Effect of Apical Patency on Periapical Lesion Healing

This non-randomized clinical study aims to evaluate the effect of apical patency during root canal treatment on the healing of periapical lesions in maxillary anterior teeth. Participants will be assigned to either an apical patency group or a non-patency group. Changes in periapical lesion volume will be assessed using cone-beam computed tomography (CBCT) one year after treatment. The study aims to provide an objective volumetric assessment of the potential contribution of apical patency to periapical healing.

Inclusion Criteria: * Adult patients. * Systemically healthy and not using regular systemic medications. * A single-rooted maxillary anterior tooth requiring primary root canal treatment. * Diagnosis of chronic apical periodontitis in the study tooth. * The tooth was restorable. * Absence of root fracture or crack. * Absence of internal or external resorption. * Root canal negotiable to the apical region with a small hand file. * Ability to establish a reliable working length. * Availability of a CBCT scan of the relevant maxillary anterior region, previously obtained for clinical purposes or indicated during the treatment process. Exclusion Criteria: * Pregnancy or breastfeeding. * Previous endodontic treatment of the study tooth. * Severe canal calcification. * Suspected root fracture or crack. * Internal or external root resorption. * Periodontal probing depth of 5 mm or greater. * Previous surgical intervention in the relevant region. * Inability to negotiate the root canal. * Inability to establish a reliable working length.