Pumch Therapy For Chronic Periapical Periodontitis In Mandibular Premolar

Chronic periapical periodontitis is a common yet challenging condition to treat, particularly when complicated by difficult root canal anatomy. This case introduces a novel treatment, Photoacoustic-steaming Unite Minimal-invasive Chemomechanical-preparation Hydramatic-obturation Therapy (PUMCH), which combines photoacoustic effects with fluid dynamics for minimally invasive root canal therapy. A 61-year-old male presented with pain, swelling, and a sinus tract in the left mandibular first premolar (tooth 34). Radiographic imaging revealed chronic periapical periodontitis with bone destruction around the apex. The root canal system was complex, with the lingual canal orifice inaccessible by conventional ultrasonic tools. The PUMCH technique utilizes photoacoustic energy to enhance fluid dynamics, aiding in the cleaning of difficult-to-reach canal areas. Negative pressure ensures efficient obturation and reduces reinfection risk, especially in challenging cases with complex anatomy. This minimally invasive approach addresses limitations of traditional methods. The PUMCH therapy successfully treated chronic periapical periodontitis, with healing and symptom relief observed at one-month follow-up. This technique offers a promising, minimally invasive solution for managing complex root canal systems and improving outcomes in chronic pulp diseases.