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242 INFECTIONS OF THE PERI-APICAL TISSUES

of the canals and treatment of the apical complications is
concerned, and also on the systemic condition of the patient.

DIAGNOSIS AND PROGNOSIS

The use of the X-ray is the most valuable diagnostic
measure in these cases, and it should be resorted to for this

purpose at the beginning of all cases where root canal work is
to be attempted. Anterior teeth with straight, well developed

roots, offer the best prognosis, the bicuspids next, while
molars, owing to the technical difhculties involved, afford the
poorest chances of a successful outcome. Pyorrhetic teeth,
affected with apical complications, are usually poor risks,

and in many instances had better be extracted at once.
Types of cases usually unfavorable for treatment are those in
which there is too much dead apical cementum, resulting from
extensive chronic alveolar abscess, those on which there is a
large amount of dead alveolar cementum as exhibited in
pyorrhea cases, and teeth with abscesses opening into the

antrum. In cases of this nature, the pericementum is often
extensively destroyed, the cementum encrusted with calculus,
necrotic, and pus-soaked, and in a condition which it is im-

possible to restore to the normal state. In the latter types,
extraction is usually advisable. In the milder forms of
chronic apical infection, and even in some of the cases of
more extensive granuloma, the operation of excision of the
root end, to be described later, may be performed and the
tooth restored to prolonged periods of usefulness.
In reading the radiograph, which should be made in every

instance, teeth known to be normal should be studied first,
with the assistance of a reading glass or dentiscope. On a
normal tooth, the peridental membrane may be seen as a

continuous radiolucent line encircling the root. Surrounding