Crevicular Fluid and the Inflamed Pulpal Tissue

Inclusion criteria

Systemically healthy male and female individuals aged between 18 and 50 years

No physical or mental disabilities

No underlying systemic diseases

Mandibular permanent premolar teeth diagnosed with symptomatic irreversible pulpitis with apical periodontitis

Mandibular permanent premolar teeth diagnosed with symptomatic irreversible pulpitis without apical periodontitis

Diagnosis based on the terminology of the American Association of Endodontists (2009)

Patients who provided written informed consent

Fully developed teeth with no previous pulp exposure

Positive response to cold testing

Positive response to electric pulp testing

Exclusion criteria

Requirement for antibiotic prophylaxis

Diabetes or hematologic disorders

Use of anti-inflammatory drugs, antibiotics, or antidepressants within the previous four weeks

Pregnancy at the time of treatment

Heavy plaque or calculus accumulation

Gingival redness and bleeding

Severe gingivitis or generalized periodontitis

Gingival pocket depths greater than 3 mm

Negative response to sensibility testing (cold test or electric pulp testing)

Presence of apical radiolucency (PAI > 2)

Previously initiated endodontic treatment

Internal or external root resorption

History of trauma

Severe calcific metamorphosis with obliterated root canal spaces on periapical radiographs

Vertical root fractures

Mobility greater than Grade I (Miller's mobility index)

Swelling or sinus tract associated with the treated tooth

Presence of periodontal-endodontic lesions

Teeth that could not be properly isolated with a dental dam

Collection of less than 10 µL of blood from each site

Conflicting clinical and radiographic findings preventing clear group assignment

No bleeding from one or more canal orifices (possible partial necrosis)