P.E.A.R.L. Technique (Periapical Exudate Aspiration via Root canal Lumen): presentation of a case report

Aim: This study aimed to introduce and clinically validate a novel conservative technique, P.E.A.R.L. (Periapical Exudate Aspiration via Root canal Lumen), designed to manage acute periapical abscesses with associated facial swelling. The technique allows for direct aspiration of periapical exudate via the root canal system, potentially eliminating the need for surgical drainage or systemic antibiotic therapy. Materials and Methods: A clinical case involving a necrotic mandibular second premolar (tooth 4.5) presenting with acute facial swelling was treated using the P.E.A.R.L. technique. After establishing the working length, the canal was gently instrumented and irrigated. Apical patency was achieved with a small manual file to stimulate periapical exudate release. When exudate was not initially present within the canal, a fine endodontic suction tip (Ø 0.30 mm) was connected to high-vacuum suction and positioned slightly beyond the apical foramen to allow negative pressure drainage. No systemic antibiotics were administered. Root canal obturation was performed in the same session. Results: Facial swelling and associated symptoms resolved within 36 hours following treatment. No postoperative complications occurred, and clinical and radiographic follow-up confirmed the infection's resolution. The case demonstrated successful management of an acute periapical abscess in a single visit without surgical incision or pharmacological support. Conclusions: The P.E.A.R.L. technique offers a conservative, efficient, and minimally invasive approach for managing periapical abscesses. It may reduce or eliminate the need for mucosal incision and antibiotic therapy, shorten treatment duration, and allow definitive root canal therapy to be completed in a single session. Further clinical studies are recommended to validate its broader applicability and long-term outcomes.