The effect of a laser on large-sized apical lesion healing

INTERVENTION: Following the randomization procedure, patients will be divided into two groups (45 permanent upper incisors in each group) using the simple randomization method and a random sequence created using the website https://www.random.org/: Group 1 (control group) will be divided into three sub‐groups: G1‐A: Irrigant activation with Ultrasonic G1‐B: Irrigant activation with Xp‐Endo finisher G1‐C: Irrigant activation with Diode laser Group 2 (study group) will be divided into three groups as the control group but with bio‐stimulation by external application of diode laser. After working length determination, instrumentation and sterilizing root canals, sodium hypochlorite (SH) and EDTA will be activated in three ways: Ultrasonic activation groups: U‐file will be inserted 2 mm before the apex, where SH will be activated for 5 minutes and EDTA will be activated for 30 seconds. Xp‐Endo Finisher groups: Xp‐Endo Finisher file will be inserted to the full working length, where SH will be activated for 5 minutes and EDTA will be activated for 30 seconds. Diode laser groups: the tip of the diode laser device will be inserted 2 mm before the apex, where SH will be activated for 5 minutes and EDTA will be activated for 30 seconds. All groups will be irrigated with chlorhexidine as the final irrigant, obturated with Gutta‐percha and Ah‐plus sealer using continuous vertical waves technique, and restored with resin‐bonded restoration. As for bio‐stimulation groups, mucosa opposing the peri‐apical area will be irradiated with a diode laser tip for 60 seconds immediately and 2, 4, 6, 8, 10, and 12 CONDITION: Apical lesions of permanent upper incisors ; Oral Health PRIMARY OUTCOME: ; 1. Postoperative pain measured using the visual analog scale (VAS) before treatment, 1, 3, 7 and 14 days; 2. Swelling and tooth mobility measured according to their presence/absence before treatment, 1, 3, 7 and 14 days; 3. Apical lesion volume and density measured using CBCT images before treatment, 6, and 12 months; SECONDARY OUTCOME: Percentage of apical lesions healing measured using CBCT images by comparing the baseline with 6, and 12 months follow‐up images INCLUSION CRITERIA: 1. Healthy patients without any systemic disease or compromised immune status 2. Patients aged between 25 and 44 years old 3. Patients with at least one permanent closed��ape Xupper incisor first with an asymptomatic apical lesion sized 5 to 10 mm²