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APICOECT0MY 249

be avoided or neutralized with alcohol, to prevent spreading
to adjacent tissues.
2. The Routine Method , which is the one largely used at
present, consists in the use of a local anesthetic, such as
Ethyl chlorid or conductive anesthesia, after which, under

aseptic precautions, the gum is lanced to the bone and the
periosteum turned up with an excavator, small scaler, chisel
or periosteotomy The bone is then drilled through to the
apex of the root, following which, after clearing the canals,
normal saline solution, peppermint water, or cinnamon water

is injected from the root canal with a hypodermic syringe
(around the needle of which is packed unvulcanized rubber)
through the fistulous opening. This forcible injection still
further establishes the fistula, and forces out the contents of

the abscess tract, completing free drainage. After free
drainage is established, force through from the root canal, by
means of unvulcanized rubber, after the method of pressure
anesthesia, phenol, phenol compound, phenol-sulphonic acid,

sulphuric or aromatic sulphuric acids, to cauterize the tract.
In addition to establishing the sinus, the sealing into the
canals of the same medicaments used for abscess without
sinus, the flushing of the sinus through and through, with the
bland solutions previously mentioned, and the cauterizing

of the tract are indicated. These procedures are repeated
until healing occurs. In the majority of cases it will be
deemed advisable to extract the affected tooth rather than to
attempt procedures of this nature. In case all the previously
mentioned methods of treatment fail, and extraction is not

indicated, the operation of apicoectomy may be attempted.

Apicoectomy

First fill the root canal, after having obtained a radiograph.

Then inject a local anesthetic, and, under aseptic precautions,