Comparison of Root Canal Desinfection Protocols

This study aims to evaluate and compare the disinfecting efficacy of two supplementary antimicrobial protocols in teeth with apical periodontitis: Er,Cr:YSGG laser activated irrigation and ultrasonic activation using a piezoelectric ultrasonic device (Dentsply International Inc., York, PA, USA) and Irrisafe tip (Satelec/Acteon, Merignac, France), comparing the detection of bacteria before and after instrumentation.

Secondary aims are to assess presence of bacteria before and after chemomechanical preparation using two microbiological methods:

* ATP level analysis using the Endocator device
* Quantitative PCR (qPCR) for total bacterial quantification.

• Desinfection device (Device): Desinfection protocol with (LAI): Er,Cr:YSGG laser (2780 nm) delivered with a radial-firing tip.
• Analytical microbiological methods (Device): Endocator: Measures ATP levels (Endoscore and RLU) to rapidly assess bacterial load in less than one minute.

Primary outcomes

• Reduction of bacteria in the root canal system [Immediately after the irrigation activation procedure, ATP levels will be measured, and qPCR analysis will be performed at the end of the study, once all samples have been collected.]: Evaluation of the effectiveness of different irrigation activation devices by assessing bacterial reduction in the root canal system. ATP levels will be measured (Endoscore and RLU values) to provide a rapid assessment of bacterial load in less than one minute. Subsequently, bacterial reduction will be confirmed by quantitative polymerase chain reaction (qPCR) analysis

Sex: All, ages: 18 Years to 70 Years, accepts healthy volunteers

Inclusion Criteria:

* Adult patients able to give informed consent and willing/able to comply with study procedures and follow-up.
* Molar teeth indicated for endodontic treatment.
* Teeth with intact pulp-chamber walls (no extensive coronal destruction).
* Necrotic pulp confirmed by pulp testing.
* Clinical and radiographic evidence of asymptomatic apical periodontitis.

Exclusion Criteria:

* Immature teeth
* Teeth with calcified or obliterated canals
* Teeth with extensive coronal destruction
* Teeth with previous endodontic treatment
* Symptomatic apical periodontitis
* Teeth with periodontal pockets greater than 4 mm
* Patients who have received systemic antibiotics in the last 3 months
* Patients with a history of diabetes or immune impairment
* Pregnant patients