Bacterial Reduction After Supplementary Disinfection Procedures in Infected Root Canals

Inclusion Criteria: * Diagnosis of pulp necrosis with apical periodontitis (AP) confirmed by pulp tests, clinical and radiographic evidence. * Tooth with no response to cold and electric pulp testing (done at screening). * Single canalled premolars with intact pulp chamber walls. * Patient must be 18 years of age or older Exclusion Criteria: * Teeth with vital pulp. * Teeth with incomplete root formation (immature with apical periodontitis). * Teeth with extensive crown destruction. * Teeth with previous endodontic treatment or intervention (pulp debridement). * Teeth with acute/ chronic apical abscess. * Teeth with internal or external resorption. * Teeth with non-odontogenic facial pain. * Teeth with periodontal pockets deeper than 4 mm. * Teeth with advanced untreated periodontal disease or recent periodontal surgery. * Teeth with mobility score greater than 2. * Teeth with a fracture or visible crack. * Patients with diabetes or immune compromised conditions. * Patients who received systemic antibiotics within the last 3 months. * Patients taking corticosteroids. * Patients who are pregnant.