Assessment of Postoperative Pain and Bacterial Load Reduction After Using TruNatomy and ProTaper Next Rotary Systems in Patients With Necrotic Mandibular Molars: A Randomized Clinical Trial

Inclusion Criteria: * \- Medically free patients. * Mandibular permanent molar teeth: * Diagnosed clinically with pulp necrosis. * Absence of spontaneous pain. * Slight widening in the periodontal membrane space or with periapical radiolucency * Patient's age ranges between 22 to 45 years with no sex predilection. * Patients who can understand Modified Visual Analogue Scale (VAS). * Patients' acceptance to participate in the trial. * Patients able to sign informed consent. Exclusion Criteria: * \- Medically compromised patients: Pain levels and healing following treatment would be compromised as these patients have shown higher incidence of pain and lower healing rate. * Pregnant women: Avoid radiation exposure, anesthesia, and medication. * If analgesics or antibiotics have been administrated by the patient during the past 24 hours preoperatively might alter their pain perception. * Patients reporting bruxism or clenching: Avoid further pressure on an already inflamed tooth inducing subsequent irritation and inflammation. * Teeth that show association with acute periapical abscess and swelling: Need special treatment steps which could involve additional visits with incision and drainage. Also, it could influence initiation and progression of postoperative pain. * Greater than grade I mobility or pocket depth greater than 5mm. Need special surgical and/or periodontal therapy. * No restorability: Hopeless tooth. * Vital teeth. * Immature teeth. * Radiographic evidence of ex…