Effect of Cyperus Articulatus on Bacterial Reduction and Postoperative Pain

Successful endodontic treatment depends on effective elimination of microorganisms from the infected root canal system and prevention of reinfection. However, complete disinfection remains difficult because of the complex anatomy of the root canal system, allowing residual microorganisms to persist and contribute to persistent apical periodontitis and treatment failure.

Inclusion Criteria: * Healthy adult Patient. * Medically free patients. * Mandibular permanent premolar teeth: * Diagnosed clinically with necrotic pulp. * Absence of pain. * Radiographic evidence of chronic apical periodontitis . * Radiographic evidence of single root with single canals. * Normal occlusal contact with opposing teeth. * Patients' acceptance to participate in the trial. Exclusion Criteria: * Medically compromised patients having significant systemic disorders (ASA III or IV). * If analgesics or antibiotics have been administrated by the patient during the past 24 hours preoperatively as it might alter their pain perception. * Pregnant women: to avoid radiation exposure, anaesthesia, medication and hormonal fluctuation that might increase pain prevalence. * Patients reporting bruxism, clenching, TMJ problems or traumatic occlusion: to avoid further pressure on inflamed tooth which induce subsequent irritation and inflammation. * Patients with two or more adjacent teeth requiring endodontic treatment. * Teeth that requires further procedural steps or multidisciplinary approach, which is out of this experiment's scope: i. Association with swelling or fistulous tract. ii. Acute periapical abscess. iii. Mobility Grade II or III. iv. Pocket depth more than 5mm. v. Previous root canal treatment. vi. Non-restorable. vii. Immature root. viii. Radiographic evidence of external or internal root resorption, vertical root fracture, perforation, calcification. * Inability to perceive the given instructions.