The Effect of Eddy Sonic Versus AF Max Activation of Bio-ceramic Sealer on Post-operative Pain in Teeth with Symptomatic Irreversible Pulpitis with Apical Periodontitis

Inclusion criteria

• Age range is from 18 to 40 years old.
• No sex predilection
• Patients seeking root canal treatment.
• restorable teeth.
• Positive patient acceptance for participating in the study.
• patients able to sign informed consent.
• Systematically healthy patient (ASA I, Il).
• Patient who can understand the numerical rate scale and sign an informed consent.
• Mandibular first molar teeth with pain on bite or percussion
• Preoperative sharp (moderate or severe) pain.
• Vital response of pulp tissue to cold pulp tester (ethyl chloride spray).
• widening in periodontal membrane space in radiographic appearance.

Exclusion criteria

• Patients with American Association of Anesthesiologists (ASA) classifications other than ASA 1 & Il
• Patients who have already ingested preoperative medication, such as analgesics, non-steroidal, or steroidal anti-inflammatory drugs, within 12 hours of the start of treatment.
• This was done to prevent any misinterpretation of the diagnosis or post-treatment pain severity, as these drugs substantially lower post-endodontic pain (Jorge-Arajo et al.,2018).
• Patients with NSAID allergy.
• Patients having two or more adjacent teeth needing root canal therapy
• Pregnant patients.
• Patients with bleeding disorder.
• Patients with long-term corticosteroid use.
• Teeth having:

• Necrotic pulp.
• History or presence of swelling or fistulous tract.
• Acute/chronic periapical abscess.
• Mobility more than grade 1.
• Pocket depth of more than 5mm
• No possible restorability.
• Previous root canal treatment.
• Periapical radiolucency.
• External or internal resorption
• Vertical root fracture.
• TMJ problems, bruxism, clenching or traumatic occlusion.
• Inability to understand and perform the given instructions.