Received: 17.12.2025
Accepted: 24.12.2025
Published online: 30.12.2025
UDC: 616.314.163-08
DOI: 10.70113/1815-9443.2025.46.53.005
PERSONALIZATION OF ENDODONTIC TREATMENT FOR CHRONIC APICAL PERIODONTITIS
Tulegenova I.M.1, Kopbayeva M.T.1, Yelubay N.E.1
Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
Background. Chronic apical periodontitis (CAP) is a major cause of secondary tooth loss, and treatment success depends on adequate disinfection of the root canal system, particularly in anatomically complex canals.
Aim. To evaluate the effectiveness of a personalized endodontic protocol for CAP using clinical, radiological, and microbiological outcomes.
Materials and Methods. An open-label randomized controlled study included 80 patients aged 18 – 60 years diagnosed with CAP. Participants were randomly allocated to a personalized protocol group (n=40) or a standard protocol group (n=40). The personalized protocol involved instrumentation with Endostar E3 Azure, irrigation with 3% sodium hypochlorite with ultrasonic activation, and final irrigation with the herbal agent Rotokan for 2 minutes; the control group received the standard protocol with 3% sodium hypochlorite and ultrasonic activation without Rotokan. Outcomes included clinical symptom scores at day 7, radiological healing assessed by CBCT-based indices (PUOD) and periapical index (PAI, D. Orstavik scale) at 12 months, and microbiological findings. Statistical significance was set at p<0.05. Results. Both groups showed clinical improvement; however, symptom reduction at day 7 was greater in the personalized protocol group (1.15±0.04 vs 1.43±0.06; p<0.05). At 12 months, PUOD was higher in the personalized group (96.7±4.00% vs 89.5±4.10%; p<0.05), and mean PAI was lower (1.0±0.08 vs 1.80±0.07). Microbiological assessment demonstrated markedly lower residual microbial growth in the personalized protocol group compared with the control group. Conclusion. A personalized, CBCT-informed endodontic protocol incorporating enhanced irrigation and final Rotokan irrigation was associated with improved short-term clinical outcomes and superior radiological healing at 12 months compared with the standard approach.
Keywords: endodontics; chronic apical periodontitis; root canal system; irrigation; sodium hypochlorite; cone-beam computed tomography; periapical index.
