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248 INFECTIONS OF THE PERI-APICAL TISSUES
these cases, dilute the formo-cresol remedy, or use campho-
phenique, phenol compound, Black's 1-2-3, ^^ Eucalyptol
compound. If, after using one or the other of these reme-
dies, and serum continues to exude, dry and fill the canals, and
give the case physiological rest for a week or two, before
placing the permanent filling in the crown of the tooth.
In case the Routine treatment, as described, fails, in very
mild and simple cases the Acid Treatment may be tried.
There are probably complications present, which require
additional remedies to stimulate granulation and healing.
In these cases, force through the apical foramen, after the
method of pressure anesthesia, phenol-sulphonic acid, 50
per cent, sulphuric, or aromatic sulphuric acid, or 15 per cent,
trichloracetic acid, to stimulate granulation. Before doing
this, evacuate the pus and then after the acid injection, seal
in modified formo-cresol or the other agents previously
mentioned. This acid treatment may be repeated at a
subsequent visit, if necessary, and will frequently check the
condition. If another tooth is involved, that should also be
opened and treated. The acid treatment should not be
attempted in cases of granuloma with extensive involvement
of the root end and apical tissues.
If the Acid Treatment fails, or is not adopted, then estab-
lish an artificial sinus and treat as described under "Abscess
with Sinus, ''^ or perform the operation of apexotomy.
Two methods may be described for establishing an artifi-
cial sinus.
I. Black'' s Method.—Immerse the face of a foot-shaped
plugger in phenol, and touch to the gum over the apex of the
affected tooth. Repeat the procedure and continue in this
manner, applying slight pressure until the bone is reached,
when a spear drill, dipped in phenol, is quickly run through
the alveolar plate to the root apex. Excess of phenol should
these cases, dilute the formo-cresol remedy, or use campho-
phenique, phenol compound, Black's 1-2-3, ^^ Eucalyptol
compound. If, after using one or the other of these reme-
dies, and serum continues to exude, dry and fill the canals, and
give the case physiological rest for a week or two, before
placing the permanent filling in the crown of the tooth.
In case the Routine treatment, as described, fails, in very
mild and simple cases the Acid Treatment may be tried.
There are probably complications present, which require
additional remedies to stimulate granulation and healing.
In these cases, force through the apical foramen, after the
method of pressure anesthesia, phenol-sulphonic acid, 50
per cent, sulphuric, or aromatic sulphuric acid, or 15 per cent,
trichloracetic acid, to stimulate granulation. Before doing
this, evacuate the pus and then after the acid injection, seal
in modified formo-cresol or the other agents previously
mentioned. This acid treatment may be repeated at a
subsequent visit, if necessary, and will frequently check the
condition. If another tooth is involved, that should also be
opened and treated. The acid treatment should not be
attempted in cases of granuloma with extensive involvement
of the root end and apical tissues.
If the Acid Treatment fails, or is not adopted, then estab-
lish an artificial sinus and treat as described under "Abscess
with Sinus, ''^ or perform the operation of apexotomy.
Two methods may be described for establishing an artifi-
cial sinus.
I. Black'' s Method.—Immerse the face of a foot-shaped
plugger in phenol, and touch to the gum over the apex of the
affected tooth. Repeat the procedure and continue in this
manner, applying slight pressure until the bone is reached,
when a spear drill, dipped in phenol, is quickly run through
the alveolar plate to the root apex. Excess of phenol should
