Page 500 - My FlipBook

498 DENTO-ALVEOLAR ABSCESS.
apex. The canal thoroughly sterilized is to be solidly filled with gutta-
percha. A vertical incision is made which includes the fistula and
the opening through the process
exposes the process ; is enlarged, by-
sweeping around its borders a large dentate bur. The incision, open-
ing and abscess cavity arc now packed with cotton saturated with phenol
sodique, until all bleeding ceases.
The necrosed cementum is now exposed ; a small and extremely sharp
fissure bur, driven rapidly, is laid against the distal wall of the root and
a constant pressure up(^n the bur maintained luitil the dead part is ampu-
tated. A sharp scaler may now be employed to round the edges of the
root and make the cut surface smooth.
The cavity is syringed with phenol sodique, to thoroughly remove
as a
all blood-clots—favorable breeding-grounds for organisms ; final
measure the walls are touched with campho-phenique, and the edges of
the incision brought together, using if necessary a stitch to unite the
upper edges. In the abscess cavity iodoform or nosophen gauze is to
be packed, and renewed in a couple of days. For a week the patient
is directed to employ repeatedly a mouth-wash of 3 per cent, pyrozone.
No attempt should be made to fill such a tooth with cohesive foil for
several months.
In some of the cases of anomalous root form, such as a sharp bend
upon the upper end of the root, and which renders it impossible to
gain access to the apex of the root even through the aid of sulfuric acid,
it may be necessary to treat the abscess through the fistulous opening.
The roots are sterilized and cleansed to as great a depth as possible by
the aid of sulfuric acid and fine cleansers, and the endeavor made to
force hydrogen dioxid through the apical foramen and out of the fistula
by means of a syringe. The cavity of the crown is filled Avith pink
gutta-percha, and through it the nozzle of a syringe filled Avith 3 per
cent, pyrozone is thrust, well up the canal. The piston of the syringe
is forced down ; it may be the solution will appear at the opening of
the fistula, or it may be the solution will fail to penetrate the fora-
men and its backward pressure will force the gutta-percha from posi-
tion. In that event myrtol is placed in the canal, which is filled with
thread holding the same material. Three per cent, pyrozone is injected
into the abscess cavity through the fistula, until eflFervescence ceases.
The nozzle of a minim syringe (Fig. 441). charged with campho-
phenique or the 1, 2, 3 mixture is passed into the abscess sac, and a
couple of drops deposited. In very many cases the abscess will then
proceed to recovery. The treatment should be repeated if necessary.
If several dressings applied at intervals of a week do not cause a
disappearance of pus formation, amputation of the offending portion
of the root will be necessary. An heroic method of treating chronic