The Impact Of Different Final Irrigation Activation Techniques On Postoperative Pain

Inclusion Criteria: * solitary-rooted lower premolar teeth with acute irreversible pulpitis and apical periodontitis who were in the age range between 18 and 40 years old. * Each patient received root canal treatment in one session. * restorable teeth with a normal periodontal score index of less than two * severe preoperative pain (Vas score 3) * discomfort response on biting/mastication or percussion but no mobility. * Discomfort response on palpation of surrounding tissue but with no intraoral swelling. * Patients who stopped medications for the last 12 hours before the procedure * The radiograph showed only normal or slight widening in the periodontal ligament space of the affected root. Exclusion Criteria: * patients with any serious systemic disease * Patients under the age of eighteen or incapable of giving informed consent * Patients over forty * Patients with a mandibular premolar involving multiple canals or huge periapical pathosis * Patients with severe preoperative pain on biting/mastication or percussion * Mandibular premolar with open apices * Mandibular premolar with periodontal involvement * Retreated cases, sinus tract presence, and swelling of surrounding soft tissues * patients who had been pregnant and allergic patients with local anesthetic agents