Evaluation of Post-operative Pain and Bacterial Load Reduction After Application of Three Intra-canal Medications (Cocoa Husk Versus Calcium Hydroxide With and Without Cocoa) in Necrotic Mandibular First Molar

The study will aim to evaluate the postoperative pain and bacterial load afterapplication of two intracanal medications in mandibular first molar teeth with necroticpulp.Methods (Participants, Interventions, and Outcomes)Study Setting:This randomized clinical trial will include 36 patients, equally allocated into threegroups (12 patients each). Participants will be recruited from the Outpatient Clinic ofthe Endodontic Department, Faculty of Oral and Dental Medicine, Future University inEgypt. All treatments will be performed by a postgraduate master's degree candidate usinga Ritter dental unit (Germany) and Sirona digital intraoral radiography (Nanopix, size2).Eligibility Criteria:Eligible participants will be 18‐40 years old with necrotic pulp and symptomatic apicalperiodontitis in restorable mandibular first molars (Type III mesial and distal canals)and willing to participate. Exclusion criteria include pregnancy, systemic diseases,recent use of analgesics or antibiotics, bruxism or clenching, severe traumaticmalocclusion, and teeth with periapical radiolucency, root resorption, pulpstones/calcifications, or previous endodontic treatment.